Serum Lipase Levels Research Articles

Effects of alpha-tocopherol on acute pancreatitis in rat.

Acute pancreatitis is a disease with high morbidity and mortality, despite all the advances in technology. The overall mortality rate of acute pancreatitis is 10%, whereas the mortality rate in infected necrotizing pancreatitis is approximately 35%. In this study, we aimed to establish acute pancreatitis in rats in order to try out the alpha-tocopherol treatment protocol and to reveal the results biochemically and histopathologically. Twenty-four male male Sprague-Dawley rats weighing between 300 and 350 g were used in the study. In Group 1, 80 µg/kg of normal saline was subcutaneously injected into eight rats; in Group 2, 80 µg/kg of cerulein was subcutaneously injected into eight rats; and in Group 3, 80 µg/kg of cerulein was subcutaneously injected into eight rats. In addition, 30 mg/kg of alpha-tocopherol was intraperitoneally injected into eight rats. The mean Schoenberg score, serum amylase, and lipase and Neutrophil Gelatinase-Associated Lipocalin (NGAL) levels were statistically significantly higher in Group 2 than in Group 1. The mean Schoenberg score and serum amylase and lipase levels were statistically significantly lower in Group 3 than in Group 2. In this experimental study rat model of cerulein-induced acute pancreatitis, 30 mg/kg of alpha-tocopherol was injected intraperitoneally to examine its effect on pancreatitis. The improvement was observed in the histopathological examination of pancreatic tissues. We think that alpha-tocopherol may have a therapeutic effect on pancreatic tissue.

Isoliquiritigenin Ameliorates Acute Pancreatitis in Mice via Inhibition of Oxidative Stress and Modulation of the Nrf2/HO-1 Pathway.

Oxidative stress plays a crucial role in the pathogenesis of acute pancreatitis (AP). Isoliquiritigenin (ISL) is a flavonoid monomer with confirmed antioxidant activity. However, the specific effects of ISL on AP have not been determined. In this study, we aimed to investigate the protective effect of ISL on AP using two mouse models. In the caerulein-induced mild acute pancreatitis (MAP) model, dynamic changes in oxidative stress injury of the pancreatic tissue were observed after AP onset. We found that ISL administration reduced serum amylase and lipase levels and alleviated the histopathological manifestations of pancreatic tissue in a dose-dependent manner. Meanwhile, ISL decreased the oxidative stress injury and increased the protein expression of the Nrf2/HO-1 pathway. In addition, after administering a Nrf2 inhibitor (ML385) or HO-1 inhibitor (zinc protoporphyrin) to block the Nrf2/HO-1 pathway, we failed to observe the protective effects of ISL on AP in mice. Furthermore, we found that ISL mitigated the severity of pancreatic tissue injury and pancreatitis-associated lung injury in a severe acute pancreatitis model induced by L-arginine. Taken together, our data for the first time confirmed the protective effects of ISL on AP in mice via inhibition of oxidative stress and modulation of the Nrf2/HO-1 pathway.

Acute pancreatitis as a rare complication of diclofenac therapy

We report a rare case of diclofenac-induced acute pancreatitis in a 52-year-old female who presented to the emergency department with severe abdominal pain after ingesting one tablet of diclofenac sodium 50 mg. The patient had a history of acute pancreatitis after diclofenac ingestion 6 months ago, and there was no history of alcohol intake. Serum amylase and lipase levels were high, and abdominal ultrasonography showed a contracted gallbladder without lithiasis, normal biliary tree, and liver. The patient received conservative management with analgesia, hydration, and fasting, and we resumed back her insulin and amlodipine. She was discharged on the 6th day of admission after significant clinical and laboratory improvement. During ambulatory follow-up, the patient presented complete resolution of the symptoms and biochemical results. The patient was advised to avoid nonsteroidal anti-inflammatory drugs.

Combination of diclofenac and aggressive hydration for the prevention of post-ERCP pancreatitis.

