72 research outputs found
Advances in Pancreatic Cancer, Intraductal Papillary Mucinous Neoplasms, and Pancreatitis
Peripancreatic collections in acute pancreatitis: Correlation between computerized tomography and operative findings
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Advances in Pancreatic Cancer, Intraductal Papillary Mucinous Neoplasms, and Pancreatitis
According to the theme of the Golden Jubilee Issue of our journal, we present a commentary on landmark contributions reported in the journal on pancreatic cancer, pancreatic cysts, and intraductal papillary mucinous neoplasms (IPMN) and pancreatitis
Mo1331 When, Why and How Do Patients With Acute Pancreatitis Die? A Large Experience of 910 Direct (Not Transfer), Consecutive Admissions in Recent Years
Organ failure as an indicator of severity of acute pancreatitis: Time to revisit the Atlanta classification
Mo1367 Splanchnic Vein Thrombosis in Acute Pancreatitis: A Study in 967 Recent, Direct, Consecutive Admissions at a Tertiary-Care Institution
591f Natural History of Arterial Pseudoaneurysms in Acute Pancreatitis: A Large Experience From a Tertiary Institution
S1371 Admission Systemic Inflammatory Response Syndrome (SIRS) Score Predicts the Development of Primary Intra-Abdominal Infection in Patients With Acute Pancreatitis
Role of endoscopic ultrasound during hospitalization for acute pancreatitis
Endoscopic ultrasound (EUS) is often used to detect the cause of acute pancreatitis (AP) after the acute attack has subsided. The limited data on its role during hospitalization for AP are reviewed here. The ability of EUS to visualize the pancreas and bile duct, the sonographic appearance of the pancreas, correlation of such appearance to clinical outcomes and the impact on AP management are analyzed from studies. The most important indication for EUS appears to be for detection of suspected common bile duct and/or gall bladder stones and microlithiasis. Such an approach might avoid diagnostic endoscopic retrograde cholangio-pancreatography with its known complications. The use of EUS during hospitalization for AP still appears to be infrequent but may become more frequent in future
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Staging exocrine pancreatic dysfunction
Digestive capacity of the gastrointestinal tract, largely but not wholly, depends on exocrine pancreatic function to achieve near complete digestion and absorption of ingested food. Coefficient of fat absorption (CFA), the proportion of ingested fat absorbed (normal >93%), reflects digestive capacity. Exocrine pancreatic insufficiency (EPI) is the state of insufficient digestive capacity (CFA <93%) caused by severe loss of pancreatic exocrine function despite variable compensation by upregulation of extra-pancreatic lipolysis. Fecal elastase 1 (FE1) level is the most widely used, though imperfect, non-invasive test of pancreatic enzyme output. Decline in pancreas enzyme output, or pancreatic exocrine dysfunction (EPD), has a variable correlation with measurable decline in CFA. EPI results in steatorrhea, weight loss and nutrient deficiency, which are mitigated by pancreatic enzyme replacement therapy (PERT). We propose a staging system for EPD, based on measurement of fecal elastase (FE1) and, if necessary, CFA and serum fat-soluble vitamin levels. In Stage I (Mild) EPD, FE1 is 100–200 mcg/gm; if steatorrhea is present, non-pancreatic causes are likely. In Stage II (Moderate) EPD), FE1 is < 100 mcg/gm without clinical and/or laboratory evidence of steatorrhea. In Stage III, there are marked reductions in FE1 and CFA, but vitamin levels remain normal (Severe EPD or EPI without nutritional deficiency). In Stage IV all parameters are abnormal (Severe EPD or EPI with nutritional deficiency). EPD stages I and II are pancreas sufficient and PERT may not be the best or first approach in management of early-stage disease; it needs further study to determine clinical utility. The term EPI refers strictly to EPD Stages III and IV which should be treated with PERT, with Stage IV requiring micronutrient supplementation as well
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