Severe acute pancreatitis: pathogenesis, diagnosis and surgical management

Portelli, Mark; Jones, Christopher D.

doi:10.1016/s1499-3872(16)60163-7

Cited by 134 publications

(106 citation statements)

References 32 publications

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“…When migrating in nature, gallstones may obstruct the pancreatic duct, a mechanism shared with endoscopic retrograde cholangiopancreatography (ERCP) (5%-10%), pancreas divisum, and dysfunction of the sphincter of Oddi [9]. Prolonged consumption of alcohol (4-6 drinks/day for >5 years) is the second important cause of AP (30%), and causes the disease by lowering the activation threshold of trypsin enzyme, resulting in cell necrosis [2]. This mechanism is observed more frequently in men, probably due to the differences in the intake or in genetics.…”

Section: Etiologymentioning

confidence: 99%

“…Mutations and polymorphisms in certain genes, including those encoding cationic trypsinogen, serine protease inhibitor of Kazal type 1, a regulator of transmembrane conductance in cystic fibrosis, chymotrypsin C, calcium-sensitive receptor, and claudin-2, have been reported to be associated with AP and CP. These serve as cofactors interacting with other causes, for example, the mutation of claudin-2 in synergism with alcohol consumption [2,10,20].…”

Section: Etiologymentioning

confidence: 99%

“…Acute pancreatitis (AP) develops as a result of premature activation of digestive enzymes released by the exocrine pancreas, mainly the conversion of trypsinogen into trypsin, inside the acinar cells, leading to the self-digestion of these cells and the stimulation of macrophages. The stimulation of macrophages, in turn, induces the production of pro-inflammatory cytokines, tumor necrosis factor-alpha (TNF-α), and interleukins (IL), all of which play a vital role in the pathogenesis of AP [1,2]. The majority of the cases of AP are mild (80%), while a small number of cases are severe in nature with a mortality rate of up to 50%; these severe cases serve as the key to understand the etiology, pathology, severity, prognosis, and complications associated with AP, so as to provide adequate and timely management of the disease [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Review of Current Evidence in Acute Pancreatitis

Varley¹,

Rossi²,

Murray³

et al. 2019

obm hg

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Acute pancreatitis (AP), an inflammatory condition of the pancreas, is one of the most common ailments of the gastrointestinal system, which results in significant morbidity and mortality. The main etiological causes of AP include alcohol consumption, gallstones, hypertriglyceridemia, and biliary stones. The clinical signs and symptoms of AP and the diagnostic criteria for this disease have been well established. Multiple scoring systems are applied to predict the severity and prognosis of AP, and the associated mortality. The present review of the literature highlights the recent significant contributions in the areas of etiology, risk factors, epidemiology, diagnosis, complications, prognosis, and the latest modalities in the treatment, which could be beneficial in the management of AP.

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Section: Etiologymentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Review of Current Evidence in Acute Pancreatitis

Varley¹,

Rossi²,

Murray³

et al. 2019

obm hg

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“…For those patients, which are thought as severe AP (SAP), systemic inflammatory response syndrome and various organ dysfunctions are finally induced secondary to the pancreatic damage . In SAP, high morbidity and mortality are often observed clinically . Thus, the early and effective assessment of severe cases is still of urgency and benefits the early interventions.…”

Section: Introductionmentioning

confidence: 99%

The early predictive role of complement C3 and C4 in patients with acute pancreatitis