To investigate whether aggressive hydration can increase the efficacy of prophylactic non-steroid anti-inflammatory drugs (NSAIDs) in prevention of post-ERCP pancreatitis. NSAIDs are recommended for the prevention of PEP; however, whether aggressive hydration can have additional benefits in this regard is not known. Patients candidate for ERCP received either pre-procedural rectal diclofenac (100 mg) alone (n = 112) or in combination with aggressive hydration by lactate ringer's (n = 107) as prophylactic method. PEP was defined based on increase in serum levels of pancreatic enzymes (from baseline to 24 hours following the procedure) accompanied with symptoms. PEP was occurred in 3 patients in the diclofenac only group and in 1 patient in the diclofenac + hydration group with no significant difference (2.7% vs. 0.9%, P = 0.622). Serum amylase levels decreased over time in the diclofenac + hydration group but not in the diclofenac only group. Also, serum lipase levels decreased more rapidly over time in the diclofenac + hydration group compared to the diclofenac only group. Combination prophylactic therapy with NSAIDs plus aggressive hydration does not seem to have additional clinically important benefits in preventing PEP. Studies with larger sample of patients are required in this regard.

Ethanolic extract of fenugreek seeds moderates dimethoate-induced pancreatic damage in male rats.

Dimethoate is a widely used organophosphate insecticide known to be toxic to the pancreas. The aim of this study is to detect the possible protective effects of the fenugreek seed ethanolic extract on the biochemical, histological, and ultra-structural abnormalities induced by dimethoate chronic exposure in the pancreas of adult male rats. The study was conducted on 50 adult male albino rats that were divided equally into 5 groups: (group I) negative control, (group II) vehicle control group, (group III) fenugreek-treated group that was given 400mg/kg ethanolic fenugreek seed extract once daily, (group IV) dimethoate group received 20mg/kg/day dimethoate, and (group V) dimethoate- + fenugreek-treated group received a combination of dimethoate and fenugreek in the same previous doses. Dimethoate treatment caused a significant increase in serum glucose, amylase, and lipase levels and a significant decrease in serum insulin. A significant increase in lipid peroxidation and pro-fibrotic cytokine (TGF-β1) together with a significant reduction of the antioxidant {reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD)} activities and the anti-inflammatory (IL-4) in pancreatic tissues was also recorded. There was a histological and ultra-structural evidence of pancreatic acinar and islet cell injury. The recorded abnormalities were reversed in dimethoate+fenugreek treated group indicating that fenugreek ethanolic extract can serve as an antidote for dimethoate-induced pancreatic insult.

Predictive Factors for Long Operative Duration in Patients Undergoing Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiography for Combined Choledochocystolithiasis

Purpose:Choledochocystolithiasis and its associated complications such as cholangitis and pancreatitis are managed by endoscopic retrograde cholangiography (ERC), with endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). However, affected patients present with complex conditions linked to operative difficulties in performing LC. The aim of this study was to elucidate the predictive factors for a prolonged LC procedure following ERC for treating patients with choledochocystolithiasis.Materials and Methods:The medical records of 109 patients who underwent LC after ERC for choledochocystolithiasis from September 2012 to August 2014 were evaluated retrospectively. The cases were divided into long and short operative duration groups using a cutoff operative time of 90 minutes. We used univariate and multivariate analyses to investigate predictive factors associated with long operative duration according to clinical variables, ERC-related factors, and peak serum levels of laboratory test values between the initial presentation and LC (intervening period).Results:Seventeen patients needed >90 min to complete LC. The presence of acute cholecystitis, placement of percutaneous transhepatic gallbladder drainage, higher peak serum white blood cell count and levels of C-reactive protein (CRP), and lower peak serum levels of lipase during the intervening period were associated with prolonged operative duration. Multivariate analysis showed that the independent predictive factors for long operative duration were the presence of acute cholecystitis (hazard ratio, 5.418; P=0.016) and higher peak levels of CRP (hazard ratio, 1.077; P=0.022).Conclusion:When patients with choledochocystolithiasis are scheduled for LC after ERC, the presence of acute cholecystitis and high CRP levels during the intervening period could predict a protracted operation.

