Medical Treatment Of Acute Pancreatitis Research Articles

Effect of sevoflurane on the pain syndrome and course of acute pancreatitis: сlinical cases

BACKGROUND: Acute pancreatitis is a potentially life-threatening disease, which is based on a severe inflammatory process and enzymatic autolysis of the pancreas. Currently, there is no effective medical treatment for acute pancreatitis. Its therapy is based on early infusion, adequate anesthesia, enteral nutrition, antibiotic therapy for infected pancreatic necrosis, and sanitizing procedures for the development of purulent and septic complications. In the last decade, experimental, and clinical studies have proven the powerful anti-inflammatory effect of the inhalation anesthetic sevoflurane. Sevoflurane reduces inflammation, both by blocking the nuclear factor kappa-bi and reducing the release of reactive oxygen species and pro-inflammatory cytokines.
 CLINICAL CASES DESCRIPTION: We used inhaled sevoflurane in three patients with acute pancreatitis. For one inhalation, 5 mL of sevoflurane was used and poured into a 200-mL container. The duration of one inhalation was approximately 40 min, during which time the anesthetic had completely evaporated. The maximum concentration of sevoflurane in exhaled air reached 0.40.5%, which did not cause the patient to fall asleep. Inhalations were performed three times a day for 2 days. In all patients, the pain syndrome decreased by three times according to the visual analog scale on day 1. The level of amylase on day 2 decreased by 2.5 times. The leukocyte count decreased by 20%. On day 2, all patients developed intestinal motility, and the patients were transferred from the anesthesiology-reanimation department to the surgical department. All the patients recovered.
 CONCLUSION: The inhalation of sevoflurane alleviated the pain syndrome, reduced amylase levels, and improved intestinal motility in acute pancreatitis.

Procalcitonin-guided reduction of antibiotic use in acute pancreatitis

Acute pancreatitis is a challenging disease to treat, representing a substantial clinical and economic burden. It is ranked among the top causes of acute emergency admission among gastrointestinal disorders and leads to substantial use of health-care resources and related costs.1 The recommended medical treatment of acute pancreatitis is conservative, but because evidence informing decision making is mostly of low quality and the outcomes are potentially severe, there is a tendency toward an excess in medical care.

Clinical Analysis of Emergency Medical Treatment of Acute Pancreatitis

Clinical Analysis of Emergency Medical Treatment of Acute Pancreatitis

English

BACKGROUND Acute pancreatitis is an emergency condition presenting with abdominal pain and is usually associated with increased pancreatic enzyme levels in blood or urine as an outcome of inflammatory disease of pancreas showing characteristic findings of pancreatic inflammation on contrast enhanced computerized tomography (CECT). The severity of the disease varies widely from mild disease needing conservative treatment to severe and complicated disease with high morbidity and mortality. We intend to determine the current trends in the diagnosis and management of acute pancreatitis in M.K.C.G Medical College and Hospital, Berhampur, Odisha. METHODS This was a prospective observational study. All the patients of acute pancreatitis of both the sexes and of different ages, who were admitted in the Department of General Surgery of M.K.C.G. Medical College and Hospital, Berhampur, Ganjam, Odisha from August 2018 to July 2020 (including 6 months of follow up period) were included in this study. RESULTS Out of 80 patients in our study group, 68 patients (85 %) were males with mean age of 39.06 years. Pain was the most common mode of presentation (100 %) followed by nausea and vomiting (92.5 %), abdominal distension (43.8 %), fever (18.8 %) and jaundice (5 %). Lipase supported the diagnosis in 78.8 % cases while amylase in 67.5 % cases. CECT had a sensitivity of 100 %, specificity of 80 % in diagnosing acute pancreatitis while ultrasonography (USG) had a sensitivity of 89.3 %. Majority of the patients were managed conservatively (86.25 %) whereas only 13.75 % patients required surgical management. CONCLUSIONS The most common aetiological factor in acute pancreatitis is alcohol consumption and the most accurate diagnostic investigation is serum lipase and CECT abdomen. Most of the cases were mild to moderate and were managed conservatively. Octreotide has a definite role in medical treatment of acute pancreatitis. KEYWORDS Pancreatitis, Alcohol, Cholecystitis

