Cardiocirculatory pathophysiological mechanisms in severe acute pancreatitis

García, Miguel Angel Sendín; Calvo, José F.

doi:10.4292/wjgpt.v1.i1.9

Cited by 13 publications

(5 citation statements)

References 60 publications

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“…nitric oxide) and vasoconstrictor (endothelin and angiotensin) mediators have been proposed. 36 Respiratory failure was the most common systemic complication in our study and there was also no significant difference in the incidence of systemic complications in both biliary and non-biliary groups, but there was some variation in the incidence systemic complications as compared with other studies. 21 The need of intervention depends on the type of complications that develops after an episode of AP.…”

Section: Jssn 2017; 20 (1)contrasting

confidence: 40%

Comparison of clinical course of Acute Biliary and Non-Biliary Pancreatitis

Bhattarai

Devkota

Kandel

et al. 2017

J. Soc. Surg. Nepal

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Introduction: Incidence of acute pancreatitis (AP) varies in different parts of the world. The published data are mainly based on retrospective analysis of hospital admissions, which show that there are considerable geographical differences in the incidence rate. There are also regional divergences with regard to the etiology, and its impact on morbidity and mortality. Therefore, we compare the clinical course of acute biliary and non-biliary pancreatitis at the Tribhuvan University Teaching Hospital (TUTH) as well as we compare the morbidity and mortality and duration of hospital stay in these groups. Methods: This prospective study included the patients with a diagnosis of AP over a period of one year. Eighty-five patients with the diagnosis of AP were included in the study. Revised Atlanta classification system (2012) was used to diagnose and define the severity of disease. The occurrence of local and systemic complications, median duration of hospital stay and mortality in AP was studied. Results: Among 85 patients, 34 patients were females and 51 were males. Among them, 46 patients belonged to the biliary group and 39 belonged to the non-biliary group. Alcohol intake was the major etiology in the non-biliary group (n = 26) and all of them were male. The majority of the gallstone induced AP patients were female (n = 29). Twenty-nine patients developed severe acute pancreatitis (SAP: 16 in biliary and 13 patients in non-biliary group). Complications were mostly seen in SAP. The acute fluid collection was the most common local complication (15 patients in biliary and 15 patients in non-biliary group, p > 0.05) and respiratory failure was the most common systemic complication (18 patients in biliary and 16 patients in non-biliary group, p > 0.05) in both groups. Three patients in biliary group and four patients in non-biliary group died due to multi-organ failure (p > 0.05). There was no statistical significant difference in the median duration of hospital stay in these groups. Conclusion: Though pathogenesis vary for different etiologies, once the disease process has started, local complications, systemic complications, duration of hospital stay and mortality in AP depends on the severity of the disease irrespective of the etiology.

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Section: Jssn 2017; 20 (1)contrasting

confidence: 40%

Comparison of clinical course of Acute Biliary and Non-Biliary Pancreatitis

Bhattarai

Devkota

Kandel

et al. 2017

J. Soc. Surg. Nepal

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“…In summary, patients with SAP are frequently characterized by a severe hypovolemic and distributive shock, which ultimately leads to the development of MOF [ 23 – 25 ]. The extent of fluid depletion/shifts is, however, difficult to assess precisely.…”

Section: Hypovolemia and Organ Failurementioning

confidence: 99%

Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit: a narrative review

Crosignani

Spina

Marrazzo

et al. 2022

Ann. Intensive Care

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Patients with acute pancreatitis (AP) often require ICU admission, especially when signs of multiorgan failure are present, a condition that defines AP as severe. This disease is characterized by a massive pancreatic release of pro-inflammatory cytokines that causes a systemic inflammatory response syndrome and a profound intravascular fluid loss. This leads to a mixed hypovolemic and distributive shock and ultimately to multiorgan failure. Aggressive fluid resuscitation is traditionally considered the mainstay treatment of AP. In fact, all available guidelines underline the importance of fluid therapy, particularly in the first 24–48 h after disease onset. However, there is currently no consensus neither about the type, nor about the optimal fluid rate, total volume, or goal of fluid administration. In general, a starting fluid rate of 5–10 ml/kg/h of Ringer’s lactate solution for the first 24 h has been recommended. Fluid administration should be aggressive in the first hours, and continued only for the appropriate time frame, being usually discontinued, or significantly reduced after the first 24–48 h after admission. Close clinical and hemodynamic monitoring along with the definition of clear resuscitation goals are fundamental. Generally accepted targets are urinary output, reversal of tachycardia and hypotension, and improvement of laboratory markers. However, the usefulness of different endpoints to guide fluid therapy is highly debated. The importance of close monitoring of fluid infusion and balance is acknowledged by most available guidelines to avoid the deleterious effect of fluid overload. Fluid therapy should be carefully tailored in patients with severe AP, as for other conditions frequently managed in the ICU requiring large fluid amounts, such as septic shock and burn injury. A combination of both noninvasive clinical and invasive hemodynamic parameters, and laboratory markers should guide clinicians in the early phase of severe AP to meet organ perfusion requirements with the proper administration of fluids while avoiding fluid overload. In this narrative review the most recent evidence about fluid therapy in severe AP is discussed and an operative algorithm for fluid administration based on an individualized approach is proposed.

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“…The pathogenic mechanism, pathologic process and management of SAP have yet to be completely clarified. Thus, the incidence of serious complications of SAP and morbidity rates could not be substantially decreased (8,(10)(11)(12). Previous studies showed that NF-κB plays a critical role in the clinical course of pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

Healing Effects of Single-Dose Triptolide in Rats with Severe Acute Pancreatitis

Özden

Kilitçi

Şahin

et al. 2020

Düzce Tıp Fakültesi Dergisi

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Aim: Severe acute pancreatitis (SAP) carries high morbidity and mortality risk. If the proinflammatory response phase of SAP cannot be controlled, it may result in multiorgan failure (MOF). Nuclear factor-kappa B (NF-κB) activation plays an important role in the development of MOF. In this study, it was aimed to investigate the healing effects of triptolide, an anti-inflammatory and immunosuppressive agent in rats with SAP. Material and Methods: A total of 20 Wistar-Albino rats were divided into two groups as the SAP and triptolide treatment (TT) groups. SAP was induced by intraperitoneal injection of cerulean (50 mg/kg) in both groups. TT group was administered a single dose (0.2 mg/kg) triptolide 24 hour after the induction of SAP. Serum ALT, AST, GGT, Lipase, Glucose, ALP and amylase levels and pancreatic tissue samples were examined. Results: Serum glucose and amylase levels were found to be significantly lower in the TT group (p=0.011 and p=0.035, respectively). There was no significant difference between the groups in terms of other biochemical parameters. Pancreatic edema, acinar cell degeneration, fat necrosis, intrapancreatic&perivascular inflammation, inflammation in the peripancreatic fat tissue were common histopathological findings in both groups. There was no significant difference between the groups in terms of histopathologic changes. Conclusion:Cerulein-induced pancreatitis is a successful method for experimental SAP. The healing effects of single-dose triptolide treatment are not evident in the early phase of SAP. The therapeutic effects of triptolide on inflammatory and oxidative stress were not significantly approved by histopathological and biochemical parameters by the pancreatic tissue.

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Cardiocirculatory pathophysiological mechanisms in severe acute pancreatitis

Cited by 13 publications

References 60 publications

Comparison of clinical course of Acute Biliary and Non-Biliary Pancreatitis

Comparison of clinical course of Acute Biliary and Non-Biliary Pancreatitis

Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit: a narrative review

Healing Effects of Single-Dose Triptolide in Rats with Severe Acute Pancreatitis

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