A portable high-intensity focused ultrasound system for the pancreas with 3D electronic steering: a preclinical study in a swine model.

PurposeThe aim of this animal study was to evaluate the safety and feasibility of a portable, ultrasonography-guided, high-intensity focused ultrasound (USg-HIFU) system to treat the pancreas.MethodsEight swine were included. Using a portable HIFU device (ALPIUS 900, Alpinion Medical Systems), ablations were performed on the pancreas in vivo. Different acoustic intensities were applied (1.7 kW/cm2 or 1.5 kW/cm2, n=2 [group A for a pilot study]; 1.5 kW/ cm2, n=3 [group B]; and 1.2 kW/cm2, n=3 [group C]). Magnetic resonance imaging (MRI) was performed immediately (group A) or 7 days (groups B and C) after HIFU treatment. In groups B and C, serum amylase and lipase levels were measured on days 0 and 7, and performance status was observed every day. Necropsy was performed on days 0 (group A) or 7 (groups B and C) to assess the presence of unintended injuries and to obtain pancreatic and peripancreatic tissue for histological analysis.ResultsAblation was noted in the pancreas in all swine on MRI, and all pathologic specimens showed coagulation necrosis in the treated area. The mean ablation areas on MRI were 85.3±38.1 mm2, 90.7±21.2 mm2, and 54.4±30.6 mm2 in groups A, B, and C, respectively (P>0.05). No animals showed evidence of complications, except for one case of a pseudocyst in group B.ConclusionThis study showed that pancreas ablation using a portable USg-HIFU system may be safe and feasible, and that coagulation necrosis of the pancreas was successfully achieved with a range of acoustic intensities.

Forensic and clinical significance of serum amylase, lipase and gamma glutamyl transferase as predictors of outcome in head injured patients

Head trauma is one of the leading causes of death and disability worldwide. Combined head lesions consist of more than one form of lesions. Biochemical markers of brain injury are used in determining the extent of brain injury and predicting its outcomes. The aim of this study was to investigate the forensic and clinical significance of serum amylase, lipase and gamma glutamyl transferase (GGT) as predictors of the outcome in head injured patients. Patients and methodsSixty head injured patients were enrolled and subjected to personal history taking, general and local physical examination. Glasgow coma scale (GCS), head computed tomography scan and pelvi-abdominal ultrasound were performed. Two blood samples (each 3 mL) were drawn at the time of admission and after 24 h for measuring serum amylase, lipase and GGT levels using special kits. ResultsMost cases of head trauma occurred accidentally during daytime, in the street as a result of falls and road traffic accidents (RTA). Significant increase of serum amylase, lipase and GGT levels on re-evaluation after 24 h from admission were demonstrated in combined head lesions. There was a high significant negative correlation between GCS and these enzymes both on admission and 24 h after admission. Serum levels of measured enzymes were significantly higher in non-survivors as compared to survivors. ConclusionSerum amylase, lipase and GGT are good predictors of the outcome in head injured patients. This could be useful for forensic experts to deduce that the poor outcome of the victims was primarily related to the effects of head trauma and its sequences.

