Acute pancreatitis in pregnancy: An unresolved issue

Jain, Pankaj

doi:10.3748/wjg.v16.i16.2065

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…An observational study of 54 pregnant patients with AP showed that HL is associated with more intrauterine fetal distress and worse fetal outcomes compared with AP from other etiologies (13). Severe pancreatitis is often complicated by varying degrees of multi-organ failure such as acute respiratory failure, acute renal failure, heart failure and arrhythmias, gastrointestinal bleeding, and pancreatic encephalopathy (3). SAP is a serious complication during pregnancy and the main cause of maternal and fetal death, with its fetal mortality rate at 10-30% (14).…”

Section: Treatment and Diagnosis Of Hyperlipidemia Acute Pancreatitis...mentioning

confidence: 99%

“…Acute pancreatitis (AP) is an inflammatory process affecting the pancreas and is characterized by severe abdominal pain and increased levels of amylase and lipase (1). AP in pregnancy (APIP) is a rare complication (incidence between 1 in 12,000 and 1 in 1,000) that threatens the health of the patient and their offspring (2,3). APIP is associated with increased risk of prematurity, preeclampsia, post-partum hemorrhage, maternal death and fetal demise.…”

Section: Introductionmentioning

confidence: 99%

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Treatment and diagnosis of hyperlipidemia acute pancreatitis in pregnancy associated with pre‑pregnancy obesity and diabetes: A case report

Cao,

Ni,

Gan

et al. 2023

Exp Ther Med

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Hyperlipidemia acute pancreatitis (HLAP) is a specific type of pancreatitis mainly caused by elevated serum triglyceride (TG) levels. Therefore, knowledge of patients' medical history is crucial to the identification of those at high risk of HLAP. Diabetes and obesity are associated with high levels of triglycerides, a risk factor for the development of HLAP, which should be controlled before pregnancy. Moreover, HLAP is associated with additional diagnostic and management challenges related to hyperlipidemia (HL) and pregnancy. HLAP during pregnancy has a rapid onset and rapid progression, and complications are more likely to damage the function of multiple organs. HLAP is more common after 28 weeks of pregnancy, the cause is mostly high TG and the serum TG of the patient is often >1,000 mg/d1. Clinicians should be alert to the occurrence of server acute pancreatitis (AP). Therefore, clinicians need to identify and implement effective treatment in a timely manner to control the progression of HLAP during pregnancy and improve pregnancy outcomes. The present study reported the case of a 26-year-old pregnant patient who was hospitalized for epigastric pain at 35 weeks and 2 days of gestation. Medical and family history reported previous diagnoses of diabetes and obesity (weight before pregnancy, 103 kg; BMI, 36.40 kg/m 2 ). Laboratory tests demonstrated high levels of lipase and amylase, a notable systemic inflammatory response, HL, coagulopathy, hypoproteinemia and hyperglycemia. Abdominal ultrasonography demonstrated a hypoechoic pancreatic head. A clinical diagnosis of AP was confirmed using CT scanning. Initial interventions for HLAP included aggressive intravenous hydration, bowel rest, pain control and a combination of heparin and insulin. Lipid-lowering agents were administered to reduce serum lipid levels. Hemoperfusion and continuous renal replacement therapy were also used to rapidly counteract the elevated lipid levels. Antibiotics were administered in the present case because inflammatory markers such as leukocytes, neutrophils and C-reactive protein were elevated. The patient and newborn were discharged 11 days after hospitalization, with an improvement in maternal clinical health and the infant was healthy. When evaluating pregnant patients with pre-obesity and diabetes presenting with abdominal pain, obstetricians should consider HLAP. Timely diagnosis and multi-team precision treatment are effective for good outcomes for mother and baby.

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Section: Treatment and Diagnosis Of Hyperlipidemia Acute Pancreatitis...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment and diagnosis of hyperlipidemia acute pancreatitis in pregnancy associated with pre‑pregnancy obesity and diabetes: A case report

Cao,

Ni,

Gan

et al. 2023

Exp Ther Med

View full text Add to dashboard Cite

show abstract

“…In patients with alcoholic pancreatitis, the activity of gamma glutamyl transpeptidase may be increased. Increase in ALT levels by three times the normal, strongly suggests the diagnosis of biliary pancreatitis [28,29]. The triglyceride levels >1000 mg/dl (11.3 mmol) are associated with pancreatitis.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Antibiotics are not used prophylactically in every patient [36,37]. However, when indicated as in documented necrotizing pancreatitis, meta-analysis has indicated that imipenum/ cilastin are the most appropriate antibiotics [37,39]. Even though there are no studies indicating the proposed dose, a dose adjustment for pregnancy is advised [39].…”

Section: Managementmentioning

confidence: 99%

“…However, when indicated as in documented necrotizing pancreatitis, meta-analysis has indicated that imipenum/ cilastin are the most appropriate antibiotics [37,39]. Even though there are no studies indicating the proposed dose, a dose adjustment for pregnancy is advised [39]. The patient can be given oral diet in mild and moderately severe pancreatitis once he recovers from acute phase in few days and by when the patient's nausea, abdominal pain and distension would have settled.…”

Section: Managementmentioning

confidence: 99%

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