Differential roles of inflammatory cells in pancreatitis

The incidence of acute pancreatitis per 100,000 of population ranges from 5 to 80. Patients suffering from hemorrhagic-necrotizing pancreatitis die in 10-24% of cases. 80% of all cases of acute pancreatitis are etiologically linked to gallstone disease immoderate alcohol consumption. As of today no specific causal treatment for acute pancreatitis exists. Elevated C-reactive protein levels above 130,mg/L can also predict a severe course of acute pancreatitis. The essential medical treatment for acute pancreatitis is the correction of hypovolemia. Prophylactic antibiotics should be restricted to patients with necrotizing pancreatitis, infected necrosis or other infectious complications. However, as premature intracellular protease activation is known to be the primary event in acute pancreatitis. Severe acute pancreatitis is characterized by an early inflammatory immune response syndrome (SIRS) and a subsequent compensatory anti-inflammatory response syndrome (CARS) contributing to severity as much as protease activation does. CARS suppresses the immune system and facilitates nosocomial infections including infected pancreatic necrosis, one of the most feared complications of the disease. A number of attempts have been made to suppress the early systemic inflammatory response but even if these mechanisms have been found to be beneficial in animal models they failed in daily clinical practice.

急性膵炎診療ガイドライン2010の検証─初期診療と感染合併症─予防的抗菌薬投与は必要か？

急性膵炎診療ガイドライン2010の検証─初期診療と感染合併症─予防的抗菌薬投与は必要か？

A descriptive study evaluating the circumstances of medical treatment for acute pancreatitis before publication of the new JPN guidelines based on the Japanese administrative database associated with the Diagnosis Procedure Combination system

To examine the circumstances of medical treatment for acute pancreatitis before publication of the new Japanese (JPN) guidelines using the Japanese administrative database associated with the Diagnosis Procedure Combination system. We collected data from 7,193 patients with acute pancreatitis in 2008 and examined the recommended medical treatment in the new JPN guidelines [from recommendations B (considered to be recommended treatments) to D (considered to be unacceptable treatments)] according to severity of acute pancreatitis. Patients were divided into two groups: mild cases (n=6,520) and severe cases (n=673). Enteral nutrition for severe cases without ileus (recommendation B) was uncommon (13.5%). In contrast, prophylactic antibiotics were administered in a large number (80.4%) of mild cases without acute cholangitis (recommendation D). Furthermore, administration of H(2) receptor antagonists, except for cases of upper gastrointestinal bleeding (recommendation D), were performed in many patients with both mild and severe cases (66.8 vs. 78.6%). This study demonstrated a discrepancy between actual medical treatment performed and the new JPN guidelines with regard to some of the medical treatments. Future studies are required after publication of the new JPN guidelines to determine how they affect medical treatments.

Combined use of endoscopic retrograde cholangiopancreatography and computed tomography for identifying pancreatic abscesses

A 40-year-old male showed intermittent spike fever 2 1/2 months after receiving conservative medical treatment for acute pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) revealed leakage of the contrast media from the main pancreatic duct into the pancreatic parenchyma. Immediately following ERCP, computed tomography (CT) scans revealed separate poolings of this contrast media in the pancreatic head and tail. Surgical debridement of the pancreatic head and tail was therefore performed, after which drains were placed at both sites. The patient recovered successfully. To own knowledge, this is the first reported case in which pancreatic abscesses, a late complication of acute pancreatitis, were clearly identified by the use of ERCP followed by CT.

Medical treatment of acute pancreatitis: Regan PT, Mayo Clin Proc54:432–434, 1979

Medical treatment of acute pancreatitis: Regan PT, Mayo Clin Proc54:432–434, 1979