Mucobilia: An Unusual Cause of Persistent Jaundice

Mucobilia is a rare condition, characterized by the abnormal secretion of copious amounts of mucus within the extrahepatic bile ducts manifesting as obstructive jaundice or cholangitis. A spectrum of mucin-producing hepatobiliary and pancreatic neoplasms have been associated with mucobilia. We report the case of a 63 year-old male with intestinal type of intraductal papillary neoplasm of the bile duct. A 63 year-old white caucasian male with hepatitis C genotype 1b presented with right upper quadrant pain, nausea and dark urine. On physical examination, he was markedly jaundiced and tender to palpation in the right upper quadrant. Total bilirubin was elevated to 20.2 mg/dl with a direct component of 15. Albumin was normal and INR was 1.0. AST and ALT were 55 and 43 IU/L, ALP was 148 IU/L. An ultrasound of gallbladder showed a thickened gallbladder wall but no stones. A CT abdomen was suggestive of early acute cholecystitis and common bile duct (CBD) dilation of 7 mm. An ERCP demonstrated dilated intrahepatic ducts and occlusion of the CBD due to thick mucous. A cholangiogram showed diffuse moderate dilation of the biliary tree and several filling defects in the CBD. The patient improved clinically with rapid decrease in the marked hyperbilirubinemia after clearing of the mucous and placement of a biliary stent. He was shortly thereafter discharged with a referral for a repeat ERCP/cholangioscopy. Biopsies of the bile duct showed small fragments of acutely inflamed ductal mucosa with reactive changes in a background of gastrointestinal epithelium contamination. The patient underwent a laparoscopic converted to open right hepatectomy for a hepatic adenoma. Surgical pathology of the bile ducts showed an intraductal papillary neoplasm, intestinal type with focal high-grade dysplasia. Mucobilia is a rare cause of biliary obstruction. The differential diagnosis includes benign neoplasms such as biliary mucinosis, biliary papillamatosis and cystadenomas of the pancreas or bile duct and malignant neoplasms such as mucin-producing cholangiocarcinoma and cystadenocarcinomas of the pancreas, liver, or biliary tree. The workup for mucobilia generally begins as is usual for obstructive jaundice, including CBC, CMP, LFTs and serum amylase and lipase levels. Cholangioscopy allows direct visualization of intraductal mucin-producing neoplasms and permits biopsy of biliary lesions, which makes it the preferred diagnostic modality. Surgery remains the mainstay of therapy.Figure: CT Scan abdomen demonstrating dilated intrahepatic duct without any obvious mass.Figure: ERCP with spyglass demonstrating mucin at the ampulla.Figure: Mucin-producing mass in segment 8.

Revisiting the Management of Hypertriglyceridemia-Induced Pancreatitis

Introduction: Hypertriglyceridemia (HTG) is an infrequent, although well-recognized cause of acute pancreatitis (AP). Plasmapheresis has been used in severe cases of HTG-AP to actively and rapidly correct elevated TG levels. However, due to the heterogeneity in severity of AP, clinical outcomes used to determine efficacy and lack of well-balanced control groups, the role of Plasmapharesis in HTG-AP remains in question.Figure: Average Serum Triglyceride in Plasmapheresis and Non-Plasmapheresis groups up to 96 hours after Admission.Figure: Average APACHE II score in Plasmapheresis and Non-plasmapheresis groups up to 96 hours After Admission. Abbreviation: APACHE, acute physiology and chronic health evaluation.Table: Table. Pre-match and Post-match Comparison Between Plasmapheresis and Nonplasmapheresis GroupOur aim was to evaluate the role of plasmapheresis vs standard therapy in a large case-matched series of patients with severe HTG-AP. Methods: This is a retrospective cohort study of 142 patients with HTG-AP who were divided into plasmapheresis and non-plasmapheresis group. Inclusion criteria was serum TG level equal to or greater than 1000mg/dl, elevated serum lipase and/or abdominal pain. We compared the epidemiologic characteristics, clinical severity and end-points between the groups directly and after successful propensity score match. The clinical trajectory of plasmapheresis and post-match non-plasmapheresis group were plotted and compared. Results: Of the 142 patients, 127 patients were in the non-plasmapheresis group and 15 patients in the plasmapheresis group. Mean serum lipase levels on admission were equivalent between groups (781 unit/L vs 1167 unit/L; P=0.391) as were mean triglyceride levels on admission (7411 mg/dL vs 7193 mg/dL; P=0.848). APACHE II scores (11.4 vs 11.4; P=1.00) and Ranson's score were equally matched (3.70 vs 3.73; P=0.928). Around 60% (n=9) of patients in the non-plasmapheresis group required ICU admission vs 100% (n=15) in the plasmapheresis group (P=0.017), although there were no statistically significant differences regarding in-hospital mortality, total LOS, complications of acute pancreatitis, or re-admission rate during an average follow-up of 893 days. Conclusion: Our study supports the notion that plasmapheresis is highly efficacious in reducing serum triglyceride level and improving APACHE II score in HTG-AP. However, its benefits and costeffectiveness compared to standard therapy still remains in question. Larger randomized studies are needed.

