Pancreatitis: Difference between revisions
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imported>Robert Badgett (Started prognosis section) |
imported>David E. Volk m (wikilinks - ps: what is steatorrhia?) |
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'''Pancreatitis''' is | '''Pancreatitis''' is sinflammation of the [[pancreas]]. Pancreatitis is classified as acute unless there are computed [[tomographic]] or [[endoscopic]] retrograde cholangiopancreatographic findings of chronic pancreatitis (International Symposium on Acute Pancreatitis, Atlanta, 1992). The two most common forms of acute pancreatitis are alcoholic pancreatitis and [[gallstone]] pancreatitis."<ref>{{MeSH}}</ref> | ||
==Classification== | ==Classification== | ||
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===Chronic pancreatitis=== | ===Chronic pancreatitis=== | ||
Chronic pancreatitis is "inflammation of the pancreas that is characterized by recurring or persistent abdominal pain with or without steatorrhea or [[diabetes mellitus]]. It is characterized by the irregular destruction of the pancreatic parenchyma which may be focal, segmental, or diffuse.<ref>{{MeSH|Chronic pancreatitis}}</ref> | Chronic pancreatitis is "inflammation of the pancreas that is characterized by recurring or persistent abdominal pain with or without [[steatorrhea]] or [[diabetes mellitus]]. It is characterized by the irregular destruction of the pancreatic [[parenchyma]] which may be focal, segmental, or diffuse.<ref>{{MeSH|Chronic pancreatitis}}</ref> | ||
==Etiology/cause== | ==Etiology/cause== | ||
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==Diagnosis== | ==Diagnosis== | ||
===Acute pancreatitis=== | ===Acute pancreatitis=== | ||
The diagnostic criteria for pancreatitis are "two of the following three features: 1) abdominal pain characteristic of acute pancreatitis, 2) serum [[amylase]] and/or [[lipase]] ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on [[X-ray computed tomography|CT scan]]."<ref name="pmid17032204">{{cite journal |author=Banks P, Freeman M |title=Practice guidelines in acute pancreatitis |journal=Am J Gastroenterol |volume=101 |issue=10 |pages=2379-400 |year=2006 |id=PMID 17032204 | doi=10.1111/j.1572-0241.2006.00856.x}}</ref> | The diagnostic criteria for pancreatitis are "two of the following three features: 1) abdominal pain characteristic of acute pancreatitis, 2) serum [[amylase]] and/or [[lipase]] ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on a [[X-ray computed tomography|CT scan]]."<ref name="pmid17032204">{{cite journal |author=Banks P, Freeman M |title=Practice guidelines in acute pancreatitis |journal=Am J Gastroenterol |volume=101 |issue=10 |pages=2379-400 |year=2006 |id=PMID 17032204 | doi=10.1111/j.1572-0241.2006.00856.x}}</ref> | ||
Two [[clinical practice guideline]]s state: | Two [[clinical practice guideline]]s state: | ||
: "It is usually not necessary to measure both serum amylase and lipase. Serum lipase may be preferable because it remains normal in some nonpancreatic conditions that increase serum amylase including macroamylasemia, parotitis, and some | : "It is usually not necessary to measure both serum amylase and lipase. Serum lipase may be preferable because it remains normal in some nonpancreatic conditions that increase serum amylase including[[ macroamylasemia]], [[parotitis]], and some [[carcinoma]]s. In general, serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis"<ref name="pmid17032204">.</ref> | ||
: "Although amylase is widely available and provides acceptable accuracy of diagnosis, where lipase is available it is preferred for the diagnosis of acute pancreatitis (recommendation grade A)"<ref name="pmid15831893">{{cite journal |author=UK Working Party on Acute Pancreatitis |title=UK guidelines for the management of acute pancreatitis |journal=Gut |volume=54 Suppl 3 |issue= |pages=iii1-9 |year=2005 |id=PMID 15831893 | doi=10.1136/gut.2004.057026 | url=http://gut.bmj.com/cgi/content/full/54/suppl_3/iii1}}</ref> | : "Although amylase is widely available and provides acceptable accuracy of diagnosis, where lipase is available it is preferred for the diagnosis of acute pancreatitis (recommendation grade A)"<ref name="pmid15831893">{{cite journal |author=UK Working Party on Acute Pancreatitis |title=UK guidelines for the management of acute pancreatitis |journal=Gut |volume=54 Suppl 3 |issue= |pages=iii1-9 |year=2005 |id=PMID 15831893 | doi=10.1136/gut.2004.057026 | url=http://gut.bmj.com/cgi/content/full/54/suppl_3/iii1}}</ref> | ||
