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A great deal of progress has been made in the last 50 years in the diagnosis and treatment of acute pancreatitis. Many landmark studies have been published and have focused on the classification of acute pancreatitis, markers of s...
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A great deal of progress has been made in the last 50 years in the diagnosis and treatment of acute pancreatitis. Many landmark studies have been published and have focused on the classification of acute pancreatitis, markers of severity, important roles of imaging and endoscopy, and improvements in our treatment. This report will review several landmark studies, describe ongoing controversies in management decisions including standards of early fluid resuscitation and appropriate use of enteral feeding, and outline what will be required in the future to improve the care of patients with acute pancreatitis.
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Background The length of hospitalization is prolonged in patients with acute pancreatitis due to delay in feeding. The present study aimed at evaluating hunger-based early feeding for its efficacy in reducing length of hospitalisa...
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Background The length of hospitalization is prolonged in patients with acute pancreatitis due to delay in feeding. The present study aimed at evaluating hunger-based early feeding for its efficacy in reducing length of hospitalisation. Aims and Methods This was a parallel arm superiority randomized control trial. Patients with moderate and severe acute pancreatitis were randomised into hunger-based feeding and conventional feeding groups. Patients in hunger-based feeding group commenced feeding once they felt hungry and in conventional feeding group after normalization of biochemical parameters and resolution of symptoms. Patients were followed up till their discharge and were analyzed for length of hospitalisation, fasting duration, feed intolerance, incidence of infective morbidities and invasive procedures. Results Hunger-based feeding and conventional feeding group included 56 and 54 patients, respectively. Hunger-based feeding led to a decrease in length of hospitalization (6.3 days in hunger-based feeding vs 7.3 days in conventional feeding group, P = 0.041) and fasting duration (1.6 days in hunger-based feeding vs 2.7 days in conventional feeding group, P = 0.001).The incidence of feed intolerance (P = 0.098), infective morbidities and invasive non-surgical procedures were similar in both the groups. Conclusion Hunger-based feeding significantly reduces length of hospitalization and fasting duration in cases of moderate and severe acute pancreatitis without any significant rise in the incidence of complications. Registration number of Clinical Trails Registry India CTRI/2019/01/017,144.
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Background Acute pancreatitis (AP) is considered one of the most common gastrointestinal disorders; the annual worldwide incidence for AP is 4.9–73.4 cases / 100,000 people and the total mortality rate is 4–8%, increasing to 33%...
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Background Acute pancreatitis (AP) is considered one of the most common gastrointestinal disorders; the annual worldwide incidence for AP is 4.9–73.4 cases / 100,000 people and the total mortality rate is 4–8%, increasing to 33% in patients with infected necrosis. This study aims to assess the outcome of providing standardized evidence-based care to patients with acute biliary pancreatitis. Methods Thirty patients diagnosed with acute biliary pancreatitis, were enrolled in this study and managed according to the Japanese guidelines, 2015 with a complementary scope on other recent guidelines. Results Out of 30 patients in the study, 60% were females. Twenty-five cases were presented in the early phase of the disease while the rest presented in the late phase. Gallstones were the commonest cause (80%). The complications encountered were a systemic complication in one case, organ failure in three cases, and the local complications in the form of fluid collections in (43.3%) of cases.Out of 30 patients, 6 patients had an intervention. The main approach was minimally invasive techniques (4 cases), Open approach was performed in 2 cases. The total mortality rate was 10%. Most mild cases were discharged within one week from admission. Cases readmitted with recurrent attacks of acute pancreatitis were 3 cases, one male and 2 females. Conclusion By applying guidelines in the management of acute biliary pancreatitis, we can reduce disease-related morbidity and mortality. Besides, we can reduce the costs of medical services with the proper investment of healthcare resources.
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Background: In Italy, no long-term studies regarding the natural history of acute pancreatitis have been carried out. Aim: To report the results of a follow-up on a large series of patients hospitalised for pancreatitis. Methods: ...
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Background: In Italy, no long-term studies regarding the natural history of acute pancreatitis have been carried out. Aim: To report the results of a follow-up on a large series of patients hospitalised for pancreatitis. Methods: Data of 631 patients admitted to 35 Italian hospitals were retrospectively evaluated 51.7 ± 8.4 months after discharge. Results: The average recovery time after mild or severe pancreatitis was 28.2 and 53.4 days respectively. Fourteen sequelae were not resolved and 9 cases required late surgical intervention. Eighty patients (12.7%) had a second hospital admission. Of the patients with mild biliary pancreatitis, 67.9% underwent a cholecystectomy. The overall incidence of relapse was 12.7%. Mortality was 9.8% and no death was related to pancreatitis. Three patients died from carcinoma of the pancreas. Conclusion: Reported recovery time after an attack of pancreatitis was longer than expected in the mild forms. The treatment of sequelae was delayed beyond one year after discharge. The incidence of relapse of biliary pancreatitis in patients not undergoing a cholecystectomy was low, due to endoscopic treatment. Mortality from pancreatic-related causes is low, but there is an association with malignant pancreatic or ampullary tumours not diagnosed during the acute phase of the illness.
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Acute pancreatitis during pregnancy is a rare event, and can be associated with high maternal mortality and fetal loss. Gallstone disease is thought to be the most common causative factor of acute pancreatitis, but, in many cases,...