Fortuitous Splenic Rupture: An Unusual Presentation of Pancreatic Cancer

Early diagnosis of pancreatic ductal adenocarcinoma (PDAC) is difficult. Multifocal pancreatic masses are not common when it comes to PDAC. This especially holds true for cancer of the pancreatic body and tail that do not manifest with jaundice. We present a case of pancreatic cancer involving the head and tail A 52-year-old Caucasian male with past history of hypertension, gout and osteoarthritis presented to the hospital with acute left upper quadrant pain radiating to the back after sustaining a fall. Examination revealed severe tenderness to palpation of the left upper quadrant. Initial laboratory data showed hemoglobin of 10.4 g/dl, AST of 166 U/L, ALT of 352 U/L, ALP of 368 U/L and serum lipase level of 869 U/L. CT abdomen showed splenic laceration with hemoperitoneum. The patient was vigorously resuscitated, and subsequently underwent emergency laparotomy. Operative findings revealed splenic laceration with hemoperitoneum. Intraoperatively, the pancreatic tail was hard and abutted the mesocolon and omentum. Short gastric vessels were engorged suggestive of splenic vein thrombosis. Irregular masses were noticed in the head of the pancreas without involvement of superior mesenteric vasculature. Histopathology of the mass revealed PDAC. The patient underwent Whipple surgery with adjuvant FOLFIRINOX therapy. Post-operative pathology showed T3N1 disease with perineural and lymphovascular invasion. The patient is currently undergoing surveillance for recurrence. Splenic rupture is extremely rare presenting feature of pancreatic cancer. Only ten prior cases have been reported in literature. Most of those cases reported rupture of splenic artery aneurysm secondary to direct vascular invasion of PDAC. Cancer of the pancreatic tail can invade the splenic hilum causing splenic ischemia and vein occlusion which may culminate in splenic rupture. Another rare finding in our case was the multifocal nature of pancreatic cancer. Only around 50 cases have been reported so far as per our literature review. Most of the cases that have been reported in literature present as contiguous masses. Surgical removal is recommended in the absence of distant metastatic disease and local vascular invasion. Overall prognosis continues to remain grim for all stages.Figure: Splenic rupture is a rare presenting feature of pancreatic cancer. It can however present an opportunity for early stage discovery that may lead to improvement in prognosis by earlier initiation of treatment.

A Study on Determination of Biochemical Variations Of Serum Amylase And Lipase As Diagnostic Markers For Acute And Chronic Pancreatitis.

Introduction: Acute pancreatitis is a standout amongst the most widely recognized cause for hospitalization in the United States, representing around 220,000 cases for each year. Among the new cases, 80% are interstitial and 20% are necrotizing. Methodology The study was conducted From March to May 2016, in Owaisi Hospital, a 1000 bedded teaching hospital, situated in Hyderabad, providing specialized tertiary level health care services to all strata of people. Patients visiting the outpatient department of general medicine in owaisi hospital were selected for the present study, the patients selected has a history of pancreatic enzymes elevation for more than a year. Aims And Objectives : This planned study has been attempted with the accompanying targets, to concentrate on the predominance of amylase and lipase levels in acute pancreatitis patients and to assess the etiologic proof as diagnostic marker in patients with acute pancreatitis. Results: the total of 60 patients were included in the study with the history of pancreatitis, which includes 37 females and 23 males, along with the inter group evaluation of serum lipase, amylase and hemoglobin levels. Conclusion: it can be concluded that the serum amylase , lipase , SGOT and SGPT levels are increased which is associated with the decreased hemoglobin levels in both males and women, hence we conclude that the Males are more prone to acute and chronic pancreatitis than female.

