Over-the-counter drug causing acute pancreatitis

Acute pancreatitis is caused by alcohol, gall stone disease, drugs, trauma, infections, and metabolic causes such as hypercalcemia and hyperlipidemia. Hypercalcemia-induced acute pancreatitis has been well documented but only rarely occurs due to over-the-counter calcium carbonate. In this article, we present a case of over-the-counter calcium carbonate-induced acute pancreatitis

Cancer, Hepatic Lymphoma

Primary hepatic lymphoma (PHL) is a rare form of non-Hodgkin lymphoma (NHL) which primarily involves the liver, as opposed to a predominant lymph nodal or splenic involvement in other subtypes of NHL. The liver is the major reticuloendothelial organ, and hepatic involvement secondary to systemic NHL is common, such that 40% of patients with NHL posses liver involvement.[1] The majority of the patients with PHL report vague symptoms such as nausea, vomiting, upper abdominal pain or discomfort,[2][3] and approximately one-third report constitutional symptoms including fever, myalgias, and weight loss. However, due to the low incidence with characteristically vague symptoms at the outset, patients with PHL often undergo extensive investigations before reaching up to a definitive diagnosis.[4] Diagnosis of PHL depends on a liver biopsy which should be compatible with the lymphoma and with the absence of extrahepatic lymphoproliferative involvement.[5] Primary hepatic lymphoma may often confound with other space-occupying liver lesions namely the hepatocellular carcinoma, hepatic adenoma, focal hyperplasia of the liver, and hepatic hemangioma. At times it is crucial for a hepatologist to address the rare possibility of PHL besides the common notably, the hepatocellular carcinoma while approaching the space-occupying lesions of the liver

Survival outcomes of patients with concomitant acute variceal bleeding and acute coronary syndrome, and the role of antiplatelet agents: an institutional experience from a lower middle-income Country

Abstract Background There is strong evidence demonstrating the incidence of Acute Coronary Syndrome (ACS) among patients with cirrhosis, with the initiation of antiplatelet therapy being subject to debate due to an increased risk of bleeding. This study aimed to determine mortality among patients presenting with concomitant Acute Variceal Bleeding (AVB) and ACS at Index admission. Furthermore, the recurrence of AVB and ACS among patients discharged with or without antiplatelet therapy was determined. Methods This retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan on patients ≥ 18 years of age admitted to our ER with concomitant ACS and AVB between January 2002 to December 2017. Follow-up for 6 months or till death (if < 6 months), was observed, to help determine the incidence of recurrent AVB and ACS. The incidence of AVB and ACS was then compared amongst patient groups based on the usage of anti-platelet drugs on discharge. Results A total of 29 patients were included, with a mean age of 58.7 ± 11.0 years. Seven patients died on admission, having worse underlying liver disease. No mortality was reported among the remaining 22 patients. All 22 patients underwent surveillance endoscopy with variceal band ligation until obliteration, as needed. Only 7 patients from the surviving cohort received antiplatelet therapy. After 6.05 ± 1.1 months of follow-up, 1/22 (4.5%) developed recurrent AVB and 2/22 (9.1%) developed cardiovascular events. Importantly, there was no significant difference in the incidence of recurrent AVB (P = 1.000) and ACS (P = 0.091), depending on the use of antiplatelet therapy. Conclusion Concomitant AVB and ACS is a severe disorder with increased mortality among cirrhotic patients at presentation. The incidence of AVB does not seem to exacerbate with the use of antiplatelet agents, provided successful obliteration of varices is achieved using elective band ligation