Early detection of biliary pancreatitis

Gossum, A. Van; Seferian, V; Rodzynek, J J; Wettendorff, P; Cremer, Michel; Delcourt, A

doi:10.1007/bf01317048

Cited by 55 publications

(7 citation statements)

References 14 publications

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“…The diagnosis of acute pancreatitis was based on characteristic abdominal pain associated with at least a threefold increase in serum lipase levels and further confirmed by imaging techniques performed within 24 h of hospital admission. The biliary cause was suggested by clinical and laboratory data such as increased serum levels of conjugated bilirubin, AST, ALT, GGT, and AP 11,12 or by a history of gallstones and was confirmed by imaging techniques in all patients. Forty patients were enrolled within the first 24 h of onset of pain, two on the second day of illness and one on the third day after onset.…”

Section: Methodsmentioning

confidence: 93%

Ultrasonographic evaluation of the common bile duct in biliary acute pancreatitis patients: comparison with endoscopic retrograde cholangiopancreatography.

Pezzilli¹,

Billi²,

Barakat³

et al. 1999

Journal of Ultrasound in Medicine

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We compared the morphologic findings of the common bile duct by ultrasonography and endoscopic retrograde cholangiopancreatography in patients with biliary acute pancreatitis. Forty‐five patients were studied. The diagnosis of acute pancreatitis was based on the presence of characteristic abdominal pain associated with an elevation of serum amylase and lipase concentrations. All patients underwent ultrasonography and subsequently urgent endoscopic retrograde cholangiopancreatography and eventually endoscopic sphincterotomy. Ultrasonography showed gallstones in 33 patients and sludge of the gallbladder in seven patients. In the common bile duct, lithiasis was found in two patients and sludge in 25. Endoscopic retrograde cholangiopancreatography showed choledocolithiasis in eight patients and sludge of the common bile duct in 32. In 27 cases (60%) concordance occurred between ultrasonographic and endoscopic retrograde cholangiopancreatographic detection of lithiasis or sludge of the common bile duct. The average diameter of the common bile duct determined by sonography was significantly smaller (P < 0.001) than that obtained by endoscopic retrograde cholangiopancreatography. The evaluation of this parameter indicated that a good correlation existed between the values obtained with the two techniques (r(s) = 0.765, P < 0.001). Both ultrasonography and endoscopic retrograde cholangiopancreatography can provide reliable measurements of the common bile duct diameter. Ultrasonography is the technique of choice in the initial investigation of patients with biliary acute pancreatitis.

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Section: Methodsmentioning

confidence: 93%

Ultrasonographic evaluation of the common bile duct in biliary acute pancreatitis patients: comparison with endoscopic retrograde cholangiopancreatography.

Pezzilli¹,

Billi²,

Barakat³

et al. 1999

Journal of Ultrasound in Medicine

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“…Le dosage des transaminases a aussi modifié la prescription des examens échographiques. Cette modification dans la prise en charge du patient avait déjà été notée dans le cadre du dosage des transaminases pour évaluer le caractère lithiasique ou non des pancréatites aiguës [5,6,16].…”

Section: Discussionunclassified

“…La prescription des examens biologiques relève plus souvent des habitudes que d'une analyse médicale basée sur les preuves. Les transaminases, alanine-aminotransférases (ALAT) ou aspartate-aminotransférase (ASAT), ont une bonne sensibilité pour détecter les pathologies biliohépati-ques sans toutefois orienter vers un diagnostic précis [5]. Dans le contexte des douleurs abdominales, les transaminases sont fréquemment prescrites en cas de douleur de l'hypochondre droit dans l'hypothèse d'une pathologie biliaire.…”

Section: Introductionunclassified

Douleurs épigastriques aiguës non traumatiques: prévalence des transaminases élevées