O26-2 - Serum Levels of Exocrine Pancreatic Enzyme in Patients with Acute Decompensated Heart Failure

Background: Acute decompensated heart failure (ADHF) can damage systemic organs through the poor perfusion and/or congestion. The interaction between ADHF and exocrine pancreatic function was rarely investigated. Methods: We compared admission levels of serum amylase or lipase (as suggestive of exocrine pancreatic function) between patients admitted for ADHF (N = 102) and those admitted for non-ADHF causes (N = 35). Correlates to amylase or lipase were assessed by multiple regression analysis. In HF patients, associations between low amylase or lipase levels and clinical outcomes (composite of all-cause mortality and/or ADHF rehospitalization) were analyzed in the multivariate Cox regression models. Results: ADHF patients had significantly lower serum levels of amylase (median, 54 IU/L versus 68 IU/L, P = .001) and lipase (25 IU/L versus 31 IU/L, P = .018) compared with non-HF group. Amylase correlated directly with blood urea nitrogen (BUN) (coefficient, 0.552; P < .001), albumin (coefficient, 0.233; P = .020), and inversely with BNP levels (coefficient, −0.227, P = .024). Lipase correlated directly with BUN (coefficient, 0.377; P < .001) and inversely with BNP levels (coefficient, −0.364; P < .001). Although there was no association between low amylase levels and clinical outcomes, low lipase levels (<18 IU/L) was significantly associated with worse clinical outcome (hazard ratio, 1.81; P = .025). Conclusion: ADHF patients may be suffering from exocrine pancreatic insufficiency, which can be associated with poor long-term clinical outcomes possibly through malnutrition.

A preliminary study on fetal lung injury in a rat model of acute pancreatitis in pregnancy

Acute pancreatitis in pregnancy (APIP), which was thought to be rare, is becoming more frequent. In addition, high perinatal mortality among fetuses has been reported. Our research aimed to investigate and assess fetal lung injury in a rat model of APIP and its possible mechanisms. The APIP model was induced by sodium taurocholate in Sprague-Dawley rats during the third trimester. Sham-operated (SO) rats in late gestation were used as controls, and dynamic observation and detection in the SO and acute pancreatitis (AP) groups were performed at 3 time-points. Histological changes in the fetal lungs, as well as the maternal pancreas and placenta were assessed. The levels of serum amylase, lipase, TNF-α and IL-1β were detected in maternal rats, and the expression of surfactant proteins A, B, C and D as well as their mRNA were determined. In this study, fetal lung injury as well as maternal pancreas and placenta injuries occurred in a time-dependent manner. The levels of serum amylase, lipase and TNF-α were markedly increased in maternal rats, and the levels of surfactant proteins A, B, C and D in fetal lungs were significantly decreased in the fetal lungs of the AP group. Ultrastructure injuries and the dysregulated synthesis and secretion of pulmonary surfactant proteins were observed in the AP group.Our research suggests that fetal lung injury is involved in the rat model of APIP and that the dysregulated synthesis and secretion of pulmonary surfactant proteins play a critical role in fetal lung injury during APIP.

Prospective study of prediction of post-ERCP pancreatitis by 4-hour and 6-hour post-ERCP serum amylase and lipase level

Cerium oxide (CeO2) nanoparticles have been synthesized from (NH4)2Ce(NO3)6, ethylenediamine and hydrazine by a hydrothermal method. Ethylenediamine and hydrazine with pH management can control the particle growth and have an important role in the formation of nanoparticles. Various experimental parameters were examined, such as the reaction temperature, the reaction time, and the molar ratios of the starting reagents. The as-synthesized products were characterized by powder X-ray diffraction (XRD), transmission electron microscopy (TEM), scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FT-IR), and energy dispersive X-ray spectroscopy (EDX).

