Evaluation Of Acute Pancreatitis Research Articles

SMART Medical Review: Acute Pancreatitis Assessment and Management in the First 24 Hours

Acute pancreatitis (AP) is an inflammatory reaction of the pancreas caused by inappropriate trypsin activation and an injury / innate inflammatory response. The many etiologies and potentially life-threatening consequences of AP require that clinicians initiate prompt and individualized treatment upon diagnosis. Application of new advances in the management of AP are required at the point of care. To facilitate care, a group of clinical experts have developed a set of recommendations for the evaluation and management of AP during the first 24 hours based on current evidence and evolving concepts. Ten areas of care are addressed where expert recommendations may be useful: (1) physical examination, (2) laboratory tests, (3) diagnosis, (4) early treatment, (5) severity determination, (6) etiology-based management, (7) typical orders sets, (8) determining of appropriate level of care, (9) quality of care, and (10) quality improvement recommendations. Conclusion: These recommendations should become available as clinical decision support tools that are accessible at the point of care, in real time.

Exploring the regulatory mechanism of tRNA-derived fragments 36 in acute pancreatitis based on small RNA sequencing and experiments.

Acute pancreatitis (AP) is a disease featuring acute inflammation of the pancreas and histological destruction of acinar cells. Approximately 20% of AP patients progress to moderately severe or severe pancreatitis, with a case fatality rate of up to 30%. However, a single indicator that can serve as the gold standard for prognostic prediction has not been discovered. Therefore, gaining deeper insights into the underlying mechanism of AP progression and the evolution of the disease and exploring effective biomarkers are important for early diagnosis, progression evaluation, and precise treatment of AP. To determine the regulatory mechanisms of tRNA-derived fragments (tRFs) in AP based on small RNA sequencing and experiments. Small RNA sequencing and functional enrichment analyses were performed to identify key tRFs and the potential mechanisms in AP. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) was conducted to determine tRF expression. AP cell and mouse models were created to investigate the role of tRF36 in AP progression. Lipase, amylase, and cytokine levels were assayed to examine AP progression. Ferritin expression, reactive oxygen species, malondialdehyde, and ferric ion levels were assayed to evaluate cellular ferroptosis. RNA pull down assays and methylated RNA immunoprecipitation were performed to explore the molecular mechanisms. RT-qPCR results showed that tRF36 was significantly upregulated in the serum of AP patients, compared to healthy controls. Functional enrichment analysis indicated that target genes of tRF36 were involved in ferroptosis-related pathways, including the Hippo signaling pathway and ion transport. Moreover, the occurrence of pancreatic cell ferroptosis was detected in AP cells and mouse models. The results of interference experiments and AP cell models suggested that tRF-36 could promote AP progression through the regulation of ferroptosis. Furthermore, ferroptosis gene microarray, database prediction, and immunoprecipitation suggested that tRF-36 accelerated the progression of AP by recruiting insulin-like growth factor 2 mRNA binding protein 3 (IGF2BP3) to the p53 mRNA m6A modification site by binding to IGF2BP3, which enhanced p53 mRNA stability and promoted the ferroptosis of pancreatic follicle cells. In conclusion, regulation of nuclear pre-mRNA domain-containing protein 1B promoted AP development by regulating the ferroptosis of pancreatic cells, thereby acting as a prospective therapeutic target for AP. In addition, this study provided a basis for understanding the regulatory mechanisms of tRFs in AP.

COMPARISON OF THE MODIFIED CT SEVERITY INDEX WITH THE CT SEVERITY INDEX FOR THE ASSESSMENT OF ACUTE PANCREATITIS SEVERITY

Introduction: Acute pancreatitis (AP) is a frequent, mild, self-limiting condition with only minor or temporary systemic symptoms. In the evaluation of AP, imaging by CT or MRI is helpful for diagnosis as well as for identifying regional pancreatic problems and directing interventional therapies. A retrospective analysis of a prospectively collected database Material and methods: was performed. The demographic, clinical, and laboratory data of the 40 cases of acute pancreatitis in patients were reviewed for this study. 40 patients underwent CECT or MRI within 1 week of onset of symptoms. A single radiologist performed imaging studies and recorded all pancreatic, peripancreatic, and extrapancreatic ndings and complications. According to CTSI, the number of patients with mild moderate and Results: severe disease were 19, 14 and 7 respectively; According to MCTSI, the number of patients with mild, moderate and severe disease were 7, 18, 15 respectively. Mean length of hospital stay and ICU stay was 4.48±2.03 and 1.7±2.11 respectively. Both the scoring systems more accurately correlated with the length of ICU stay, organ failure and necrosectomy and accurately correlated with infection and percutaneous catheter drainage. MCTSI showed superior and better Conclusion: correlation with disease severity than CTSI. There was statistical signicant association noted with CTSI and MCTSI each with the severity parameters and outcome assessed.

