Akuutin haimatulehduksen etiologia

English summaryPeer reviewe

Ikteerinen potilas päivystyksessä

Teema : hepatologia. English summaryPeer reviewe

ACUTE PANCREATITIS in HELSINKI in 2016-2018 : INCIDENCE, ETIOLOGY and RISK FACTORS-analysis of 1378 acute pancreatitis episodes in a Finnish normal population

Objectives Updated population-based studies on acute pancreatitis (AP) in Finland are lacking. Our aim was to evaluate the current data for AP in Helsinki. Materials and methods We performed an electronic health care records (EHRs) search on AP patients treated at Helsinki University Hospital between the years 2016 - 2018. Incidence was calculated, etiological and potential risk factors, as well as severity of AP were documented and analyzed. Results Between 2016 and 2018 we found 1378 AP episodes on 1084 patients, 35% of the patients had several AP episodes, i.e., recurrent AP (RAP). The domicile-adjusted incidence was 42.2/100 000. 47% of the patients had alcohol etiology (59% men, 27% women) and 23% had biliary etiology, 21% were idiopathic and 2.9% were post-ERCP pancreatitis. 13.1% of the patients had passed at the end of September 2021. 45% of the patients were currently smoking, 11% were ex-smokers, and the highest percentage of smokers was in the group of alcohol-caused AP with 74% ever-smokers. Biliary AP had the highest amount of overweight patients. 24% of the patients used anticoagulation (AC) medication, and the percentage was significantly higher with idiopathic AP (48%). RAP, female sex and normal BMI associated with a mild form of AP. Conclusions Incidence of AP and the percentage of alcohol etiology are lower than earlier reported for Finland although still higher than in other Nordic countries. Smoking and the use of AC medication associate with AP.Peer reviewe

Sappiteiden diagnostiset ja hoidolliset tähystykset

Vertaisarvioitu• Sappi- ja haimasairauksissa vaativiakin hoitotoimenpiteitä pystytään nykyisin tekemään ¬hyvin siedetysti ja turvallisesti tähystyksessä. • Endoskooppinen retrogradinen kolangiopankreatografia (ERCP) on ensisijainen menetelmä sappitietukoksen ja tiehytkivien hoidossa. • Lähettävän yksikön kirjaamat lähetetiedot ovat olennaisen tärkeitä. • ERCP:hen liittyvät komplikaatiot jäävät useimmiten lieväasteisiksi. Niiden riski noin 5 %. • Toimenpiteen jälkeinen vatsakipu tai verenvuoto vaatii erikoissairaanhoidon arvion.Peer reviewe

Transcatheter Arterial Embolization in Lower Gastrointestinal Bleeding : Ischemia Remains a Concern Even with a Superselective Approach

Purpose To evaluate the safety. efficacy, and feasibility of transcatheter arterial embolization (TAE) in the treatment of lower gastrointestinal bleeding (LGIB). Methods Study group comprised all patients receiving angiography for LGIB in the Helsinki University Hospital during the period of 2004-2016. Hospital medical records provided the study data. Rebleeding, complication, and mortality rates 30 days) were the primary outcomes. Secondary outcomes included need for blood transfusions, durations of intensive care unit and hospital admissions, incidence of delayed rebleeding, and long-term complications, as well as overall survival. Results During the study period, angiography for LGIB was necessary on 123 patients. Out of 123, 55 (45%) underwent embolization attempts. TAE was technically successful in 53 (96%). Rebleeding occurred in 14 (26%). The complication rate was 36%, minor complications occurring in 10 (19%) and major in nine (17%). Major complications resulted in bowel resection in seven (13%). Post embolization ischemia was the most common single complication seen in nine (17%). The mortality rate was 6%. Survival estimates of 1 and 5 years were 79 and 49%. Discussion LGIB is a severe physiological insult occurring in patients who are often elderly and moribund. Although major post embolization complications occur, transcatheter arterial embolization should be the first-line approach over surgery in profuse LGIB in patients with hemodynamic instability, when colonoscopy fails or is unavailable, or when computerized tomography angiography detects small intestinal bleeding.Peer reviewe

Diclofenac Does Not Reduce the Risk of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis in Low-Risk Units