Debuc

Lejeune

Gourrierec

et al. 2011

Ann. Fr. Med. Urgence

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Les douleurs épigastriques sont le plus souvent liées à une pathologie digestive oesogastroduodénale. Cependant, les douleurs d'origine biliaire sont localisées dans l'épigastre dans la moitié des cas. Notre travail a pour but principal de déterminer la prévalence de l'augmentation des transaminases chez les patients consultant pour une douleur épigastrique aiguë et comme but secondaire de savoir si la connaissance du résultat des transaminases modifie les hypothèses diagnostiques de l'urgentiste. Méthodes : Les malades âgés de plus de 18 ans, consultant aux urgences pour douleurs épigastriques, ont été inclus. Au terme de l'évaluation initiale, une à trois hypothèses diagnostiques ont été émises par le médecin des urgences. Une seconde évaluation diagnostique a été effectuée après connaissance du résultat des transaminases et comparée à la première. Résultats : Parmi les 100 malades inclus d'âge moyen de 39 ± 16 ans, 26 (26 %) avaient des transaminases élevées. Lorsque les transaminases étaient augmentées, les nausées ou des vomissements accompagnaient plus fréquemment la douleur (p < 0,03). La connaissance du résultat des transaminases par le praticien a modifié les hypothèses diagnostiques de l'urgentiste dans 42 % des cas. Conclusion : Les transaminases sont élevées chez un quart des malades et la connaissance du résultat modifie l'analyse diagnostique de l'urgentiste. Ces résultats suggèrent une sous-estimation de l'origine biliaire des douleurs épigastri-ques. Pour citer cette revue : Ann. Fr. Med. Urgence 1 (2011). Mots clés Douleurs abdominales · Transaminase · Colique hépatique · Voies biliaires · CholécystiteAbstract Epigastric pain is often due to oeso-gastro-duodenal tract lesions. However, pain due to biliary tract lesions is also located in epigastric area in half of the cases. The main outcome measure of this study was to determine the increase in transaminases in patients with epigastric pain, and the second outcome was to determine if the results of transaminases could modify the diagnostic hypothesis of the emergency physician. Methods: Patients aged more than 18 years consulting for epigastric pain in the emergency department were included. At the end of the initial evaluation, one to three diagnostic hypotheses were made by the emergency physician. A new diagnostic evaluation was made after the knowledge of transaminases result. Results: Hundred patients aged 39 ± 16 years were included. Among them, 26 (26%) had increased transaminases. Transaminases were more frequently increased when nausea and vomiting were associated with pain (P < 0.03). The knowledge of the result of transaminases modified the diagnostic hypothesis in 42% of patients. Conclusion: Transaminases are increased in a quarter of the patients with epigastric pain, and the result of transaminases modifies the diagnostic hypothesis of the emergency physician. This suggests an under-estimation of biliary tract lesions in patients with epigastric pain. To cite this journal: Ann. Fr. Med. Urgence 1 (2011).

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“…Elevated plasma concentrations on the day of admission of glutamic oxaloacetic transaminase (GOT) were found in 88%, of alkaline phosphatase (AP) in 66% and of bili rubin in 62 % of the patients with proven gallstone pan creatitis. Van Gossum et al [41] demonstrated the posi tive predictive value to detect early biliary pancreatitis to be 84% for GOT, 92% for glutamic pyruvic transam inase (GPT), 87% for AP, provided the cutoff point was chosen at twice the upper limit of normal. Bilirubin con centrations of > 1 mg/dl showed a positive predictive value of 65% only [39].…”

Section: Biochemical Prediction Of Gallstones In Agpmentioning

confidence: 99%

Acute Gallstone Pancreatitis

et al. 1990

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The problem of acute gallstone pancreatitis is reviewed with respect to pathophysiology, diagnostic approach, and therapeutic strategy. The role of gallstones and anatomic variations of the common bile duct and pancreatic duct are analyzed. The paramount importance of urgent endoscopic retrograde cholangiopancreatography in all cases of suspected acute gallstone pancreatitis is emphasized. Early biliary surgery after recovery from pancreatitis is demonstrated to be the safest strategy to avoid a relapse of the disease and perioperative complications. In patients with common bile duct stones and severe pancreatitis the outcome seems to be improved by immediate endoscopic sphincterotomy and removal of the stones.

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Early detection of biliary pancreatitis

Cited by 55 publications

References 14 publications

Ultrasonographic evaluation of the common bile duct in biliary acute pancreatitis patients: comparison with endoscopic retrograde cholangiopancreatography.

Ultrasonographic evaluation of the common bile duct in biliary acute pancreatitis patients: comparison with endoscopic retrograde cholangiopancreatography.

Douleurs épigastriques aiguës non traumatiques: prévalence des transaminases élevées

Acute Gallstone Pancreatitis

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