Modified computed tomography severity index in evaluation of acute pancreatitis and its correlation with clinical outcome: A prospective observational study from a tertiary care teaching hospital, India.

Acute pancreatitis (AP) is one of the most common yet, the most complex and challenging abdominal emergencies encountered by clinicians globally. It runs an unpredictable course. One-fifth of all AP patients develop complications. Many prognostic predictive scoring systems are used for AP. The aim of our study was to evaluate the usefulness of modified computed tomography severity index (MCTSI) scores to predict the need for intensive care unit (ICU) stay, complications, and mortality in patients of AP. An observational, prospective study was conducted for 1 year. Fifty cases diagnosed as AP were included in this study. Contrast-enhanced computed tomography of the abdomen and pelvis was carried out in all patients. MCTSI was calculated according to CT findings. Patients' demographic details, clinical findings, duration of hospital stay, complications, and interventions were recorded. SPSS version 26.0 was used for statistical analysis. A. Grading by modified CT severity index has a significant direct correlation with the necessity of ICU admission, duration of ICU stay, and total duration of hospital stay. A modified CT severity index can be used to predict the possibility of developing local and systemic complications as well as the need for interventions. Modified CTSI is a reliable predictor of clinical course and outcome in cases of acute pancreatitis.

Acute and Chronic Pancreatitis

Clinical evaluation and surgical decision making in patients with acute pancreatitis (AP) and chronic pancreatitis (CP) are two of the most complex conditions that a general surgeon faces. Each entity has unique laboratory and radiographic investigations, operations, and postoperative care. The clinical evaluation, history, and physical examination of AP is described. The clinical features necessary for diagnosis are listed, and contrast-enhanced computed tomography is described as the gold standard for diagnosis. This review uses definitions and terminology developed at the Atlanta symposium in 1992. The severity of an episode of AP is described in terms of established scoring systems (APACHE II [Acute Physiology and Chronic Health Evaluation II], Glasgow Coma Scale score, Ranson criteria). AP can range from mild to severe necrotizing, with each described. The clinical course is described in detail. For CP, the history, physical examination, and diagnosis via investigative and imaging studies are described. The anatomic and morphologic subtypes of chronic pancreatitis are listed and the operations directed at patients with CP are detailed, and can involve drainage or combined resection and drainage. This review contains 12 figures, 14 tables, and 48 references. Keywords: Acute pancreatitis, chronic pancreatitis, gallbladder disease, alcoholism, amylase, Whipple procedure

Acute and Chronic Pancreatitis

Clinical evaluation and surgical decision making in patients with acute pancreatitis (AP) and chronic pancreatitis (CP) are two of the most complex conditions that a general surgeon faces. Each entity has unique laboratory and radiographic investigations, operations, and postoperative care. The clinical evaluation, history, and physical examination of AP is described. The clinical features necessary for diagnosis are listed, and contrast-enhanced computed tomography is described as the gold standard for diagnosis. This review uses definitions and terminology developed at the Atlanta symposium in 1992. The severity of an episode of AP is described in terms of established scoring systems (APACHE II [Acute Physiology and Chronic Health Evaluation II], Glasgow Coma Scale score, Ranson criteria). AP can range from mild to severe necrotizing, with each described. The clinical course is described in detail. For CP, the history, physical examination, and diagnosis via investigative and imaging studies are described. The anatomic and morphologic subtypes of chronic pancreatitis are listed and the operations directed at patients with CP are detailed, and can involve drainage or combined resection and drainage. This review contains 12 figures, 14 tables, and 48 references. Keywords: Acute pancreatitis, chronic pancreatitis, gallbladder disease, alcoholism, amylase, Whipple procedure

Imaging acute pancreatitis

ObjectivesAcute pancreatitis is common; the clinical course of this potentially severe condition varies widely. This paper aims to review the role of different imaging techniques in the management of acute pancreatitis, describe the main imaging findings for this entity, and explain the terms and criteria used to classify them. ConclusionsImaging techniques play a key role in the management of acute pancreatitis, from diagnosis and staging to identifying and treating complications, as well as in determining the underlying causes of the condition. For these reasons, radiologists should know the advantages and limitations of each imaging technique in the evaluation of acute pancreatitis, be familiar with the wide spectrum of imaging findings associated with it, and how to use the specific terminology derived from the Atlanta classification to ensure the standardization and quality of reports.