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Acute pancreatitis during pregnancy is a rare event, and can be associated with high maternal mortality and fetal loss. Gallstone disease is thought to be the most common causative factor of acute pancreatitis, but, in many cases, the cause remains unclear. We report a case of a 36-year-old woman at 35 wk of gestation, who presented with severe pain confined to the upper abdomen and radiating to the back. The patient was diagnosed with acute idiopathic pancreatitis, which was managed conservatively; she recovered within several days and then delivered a healthy baby. Therefore it is important to consider acute pancreatitis when a pregnant woman presents with upper abdominal pain, nausea and vomiting in order to improve fetal and maternal outcomes for patients with acute pancreatitis.
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This article reviews advances in the management of acute pancreatitis. Medical treatment has been primarily supportive for this diagnosis, and, despite extensive research efforts, there are no pharmacologic therapies that improve ...
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This article reviews advances in the management of acute pancreatitis. Medical treatment has been primarily supportive for this diagnosis, and, despite extensive research efforts, there are no pharmacologic therapies that improve prognosis. The current mainstay of management, notwithstanding the ongoing debate regarding the volume, fluid type, and rate of administration, is aggressive intravenous fluid resuscitation. Although antibiotics were used consistently for prophylaxis in severe acute pancreatitis to prevent infection, they are no longer used unless infection is documented. Enteral nutrition, especially in patients with severe acute pancreatitis, is considered a cornerstone in management of this disease.
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OBJECTIVES: The aim of this study was to evaluate the usefulness of the Bedside Index for Severity in Acute Pancreatitis (BISAP) in the early prediction of severity and mortality in AP. METHODS: The medical records of all patients...
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OBJECTIVES: The aim of this study was to evaluate the usefulness of the Bedside Index for Severity in Acute Pancreatitis (BISAP) in the early prediction of severity and mortality in AP. METHODS: The medical records of all patients with acute pancreatitis (AP) admitted to our institution between January 2008 and July 2010 were reviewed retrospectively. Severe AP was defined as the persistence of organ failure for more than 48 hours. The capacity of the BISAP score to predict severity and death was evaluated using linear-by-linear association. The predictive accuracy of the BISAP and Ranson score was measured as the area under the receiver operating characteristic curve (AUC). RESULTS: Of 299 consecutive patients, 22 (7.4%) were classified as having severe AP, and 8 (2.7%) died. There were statistically significant trends for increasing severity (P < 0.001) and mortality (P < 0.001) with increasing BISAP. The AUC for severity predicted by BISAP was 0.762 (95% confidence interval, 0.631-0.893) and by Ranson score was 0.804 (0.717-0.892). The AUC for mortality predicted by BISAP was 0.940 (0.863-1.018) and by Ranson score was 0.861 (0.734-0.988). CONCLUSIONS: We confirmed that BISAP is an accurate means of risk stratification in AP within 24 hours of presentation.
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Acute pancreatitis is one of the most common causes of hospitalisation from gastrointestinal diseases. The causes of pancreatitis vary between countries. Acute pancreatitis is classified based on Revised Atlanta classification 201...
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Acute pancreatitis is one of the most common causes of hospitalisation from gastrointestinal diseases. The causes of pancreatitis vary between countries. Acute pancreatitis is classified based on Revised Atlanta classification 2013 as mild, moderately severe and severe acute pancreatitis. Acute pancreatic severity can be stratified by scoring systems such as Ranson’s score, BISAP score, APACHE-II score, SOFA score. In severe acute pancreatitis, to diagnose, abdominal pain raised amylase or lipase, supported imaging finding and organ failure. Organ failure can be diagnosed by using Modified Marshall Scoring System. Management is started conservatively, which are fluid resuscitation, enteral nutrition, analgesics, and antibiotics. Surgical management is indicated when infected pancreas necrosis is detected. In this review, we will discuss the current management based on recent research.
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Background: Pediatric pancreatitis is an underdiagnosed disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has increased, it is now 3.6-13.3 cases per 100,000 children. Up-to-date evide...
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Background: Pediatric pancreatitis is an underdiagnosed disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has increased, it is now 3.6-13.3 cases per 100,000 children. Up-to-date evidence based management guidelines are lacking for the pediatric pancreatitis. The European Pancreatic Club, in collaboration with the Hungarian Pancreatic Study Group organized a consensus guideline meeting on the diagnosis and management of pancreatitis in the pediatric population.
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Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of the pancreas, regional tissues around the pancreas, or remote organ systems. Acute pancreatitis is one of the most common causes of e...
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Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of the pancreas, regional tissues around the pancreas, or remote organ systems. Acute pancreatitis is one of the most common causes of epigastric pain and numbers of studies have suggested that the disease may be increasing in incidence. The last two decades have seen the emergence of significant evidence that has altered certain aspects of the management of acute pancreatitis. While most cases of acute pancreatitis are mild, the challenge remains in managing the severe cases and the complications associated with acute pancreatitis. Gallstones are still the most common cause with epidemiological trends indicating a rising incidence. The surgical management of acute gallstone pancreatitis has evolved. The present study includes 60 cases of acute pancreatitis admitted in a tertiary care centre. The reason for this conduct was for the evaluation of the etiology, presenting symptoms, investigations, management and complications of acute pancreatitis in a rural set up. Once the diagnosis is made, clinical efforts should simultaneously concentrate on investigating for the underlying etiology and managing the condition by anticipating its complications. Management of acute pancreatitis is largely supportive.
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