Acute Pancreatitis In Emergency Department Research Articles

Management of acute pancreatitis in the Emergency Department

Background: Heterogeneity in clinical manifestations and outcome of pancreatitis constitutes an obstacle for the creation of a common treatment algorithm by the scientific community.
 Aim: The aim of the present study was to systematically review the management of cases of acute pancreatitis in Emergency Department (ED) and her correlation with outcome.
 Methods: Search the database Pubmed and were included observational studies and randomized trials in adults in English.
 Results: The search yielded 13 studies. Of these, 3 concerned the diagnostic approach of the disease in ED and concluded that lipase is the most reliable test in diagnosis, while computed tomography of the abdomen is not recommended as a routine examination. 5 out of 13 studies analyzed the usefulness of disease severity classification systems, with the BISAP and HASP score appearing as reliable as the APACHE II and RANSON score, but having an advantage in rapid patient evaluation. The last 5, studied the need for immediate therapeutic / invasive method, with the time of surgery from the arrival at the ED being decisive as it affects the outcome of the disease. It is generally seen that the early invasive method is gaining ground in the treatment of the disease.
 Conclusion: The main goal is to predict the most severe forms of the disease in order to receive the right (invasive or not) treatment to improve survival and quality of life.

Predictive and Prognostic Value of C-reactive Protein/Albumin and Neutrophil/Lymphocyte Ratio in the Patients Diagnosed with Acute Pancreatitis in Emergency Department

Aims: Acute pancreatitis is a severe inflammation of the pancreas presenting sudden onset with high morbidity and mortality. Simple, accessible, cost-efficient and feasible laboratory tests are still needed to demonstrate the prognosis of the patients. The aim of the present study was to search the efficiency of CRP/Alb ratio as a biochemical marker on mortality and clinical progress in the patients diagnosed with acute pancreatitis in correlation with APACHE-2.
 Methodology: This prospective case-control study was conducted with the patients diagnosed with acute pancreatitis through Atlanta criteria and healthy volunteers as a control group in the emergency department. Demographic characteristics, vital signs, ultrasound reports, clinical outcomes, neutrophil, lymphocyte, neutrophil/lymphocyte ratio (NLR), CRP, albumin and CRP/Alb ratio, APACHE-2 score within control and patient groups were recorded. Logistic regression analysis was performed to distinguish healthy volunteers from acute pancreatitis cases.
 Results: There was a statistically significant difference between CRP/Albumin and NLR measurements according to the groups and we found that the measurements of the patient group were significantly higher than the control group. The cut-off point for CRP/Albumin and NLR was found to be respectively 1.08, 4.04 and above. (Respectively; sen: 76.64%, 78.50%; spe: 97.20%, 97.20%; PPV: 96.47%, 96.55%; NPV: 80.62%, 81.89%; the accuracy: 86.92%, 87.85%). APACHE-2 scores ranged from 0 to 16, with a mean of 5.80±3.92. The probability of acute pancreatitis was significantly higher in patients with high CRP/Albumin and NLR.
 Conclusion: This study showed that CRP/Alb ratio and NLR were positively correlated with APACHE-2 scores that designed for prognosis in patients with acute pancreatitis.

Management of hypertriglyceridemia induced acute pancreatitis in emergency department

Amaç: Bu yazıda, hipertrigliseridemik akut pankreatit (HTGAP) tanısı alan hastalarda acil servis yönetimi ile ilgili deneyimlerimizi paylaşmayı amaçladık. Gereç ve Yöntem: Ekim 2015-Ekim 2016 tarihleri arasında, acil servisimize başvuran ve HTGAP tanısı alan hastaların lipaz, amilaz, trigliserid değerleri ve aldıkları tedavi rejimleri incelendi. Ortalama 1 gün/24 saat boyunca acil serviste takip edilen hastaların, klinik durumları ve başlangıç ile 24 saat sonraki trigliserid, amilaz, lipaz düzeyleri değerlendirmeye alındı. Bulgular: Çalışma süresi boyunca acil servisimize toplam 142.482 hasta başvurdu. Bu hastalardan akut pankreatit (AP) tanısı alan hasta sayısı 370’ ti. Bu hastalar içerisinde HTGAP tanılı 23-56 yaş aralığındaki 10 hastanın yaş ortalaması 36.2±19.8 olup 6' sı kadındı. Hastaların 7’ sinde hiperlipidemi, 6' sında diyabet, 2' sinde hipotroidi öyküsü vardı. Altı hasta daha önce pankreatit atağı geçirmişti. Hastaların hepsine, tanı anından itibaren acil serviste insülin infüzyon tedavisi başlandı. Ortalama 1 gün boyunca acil serviste takip edilen hastaların, klinik durumu ve 24 saat sonraki trigliserid, amilaz, lipaz düzeylerinin gerilediği görüldü. Sonuç: Acil serviste AP’ li hastalarda, etiyolojide hipertrigliseridemi akılda bulundurulmalıdır. HTGAP tanısı alan hastalarda komplikasyonları azaltmak için acil serviste erken tedavi başlanabilir ve insülin infüzyonu tedavisi, aferez tedavisine göre daha pratik ve takibi daha kolay olduğu için tüm hastalarda ilk seçenek olarak tercih edilebilir.