Pancreatitis aguda en imágenes

ObjectivesAcute pancreatitis is common; the clinical course of this potentially severe condition varies widely. This paper aims to review the role of different imaging techniques in the management of acute pancreatitis, describe the main imaging findings for this entity, and explain the terms and criteria used to classify them. ConclusionsImaging techniques play a key role in the management of acute pancreatitis, from diagnosis and staging to identifying and treating complications, as well as in determining the underlying causes of the condition. For these reasons, radiologists should know the advantages and limitations of each imaging technique in the evaluation of acute pancreatitis, be familiar with the wide spectrum of imaging findings associated with it, and how to use the specific terminology derived from the Atlanta classification to ensure the standardization and quality of reports.

Acute pancreatitis in a kidney transplant recipient and proposal of a step-wise diagnostic algorithm - A case report

Acute pancreatitis (AP) is a rarely encountered complication in patients following kidney transplantation and is associated with significant morbidity and mortality. The diagnosis is often difficult due to the lack of classic symptoms and laboratory findings. Herein, we report the case of azathioprine-induced AP leading to acute kidney injury in a kidney transplant recipient, in whom we have encountered diagnostic difficulty. Patient spontaneously recovered after drug withdrawal. We propose a step-wise diagnostic algorithm for the evaluation of AP in kidney transplant recipients.

Usefulness of Computerized Tomography Scan for the Detection and Evaluation of Acute Pancreatitis

Usefulness of Computerized Tomography Scan for the Detection and Evaluation of Acute Pancreatitis

Study of BISAP Score in Evaluation of Acute Pancreatitis and Its Severity

Study of BISAP Score in Evaluation of Acute Pancreatitis and Its Severity

Modified CT severity index for evaluation of acute pancreatitis and correlation with patient outcome

Modified CT severity index for evaluation of acute pancreatitis and correlation with patient outcome

Modified CT severity index for evaluation of acute pancreatitis and correlation with patient outcome

Modified CT severity index for evaluation of acute pancreatitis and correlation with patient outcome

Corrigendum to “Role of Biomarkers in Diagnosis and Prognostic Evaluation of Acute Pancreatitis”

Corrigendum to “Role of Biomarkers in Diagnosis and Prognostic Evaluation of Acute Pancreatitis”

Erratum for Computed tomographic angiography and ultrasonography in the diagnosis and evaluation of acute pancreatitis in dogs.

Erratum for Computed tomographic angiography and ultrasonography in the diagnosis and evaluation of acute pancreatitis in dogs.

Emerging imaging techniques for acute pancreatitis.

Acute pancreatitis (AP) is caused by acute inflammation of the pancreas and adjacent tissue and is a common source of abdominal pain. The current CT and MRI evaluation of AP is mostly based on morphologic features. Recent advances in image acquisition and analysis offer the opportunity to go beyond morphologic features. Advanced MR techniques such as diffusion-weighted imaging, as well as T1 and T2 mapping, can potentially quantify signal changes reflective of underlying tissue abnormalities. Advanced analytic techniques such as radiomics and artificial neural networks (ANNs) offer the promise of uncovering imaging biomarkers that can provide additional classification and prognostic information. The purpose of this article is to review recent advances in imaging acquisition and analytic techniques in the evaluation of AP.

Evaluation and management of acute pancreatitis.

Acute pancreatitis (AP) is one of the most common gastrointestinal causes for hospi-talization in the United States. In 2015, AP accounted for approximately 390000 hospitalizations. The burden of AP is only expected to increase over time. Despite recent advances in medicine, pancreatitis continues to be associated with a substantial morbidity and mortality. The most common cause of AP is gallstones, followed closely by alcohol use. The diagnosis of pancreatitis is established with any two of three following criteria: (1) Abdominal pain consistent with that of AP; (2) Serum amylase and/or lipase greater than three times the upper limit of normal; and (3) Characteristics findings seen in cross-sectional abdominal imaging. Multiple criteria and scoring systems have been established for assessing severity of AP. The cornerstones of management include aggressive intravenous hydration, appropriate nutrition and pain management. Endoscopic retrograde cholangiopancreatography and surgery are important aspects in management of acute gallstone pancreatitis. We provide a comprehensive review of evaluation and management of AP.