Background Nonsteroidal anti-inflammatory drugs have an inhibitory role in pathogenesis of pancreatitis. Guidelines from the European Society of Gastrointestinal Endoscopy recommend routine rectal administration of 100 mg of diclofenac or indomethacin immediately before or after ERCP for all patients without contraindications. Aims Our aim was to evaluate the effect of diclofenac in preventing post-ERCP pancreatitis (PEP) in a high-volume, low-PEP-risk ERCP unit. Methods The rate and severity of PEP were compared in groups of 1000 historical controls prior to the routine use of diclofenac and in 1000 patients receiving 100 mg diclofenac before ERCP. Results PEP occurred in 56 (2.8%) of the 2000 patients, and the rate of the pancreatitis was 2.8% in control group and 2.8% in diclofenac group (p = 1.000). The PEP rate among the native papilla patients was 3.9% in control group and 3.6% in diclofenac group (p = 0.803). In subgroup analysis of patients with a high risk of PEP, diclofenac neither prevented PEP nor made its course milder. Conclusions In an unselected patient population in a center with a low incidence of PEP, diclofenac seems to have no beneficial effect.Peer reviewe

Endoscopic therapy of sporadic non-ampullary duodenal adenomas, single centre retrospective analysis

Introduction Although sporadic non-ampullary duodenal adenomas (SNADA) are rare, with the risk of progression to cancer, they deserve therapy. Endoscopic therapy of SNADA is effective, but with the increased risk of complications, endotherapy should be performed in high-volume units. The results of endotherapy of SNADA in our unit are presented. Patients and methods A total of 97 patients with SNADA had endoscopic resection in 2005-2021 and control endoscopies between 3 and 24 months. Snare polypectomy, endoscopic mucosal resection (EMR), endoscopic band ligation (EBL) and endoloop were used (en bloc 37% and piecemeal 63%). In cases of residual/recurrent adenomas, endotherapy was repeated. Results The median size of the adenoma was 12 (5-60) mm and most polyps were sessile (25%) or flat (65%). Primary endotherapy eradicated adenomas in 57 (59%) cases. Residual and recurrence rates were 24% (n = 23) and 17% (n = 16) with successful endotherapy in 16 (70%) and 13 (81%) patients. Endotherapy was successful in 86 (89%) patients after a median (range) follow-up of 23 (1-166) months. Four out of 11 patients with failed endotherapy had surgery; seven patients were not fit for surgery. There were no disease-specific deaths or carcinoma. Eleven patients (11%) suffered from complications: perforation requiring surgery (n = 1), sepsis (n = 1), postprocedure bleeding (n = 7), cardiac arrest (n = 1) and coronary infarct (n = 1). The thirty-day mortality was zero. Colonoscopy was performed on 67 (69%) patients with neoplastic lesions in 33% patients during follow-up. Conclusions Endotherapy of SNADA is effective and safe. Repeat endotherapy in residual and recurrent adenomas is successful. Careful patient selection is mandatory.Peer reviewe

Syövän aiheuttaman sappitietukoksen hoito

Vertaisarvioitu. Näin hoidan.Sappitietukoksesta johtuva maksa-arvojen nousu on yleinen terveydenhuollossa kohdattava ongelma. Jos potilaan yleiskunto on hyvä, ei päivystyksellisiä selvittelyjä tarvita, vaan tutkimukset voidaan ohjelmoida kiireellisinä. Jos yleiskunto on huonontunut tai epäillään sappitietulehdusta, potilas tarvitsee yleensä erikoissairaanhoitoa. Lähetteessä tulisi olla selvitys potilaan yleiskunnosta ja toimintakyvystä. Syöpää epäiltäessä on tärkeää, että potilaan asiat käsitellään moniammatillisessa kokouksessa ja mieluiten jo ennen tukoksen avaamista. Tämä voidaan yleensä tehdä tukoksen läpi viedyllä stentillä endoskooppisesti tai ihon ja maksan läpi viedyllä katetrilla radiologisesti. Kokouksessa tarkistetaan, että riittävät radiologiset selvittelyt on tehty, päätetään tukoksen laukaisun tarpeesta ja tavasta, mahdollisesta kiireellisestä leikkaushoidosta tai esiliitännäishoitojen aloittamisesta. Palliatiivisessa hoidossa olevilla potilailla tulee aina tarkkaan harkita, onko toimenpiteestä odotettavissa merkittävää hyötyä

Kroonisen haimatulehduksen diagnostiikka ja hoito

VertaisarvioituKrooninen haimatulehdus on harvinainen, mutta todennäköisesti alidiagnosoitu sairaus. Sen yleisin syy on alkoholin liiallinen käyttö. Hoito kohdistetaan kipuun sekä ekso- ja endokriiniseen vajaatoimintaan. Alkoholinkäytön ja tupakoinnin lopettaminen on ensiarvoisen tärkeää. Invasiivisia hoitoja kannattaa harkita, jos kipua tai komplikaatioita ei saada hoidetuksi konservatiivisesti. Seurannassa varmistetaan potilaan pysyminen raittiina ja tarkistetaan ravitsemustila. Sairaus on etenevä ja siihen liittyy haiman vajaatoiminnan, rasvaripulin, diabeteksen ja haimasyövän riski.Peer reviewe