Clinical Symptoms and Signs and Diagnostic Requirements in Acute Pancreatitis

Malfertheiner, Peter; Büchler, Markus W.

doi:10.1007/978-3-642-83027-3_15

Cited by 12 publications

(8 citation statements)

References 25 publications

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“…Nevertheless, in a carefully performed prospective study by McMahon and Mayer in 1984, as many as 20% of apparently alcohol-related attacks of pancreatitis could also have been attributed to gallstones [19]. This indicates the necessity for routine investigation of the biliary tract in all patients with acute pancreatitis, irrespective of the suspected etiology, except those with recurrent attacks due to established chronic pancreatitis [18][19][20].…”

Section: Diagnosis and Prognosis Of Gallstone Pancreatitismentioning

confidence: 99%

“…Another pitfall of ultrasonography to be borne in mind is that a dilated common bile duct may also be observed in cases where the etiology is other than biliary and is than simply due to swelling of the inflamed pancreas [18].…”

Section: Diagnosis and Prognosis Of Gallstone Pancreatitismentioning

confidence: 99%

“…There are clinical tools specific enough to help in identifying the etiology as biliary rather than any of the other various possible causes [18].…”

Section: Diagnosis and Prognosis Of Gallstone Pancreatitismentioning

confidence: 99%

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Acute Biliary Pancreatitis

Malfertheiner

1990

Gallstone Disease

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Section: Diagnosis and Prognosis Of Gallstone Pancreatitismentioning

confidence: 99%

Section: Diagnosis and Prognosis Of Gallstone Pancreatitismentioning

confidence: 99%

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Acute Biliary Pancreatitis

Malfertheiner

1990

Gallstone Disease

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“…Abdominal pain is the major, but not the only symp tom of AP (table 1) [4,5]. Nausea and vomiting are very frequently observed.…”

Section: Clinical Diagnosis Of Acute Pancreatitismentioning

confidence: 99%

Diagnosis and Staging of Acute Pancreatitis

Malfertheiner¹,

Domínguez‐Muñoz²

1994

Dig Surg

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Determination of serum pancreatic enzymes remains the gold standard for the diagnosis of acute pancreatitis. Clinical symptoms and signs are of major importance in suspecting the disease, but they are not accurate enough to confirm the diagnosis. The different serum pancreatic enzymes have a similar accuracy in the diagnosis of acute pancreatitis. Total amylase, pancreatic isoamylase and lipase are preferred, since simple, rapid and inexpensive enzymatic methods are commercially available. More expensive and cumbersome methods (e.g. RIA or ELISA for pancreatic elastase) are useful only in special clinical circumstances. For early etiological classification of acute pancreatitis serum pancreatic enzymes and even different enzyme ratios are not reliable. For this purpose, determination of AST, bilirubin and alkaline phosphatase may make it possible to distinguish between biliary and nonbiliary origin of the disease. Ultrasonography and computed tomography provide very valuable information regarding not only etiology but also local complications of acute pancreatitis. Once the diagnosis of acute pancreatitis has been established, prognostic classification of the disease is required for adequate monitoring and treatment. Clinical symptoms and signs do not allow early assessment of the prognosis of acute pancreatitis. Multivariate scoring systems are sensitive but not sufficiently specific for the identification of severe pancreatitis. Among several biochemical markers commercially available for the assessment of severity, C-reactive protein and PMN-elastase appear to be the most valuable. These markers allow a proper selection of patients who need further investigation by contrast-enhanced CT (the gold standard for detection of pancreatic necrosis).

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“…The presence of early extra abdominal manifestations as respiratory, circulatory and/or renal failure cannot dif ferentiate between the mild and severe forms of the disease. In a prospective study of 84 patients, Malfertheiner and Btichler [10] have shown that extrapancreatic complica tions, although more frequent in necrotizing pancreatitis (60-80%), are present in 5-10% of mild cases [10]. Because early clinical pre sentation cannot predict the outcome, sev eral staging systems have been proposed to assess the severity of the disease.…”

mentioning

confidence: 99%