Diagnosing acute pancreatitis—Clinical and radiological characterisation of patients without threefold increase of serum lipase

ObjectivesDiagnosing acute pancreatitis (AP) may be challenging in patients with acute abdominal pain but missing threefold increased serum lipase levels (Lip−). This studyaims both to characterize these patients using clinical, radiological and mortality data, and to assess the group of patients who need contrast-enhanced computed tomography (CECT). MethodsIn this retrospective, IRB approved study 234 consecutive patients with AP were investigated. Inclusion criteria were single (SAP) and recurrent attacks (RAP) of AP and CECT ≥72h after onset of symptoms. Severity of AP was assessed by C-reactive protein at 48h after hospital admission and using 3 CT-based scores (CTSI, mCTSI, EPIC) by 2 observers. Mortality rates from pancreatic and non-pancreatic causes were noted with regard to lipase increase. Results were compared with paired t-test and Wilcoxon signed-rank test. Results64/234 (27%) patients belonged to Lip− group and 170/234 (73%) patients were allocated to Lip+ group. Significantly more male patients (78% in Lip− vs. 63% in Lip+, p<0.05) with RAP (63% in Lip− vs. 21% in Lip+, p<0.001) were observed in the Lip− group. EPIC was significantly lower in Lip− group compared to Lip+ group (3(IQR 2–5) vs. 2(IQR 1–3), p<0.001). Mortality from pancreatic and non-pancreatic causes was comparable in Lip− and Lip+ group (pancreatic causes: 9% vs. 6%, p=0.60; nonpancreatic causes: 8% vs. 5%, p=0.58). Conclusions27% of all patients with AP presented without threefold increase of lipase levels. Thus, they would be underdiagnosed without confirming CECT, which revealed significantly lower counts of pleural effusions and ascites. Male patients with RAP were found significantly more often among the Lip− group. Hence, they would benefit the most from CECT for diagnosing AP.

Factors associated with increased pancreatic enzymes in septic patients: a prospective study

BackgroundThe perfusion of splanchnic organs is deeply altered in patients with septic shock. The aim of the study is to identify the predictive factors of septic shock-induced increase of serum lipase and amylase and to assess and evaluate its prognostic impact.MethodsWe conducted a prospective observational study. All adult patients admitted with septic shock were eligible for our study. Serum lipase and amylase were measured on admission. Patients with and those without increased pancreatic enzymes were compared. Predictive factors of pancreatic insult identified by the univariate analysis were integrated in a stepwise multivariate analysis. Odds ratios (OR) with the 95% confidence interval (CI) were calculated accordingly. Second, the sensitivity and the specificity of amylase and lipase to predict intensive care unit (ICU) mortality were identified through the Receiver Operator Curve.ResultsFifty patients were included. Median [quartiles] age was 68.5 [58–81] years. The APACHE II score was 26 [20–31]. Twenty-three patients (46%) had increased serum amylase and/or serum lipase. Diabetes mellitus (OR = 16; 95% CI [1.7–153.5]; p = 0.016), increased blood urea nitrogen (OR = 1.12; 95% CI [1.02–1.20], p = 0.016), and decreased C-reactive protein (OR = 0.97; 95% CI [0.96–0.99]; p = 0.027) were identified as independent factors predicting increased pancreatic enzymes. Twenty patients (40%) died in the ICU. Neither serum amylase level nor serum lipase level was significantly different between survivors and non-survivors (respectively 49 [27.7–106] versus 85.1 [20.1–165] UI/L; p = 0.7 and 165 [88–316] versus 120 [65.5–592] UI/L; p = 0.952).ConclusionIncrease of pancreatic enzymes is common in patients with septic shock. Diabetes and impaired renal function are predictive of increased pancreatic enzymes. Such finding does not carry any negative prognostic value.