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Approximately 20% of patients have a relapse of pain during acute pancreatitis.<ref name="pmid17573797">{{cite journal |author=Petrov MS, van Santvoort HC, Besselink MG, Cirkel GA, Brink MA, Gooszen HG |title=Oral Refeeding After Onset of Acute Pancreatitis: A Review of Literature |journal= |volume= |issue= |pages= |year=2007 |pmid=17573797 |doi=10.1111/j.1572-0241.2007.01357.x}}</ref> Approximately 75% of relapses occur within 48 hours of oral refeeding. | Approximately 20% of patients have a relapse of pain during acute pancreatitis.<ref name="pmid17573797">{{cite journal |author=Petrov MS, van Santvoort HC, Besselink MG, Cirkel GA, Brink MA, Gooszen HG |title=Oral Refeeding After Onset of Acute Pancreatitis: A Review of Literature |journal= |volume= |issue= |pages= |year=2007 |pmid=17573797 |doi=10.1111/j.1572-0241.2007.01357.x}}</ref> Approximately 75% of relapses occur within 48 hours of oral refeeding. | ||
The incidence of relapse after oral refeeding may be reduced by post-pyloric enteral rather than parenteral feeding prior to oral refeeding.<ref name="pmid17573797"/> | The incidence of relapse after oral refeeding may be reduced by post-pyloric enteral, rather than parenteral, feeding prior to oral refeeding.<ref name="pmid17573797"/> | ||
===Chronic pancreatitis=== | ===Chronic pancreatitis=== | ||
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===Acute pancreatitis=== | ===Acute pancreatitis=== | ||
[[Clinical practice guideline]]s state: | [[Clinical practice guideline]]s state: | ||
:2006: "The two tests that are most helpful at admission in distinguishing mild from severe acute pancreatitis are APACHE-II score and serum hematocrit. It is recommended that APACHE-II scores be generated during the first | :2006: "The two tests that are most helpful at admission in distinguishing mild from severe acute pancreatitis are [[APACHE-II score]] and serum [[hematocrit]]. It is recommended that APACHE-II scores be generated during the first three days of hospitalization and thereafter as needed to help in this distinction. It is also recommended that serum hematocrit be obtained at admission, 12 h after admission, and 24 h after admission to help gauge adequacy of fluid resuscitation."<ref name="pmid17032204">{{cite journal |author=Banks P, Freeman M |title=Practice guidelines in acute pancreatitis |journal=Am J Gastroenterol |volume=101 |issue=10 |pages=2379-400 |year=2006 |id=PMID 17032204 | doi=10.1111/j.1572-0241.2006.00856.x}}</ref> | ||
:2005: "Immediate assessment should include clinical evaluation, particularly of any cardiovascular, respiratory, and renal compromise, body mass index, chest x ray, and APACHE II score" <ref name="pmid15831893">{{cite journal |author= Anonymous |title=UK Working Party on Acute Pancreatitis: UK guidelines for the management of acute pancreatitis |journal=Gut |volume=54 Suppl 3 |issue= |pages=iii1-9 |year=2005 |id=PMID 15831893 | doi=10.1136/gut.2004.057026 url=http://gut.bmj.com/cgi/content/full/54/suppl_3/iii1}}</ref> | :2005: "Immediate assessment should include clinical evaluation, particularly of any cardiovascular, respiratory, and renal compromise, body mass index, chest x ray, and APACHE II score" <ref name="pmid15831893">{{cite journal |author= Anonymous |title=UK Working Party on Acute Pancreatitis: UK guidelines for the management of acute pancreatitis |journal=Gut |volume=54 Suppl 3 |issue= |pages=iii1-9 |year=2005 |id=PMID 15831893 | doi=10.1136/gut.2004.057026 url=http://gut.bmj.com/cgi/content/full/54/suppl_3/iii1}}</ref> | ||
Revision as of 14:01, 19 February 2008
Pancreatitis is sinflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis (International Symposium on Acute Pancreatitis, Atlanta, 1992). The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis."[1]
Classification
Acute pancreatitis
Acute necrotizing pancreatitis