Zhang

Qiao

Huang

et al. 2020

Clinical Laboratory Analysis

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Acute pancreatitis (AP) is a common disease in the department of gastroenterology. The main etiologies of AP are biliary tract diseases, alcohol over-consumption, and hyperlipidemia. 1 Most of AP patients involve regional inflammation and/or necrosis of the pancreas which will result in the discharge of a variety of inflammatory mediators. However, a small proportion of patients will suffer from the systemic inflammatory reaction caused by the over-production of these inflammatory mediators. 2 For those patients, which are thought as severe AP (SAP), systemic inflammatory response syndrome and various organ dysfunctions are finally induced secondary to the pancreatic damage. 3 In SAP, high morbidity and mortality are often observed clinically. 4,5 Thus, the early and effective assessment of severe cases is still of urgency and benefits the early interventions. AbstractObjective: The prognostic role of complement C3 and C4 in peripheral blood in early stage of acute pancreatitis (AP) is unknown. In this study, we aimed to evaluate the prognostic value of C3 and C4 in early stage of AP. Methods:A total of 164 patients were enrolled in this study. The blood samples were collected within 24 hours after AP onset. We compared C3 and C4 levels in patients with different AP severity. The optimal cutoff value for them to predict severe AP (SAP) was determined by receiver operating characteristic (ROC) curve analysis. Results:The reduction of C3 and C4 levels was observed. For prediction of MSAP and SAP, the AUC of C3 and C4 levels was 0.695 (95% CI: 0.612-0.779) and 0.739 (95% CI: 0.657-0.821). The cutoff value of C3 and C4 levels was 0.705 and 0.145 g/L, with the sensitivity of 0.612 and 0.735, and the specificity of 0.735 and 0.710. For prediction of SAP, the AUC of C3 and C4 levels was 0.749 (95% CI: 0.607-0.891) and 0.766 (95% CI: 0.596-0.936). The cutoff value of C3 and C4 levels was 0.400 and 0.125 g/L, with the sensitivity of 0.859 and 0.767, and the specificity of 0.600 and 0.786. Conclusions:A marked change of complement C3 and C4 was observed in peripheral blood of patients with AP, suggesting the participation of complement system in the early phase of AP. C3 and C4 levels were sensitive and accurate in judging the severity of AP. K E Y W O R D Sacute pancreatitis, complement C3 and C4, peripheral blood, prediction, severityThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…Острый панкреатит является тяжелым воспалительным заболеванием с непредсказуемым исходом [14,18,58,65,68,82]. В патологический процесс при этом вовлекается не только сама железа, но и многие другие органы, вызывая синдром полиорганной недостаточности, завершая нередко процесс летальным исходом [8,14,18,58,68,70,72,75,82,83].…”

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Ultrasound Elastography for Assessing Acute Pancreatitis

Kabanenko¹,

Khomutova²,

Ignatiev³

2019

Rejr

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стрый панкреатит -это острое воспаление поджелудочной железы. Пациенты с тяжелым острым панкреатитом более склонны к развитию осложнений и имеют гораздо более высокий уровень смертности. По мнению многих авторов, результат исхода острого панкреатита определяется двумя факторами: объемом деструкции (некроза) и нарушением функции органа. Степень выраженности этих факторов влияет на развитие тяжелых осложнений при остром панкреатите. Основной целью новых разработок в области ультразвуковой визуализации является увеличение диагностических критериев раннего выявления этих осложнений. Эластография одна из новых разработок в области такой визуализации, позволяющая характеризовать жесткость ткани. В статье проанализированы научные публикации, рассматривающие качественные и количественные критерии анализа эластограмм, позволяющих оценить жесткость паренхимы поджелудочной железы, проведен анализ публикаций, повествующих о возможностях использования ультразвуковой эластографии в диагностике острого панкреатита.Ключевые слова: эластография, точечная эластография сдвиговой волной (SWE point shear wave elastography, AFRI) ,поджелудочная железа, острый панкреатит.Контактный автор: Кабаненко Т.П., cute pancreatitis is an acute inflammation of the pancreas. The patients who have severe acute pancreatitis are more likely to develop complications and have a much higher mortality rate. According to many authors, the outcome of acute pancreatitis is determined by two factors: the volume of destruction (necrosis) and the violation(break) of organ function. The severity of these factors affects the development of severe complications in acute pancreatitis. The main goal of new developments in ultrasound imaging is to increase the diagnostic criteria for early detection of these complications. Elastography is one of the new developments in ultrasound imaging, which allows characterizing the stiffness of the tissue. The paper represents generalization the results of an analysis of scientific publications examining the qualitative and quantitative criteria for analyzing elastograms that allow one to evaluate the stiffness of the pancreatic parenchyma. Also, the analysis of the publications telling about possibilities of use of ultrasonic elastography in diagnostics of an acute pancreatitis has been conducted

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Severe acute pancreatitis: pathogenesis, diagnosis and surgical management

Cited by 134 publications

References 32 publications

Review of Current Evidence in Acute Pancreatitis

Review of Current Evidence in Acute Pancreatitis

The early predictive role of complement C3 and C4 in patients with acute pancreatitis

Ultrasound Elastography for Assessing Acute Pancreatitis

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