Role of contrast-enhanced computed tomography in the evaluation of acute pancreatitis according to the revised Atlanta classification

Objective The aim of this study was to detect the role of contrast-enhanced computed tomography (CT) in the diagnosis of acute pancreatitis according to the revised Atlanta classification. Background Imaging plays a very important role in the management of pancreatitis. It assists diagnosis and in differentiation of the severity of pancreatitis. Besides, it helps to detect and manage the associated complications through image-guided drainage and aspiration. Contrast-enhanced CT is the most clinically useful study. In 1992, morphological stages of acute pancreatitis were made. Between interstitial pancreatitis and sterile or infected necrosis Atlanta classification was made whereas in the revised Atlanta classification focuses heavily on the morphologic criteria for defining the various manifestations by means of CT. Materials and methods This prospective study was performed on 60 patients. The study was carried out at the Diagnostic Radiology Departments of Menoufia University Hospital and the National Liver Institute. The patients were presenting with acute abdominal pain, mainly epigastric, radiating to the back and the lesions were classified according to the Atlanta classification. Results Forty-two patients were with interstitial pancreatitis, 32 patients were with acute peripancreatic collection and 10 patients were with pseudocysts and 18 patients were with necrotizing pancreatitis, nine patients with acute necrotic collection and nine patients were with walled-off necrosis with statistically significant difference of age between groups (P = 0.014). Conclusion Contrast-enhanced CT is a perfect diagnostic modality to stage the severity of inflammatory process, identify the pancreatic necrosis and describe local complications and grading of severity of acute pancreatitis. Revised Atlanta classification is more accurate for assessing patient mortality and organ failure.

Computed tomographic angiography and ultrasonography in the diagnosis and evaluation of acute pancreatitis in dogs.

BackgroundAcute pancreatitis in dogs is an under‐diagnosed disease. Current diagnostic methods are insufficient at identifying sequelae and lack prognostic capability. Computed tomographic angiography (CTA) is accurate for diagnosis and prognostication of pancreatitis in humans.ObjectivesIn comparison to ultrasound (US), CTA will (1) better diagnose more severe pancreatitis and sequelae and (2) provide assessment of patient outcome by identification of pancreatic contrast enhancement patterns.AnimalsTwenty‐six client‐owned dogs suspected to have acute pancreatitis.MethodsUS and CTA examinations performed at time of admission were compared to determine the detection of pancreatic changes and sequelae. CTA findings also were compared to outcome indicators for prognosis of dogs with acute pancreatitis. Specific canine pancreatic lipase (cPL) samples were obtained and compared with CTA findings.ResultsTen of 26 dogs had heterogeneous contrast enhancement of the pancreas. Compared to US, CTA better identified portal vein thrombosis (P = .003). Patients with heterogeneous contrast enhancement had longer hospitalization (P = .01), including hospital stays for >5 days (P = .02), had more relapses, and were more likely to have portal vein thrombosis (P = .002). Patients with heterogeneous contrast enhancement had increased spec cPL (P = .006).Conclusions and Clinical ImportanceIn comparison to US, CTA better identified dogs with more severe acute pancreatitis and those with portal vein thrombosis, factors that may predict longer hospitalization and increased risk of relapse. The presence of heterogeneous contrast enhancement and portal vein thrombosis may change therapy for patients with acute pancreatitis.

Role of Magnetic Resonance Imaging in Evaluation of Acute Pancreatitis

AbstractBackground: To investigate the role of dynamic Magnetic Resonance Imaging (MRI) in diagnosing and assessing the severity of Acute Pancreatitis (AP) patients and role out pancreatic necrosis.Aim of Study: The aim of the study was to determine the effectiveness of dynamic MRI in the diagnosis of AP and assessing the severity of AP by detection and delineation of extension of pancreatic necrosis in comparison to clinical scoring systems.Material and Methods: Thirty four patients with clinical diagnosis of acute pancreatitis underwent magnetic resonance imaging using 1.5T machine include T1, T2 weighted imaging, SPAIR and dynamic contrast. Magnetic Resonance Severity Index (MRSI) was used to assess the severity and correlated with clinical scoring based on revised Atlanta classification and Acute Physiology and Chronic Health Evaluation II (APACHE II) score.Results: T2-SPAIR is the best sequence to diagnose AP. The MRSI significantly correlates with both revised Atlanta and APACHE II scores in differentiating mild cases of AP from moderate edematous and severe necrotizing cases (p <0.001 for revised Atlanta and 0.004 for APACHE II.Conclusion: Dynamic MRI help to diagnose mild forms of AP and differentiate it from other causes of abdominal pain.MRI can be used in combination with clinical scoring for diagnosis of AP and accurate assessment of disease severity.