Protective effects of tropisetron on cerulein-induced acute pancreatitis in mice

Acute pancreatitis (AP) causes morbidity and mortality. The aim of the present study was to investigate the protective effect of tropisetron against AP induced by cerulein.Cerulein (50μg/kg, 5 doses) was used to induce AP in mice. Six hours after final cerulein injection, animals were decapitated. Hepatic/pancreatic enzymes in the serum, pancreatic content of malondialdehyde (MDA), pro-inflammatory cytokines and myeloperoxidase (MPO) activity were measured.Tropisetron significantly attenuated pancreatic injury markers and decreased the amount of elevated serum amylase, lipase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), MPO activities and pro-inflammatory cytokines levels caused by AP in mice. Tropisetron didn’t affect the pancreatic levels of MDA.Our results suggest that tropisetron could attenuate cerulein-induced AP by combating inflammatory signaling. Further clinical studies are needed to confirm its efficacy in patients with AP.

Clinical Profile of Acute Pancreatitis in Children in a Tertiary Level Hospital of Bangladesh

Background: Acute pancreatitis is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. The incidence of acute pancreatitis in children has increased significantly in the past two decades. It can be associated with severe morbidity and mortality. It should be considered in every child with unexplained acute abdominal pain.Objectives: To observe the clinical, biochemical and imaging profiles of acute pancreatitis in children.Methods: It was a cross-sectional study conducted at the Department of Pediatric Gastroenterology &amp; Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2014 through June 2015. A total of 50 cases of acute pancreatitis were included in this study. The diagnosis of acute pancreatitis was based on diagnostic criteria of acute pancreatitis made by INSPPIRE group (If a child had any 2 of the 3 criteria: the abdominal pain compatible with acute pancreatitis, elevated serum amylase and /or lipase level more than three times of upper limit of normal, imaging findings compatible with acute pancreatitis). Clinical characteristics, laboratory and imaging profile of the cases, complications were studied.Results: Among 50 cases, male were 46% and male female ratio was 0.8:1. Mean age at presentation was 10.2 ± 3.2 years. Forty eight (96%) patients had abdominal pain which was severe agonizing in 81.3% cases. The common location of pain was in epigastric region (77%). Pain radiating to back in 22.9% patients. Mean duration of pain was 6.6 ± 4.4 days before hospital admission. Vomiting was present in 72% patients followed by fever (30%). Two (4%) patients had jaundice. Ascites was noted in 12% patients and abdominal mass in 6% patients. Out of 50 cases of AP, biliary sludge was associated in 6% patients, biliary ascariasis in 4%, choledochal cyst in 2% and gallbladder stone in 2% patients. But in this study, 4% patients had Wilson disease. Laboratory tests showed leukocytosis in 28% patients, high serum amylase and lipase level in 56% and 58% patients respectively. Postive findings in ultrasonogram were present in 66% patients. In the present study, hypocalcemia was found in 38% patients, pseudocyst in 6% and pancreatic necrosis in 2% patients.Conclusion: Although acute pancreatitis may present with varieties of clinical feature, the most common one is abdominal pain and common location of pain is in epigastric region. For confirmation of clinically diagnosed pancreatitis, both serum amylase and lipase level and abdominal ultrasound are useful tools.Bangladesh J Child Health 2016; VOL 40 (3) :160-165

Acute hyperlipidemic pancreatitis accompanied by chylous ascites with normal amylase and lipase in pregnancy

Normal serum amylase is uncommon even in acute hypertriglyceridemic pancreatitis (HTGAP). However, normal serum lipase and amylase activity in HTGAP with chylous ascites is exceptionally rare. We report a pregnant woman with HTGAP and chylous ascites that were misdiagnosed. She showed acute abdominal pain and significant systemic inflammatory response, but her serum amylase and lipase levels failed to increase, although ultrasonic imaging finding of the pancreas was normal. Early clinical recognition of chylomicronemia helps clinicians diagnose HTGAP rapidly during pregnancy.