Acute necrotizing pancreatitis is a "severe form of acute inflammation of the pancreas characterized by one or more areas of necrosis in the pancreas with varying degree of involvement of the surrounding tissues or organ systems. Massive pancreatic necrosis may lead to diabetes mellitus, and malabsorption.[2]
Chronic pancreatitis
Chronic pancreatitis is "inflammation of the pancreas that is characterized by recurring or persistent abdominal pain with or without steatorrhea or diabetes mellitus. It is characterized by the irregular destruction of the pancreatic parenchyma which may be focal, segmental, or diffuse.[3]
Etiology/cause
The most common causes are gallstones and alcohol.[4]
Diagnosis
Acute pancreatitis
The diagnostic criteria for pancreatitis are "two of the following three features: 1) abdominal pain characteristic of acute pancreatitis, 2) serum amylase and/or lipase ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on a CT scan."[5]
Two clinical practice guidelines state:
- "It is usually not necessary to measure both serum amylase and lipase. Serum lipase may be preferable because it remains normal in some nonpancreatic conditions that increase serum amylase includingmacroamylasemia, parotitis, and some carcinomas. In general, serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis"[5]
- "Although amylase is widely available and provides acceptable accuracy of diagnosis, where lipase is available it is preferred for the diagnosis of acute pancreatitis (recommendation grade A)"[6]
Chronic pancreatitis
Treatment
Acute pancreatitis
Bowel rest
Approximately 20% of patients have a relapse of pain during acute pancreatitis.[7] Approximately 75% of relapses occur within 48 hours of oral refeeding.
The incidence of relapse after oral refeeding may be reduced by post-pyloric enteral, rather than parenteral, feeding prior to oral refeeding.[7]
Chronic pancreatitis
Prognosis
Acute pancreatitis
Clinical practice guidelines state:
- 2006: "The two tests that are most helpful at admission in distinguishing mild from severe acute pancreatitis are APACHE-II score and serum hematocrit. It is recommended that APACHE-II scores be generated during the first three days of hospitalization and thereafter as needed to help in this distinction. It is also recommended that serum hematocrit be obtained at admission, 12 h after admission, and 24 h after admission to help gauge adequacy of fluid resuscitation."[5]
- 2005: "Immediate assessment should include clinical evaluation, particularly of any cardiovascular, respiratory, and renal compromise, body mass index, chest x ray, and APACHE II score" [6]
APACHE II score
"Acute Physiology And Chronic Health Evaluation" (APACHE II) score > 8 points predicts 11% to 18% mortality [5] Online calculator
References
- ↑ Anonymous (2024), Pancreatitis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Anonymous (2024), Acute necrotizing pancreatitis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Anonymous (2024), Chronic pancreatitis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Anonymous (2024), Pancreatitis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 5.0 5.1 5.2 5.3 Banks P, Freeman M (2006). "Practice guidelines in acute pancreatitis". Am J Gastroenterol 101 (10): 2379-400. DOI:10.1111/j.1572-0241.2006.00856.x. PMID 17032204. Research Blogging.
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<ref>tag; name "pmid17032204" defined multiple times with different content Cite error: Invalid<ref>tag; name "pmid17032204" defined multiple times with different content Cite error: Invalid<ref>tag; name "pmid17032204" defined multiple times with different content - ↑ 6.0 6.1 UK Working Party on Acute Pancreatitis (2005). "UK guidelines for the management of acute pancreatitis". Gut 54 Suppl 3: iii1-9. DOI:10.1136/gut.2004.057026. PMID 15831893. Research Blogging.
Cite error: Invalid
<ref>tag; name "pmid15831893" defined multiple times with different content - ↑ 7.0 7.1 Petrov MS, van Santvoort HC, Besselink MG, Cirkel GA, Brink MA, Gooszen HG (2007). "Oral Refeeding After Onset of Acute Pancreatitis: A Review of Literature". DOI:10.1111/j.1572-0241.2007.01357.x. PMID 17573797. Research Blogging.