Pankreatitis akut didefinisikan sebagai kondisi inflamasi non-bakteri pada pankreas yang berasal dari aktivasi dini dari enzim pencernaan yang ditemukan di dalam sel asinar, dengan keterlibatan ...kelenjar itu sendiri, jaringan, dan organ sekitarnya. Gejala yang terjadi dapat berupa nyeri pada perut di epigastrium hingga menjalar ke punggung dan perut bagian bawah. Laporan kasus ini menyajikan Pasien perempuan, 43 tahun dengan keluhan nyeri perut bagian kanan atas dan menjalar hingga ke pinggang kanan. Nyeri dikatakan bertambah berat bila pasien tertidur dan membaik bila dalam keadaan tegak dan menarik badannya ke arah belakang. Pemeriksaan fisik menunjukkan pasien mengalami obesitas. Pemeriksaan penunjang menunjukkan terdapat peningkatan kadar lipase dan amilase. Pemeriksaan USG menunjukkan kesan kolelitiasis. Pasien didiagnosis dengan pankreatitis akut dan kolelitiasis. Pasien diterapi dengan dipuasakan, pemasangan Naso Gastric Tube (NGT), Pethidin 50 mg satu kali sehari, pantoprazol 40 mg dua kali sehari, dan simvastatin 20 mg satu kali sehari. Respon terhadap terapi dan prognosis baik.
Dijetoterapija akutnog i kroničnog pankreatitisa Orešković, Petra; Martinis, Irena; Tolić, Mandica-Tamara ...
Medicus (Zagreb, Croatia : 1992),
11/2015, Letnik:
24, Številka:
2 ASK niske doze
Journal Article
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Pankreatitis je upalno stanje gušterače koje često iz svojeg akutnog oblika može prijeći u kroničnu bolest. Bolesnici s pankreatitisom imaju povećane nutritivne potrebe zbog upale, dok, s druge ...strane, zbog boli, mučnine i povraćanja pate od energijskog, proteinskog ili nutritivnog deficita. Hipokalcemija i hipomagnezemija mogu se pojaviti već u prvim fazama akutnog pankreatitisa. Bolesnici s dugotrajnim i prekomjernim unosom alkohola mogu, uz proteinsko-energijsku malnutriciju, imati i deficit vitamina i minerala: tiamina, folne kiseline, cinka, vitamina D, K, E, A i B12 te karotena. Osnovni cilj nutritivne njege bolesnika s pankreatitisom jest osigurati adekvatan unos energije. To je osobito važno u bolesnika s akutnim pankreatitisom u kojih se pokazalo da pravilna nutritivna njega može smanjiti komplikacije i skratiti vrijeme boravka u bolnici.
Acute pancreatitis (AP) is a common, potentially lethal, acute inflammatory process with a highly variable clinical course. The aim of this study was to analyse early changes in the serum ...concentrations of pro- and anti-inflammatory cytokines in the peripheral blood of patients with the interstitial form of acute pancreatitis (IAP) and necrotic acute pancreatitis (NAP), especially in those patients who had lethal outcomes.
The prospective study enrolled 52 patients who were divided into IAP (65.38% of patients) and NAP (34.62% of patients) groups. The serum levels of interleukins (IL) 6, 8 and 10, together with tumour necrosis factor (TNF)-alpha were measured on the 1
and 3
day of hospitalisation. Significantly higher values of IL-6, IL-8 and IL-10 were found on day 1 and 3 in NAP than in IAP. IL-6 was significantly higher on both days of measurement, whereas IL-10 on the first day and IL-8 on the third day were significantly higher in the group of patients who did not survive in comparison with patients who had the interstitial form of AP.
In conclusion, the data from this study showed that immune suppression and excessive immune stimulation in the first three days after admission could indicate the development of NAP and a potentially lethal outcome.
Kliničke manifestacije akutnog pankreatitisa širokog su spektra i često predstavljaju
diferencijalno dijagnostički problem. U pristupu bolesniku sa sumnjom na razvoj akutnog
pankreatitisa nužna je ...iscrpna anamneza i detaljan fizikalni pregled, što nam uz najmanje
trostruko povećanje aktivnosti amilaza i dvostruko povećanje aktivnosti lipaza s velikom vjerojatnošću
upućuje na razvoj akutne upale gušterače. Nužno je potom procijeniti težinu
akutnog pankreatitisa, kako bismo pravovremeno prepoznali one bolesnika kojima je neophodna
24-satna intenzivna skrb, a u svrhu smanjenja njihova mortaliteta.
Acute pancreatitis represents an acute nonbacterial inflammation of the pancreas caused by a premature and ectopic activation of pancreatic digestive enzymes. Two of the most important genes in ...pancreatic autodigestion, PRSS1 and SPINK1, were implicated in the earliest discoveries of the genetic background of pancreatitis. However, the distribution of their variations displays interethnic variability, which could significantly affect the magnitude of their proposed effects on this disease worldwide. The aim of the present study was to investigate the distribution of the most important functional variations of PRSS1 (86A>T and 365G>A) and SPINK1 (101A>G), and their influence on the clinical course of acute pancreatitis in Serbian patients. The study enrolled 81 subjects, the severity of disease course was determined using the Atlanta Classification system, and the genotyping was conducted using a PCR-RFLP method. PRSS1 86A>T and 365G>A SNPs were not observed in the study population, while SPINK1 101A>G was present with the frequency of 0.62% (95% CI: 0.00, 3.83%). Due to extremely low frequencies or absences of examined variations, the proposed effect of these SNPs on the severity of acute pancreatitis could not be confirmed. The results do not support routine genotyping of either PRSS1 or SPINK1 in Serbs.
Akutni pankreatitis u djece Baraba Dekanić, Kristina; Palčevski, Goran
Medicina fluminensis,
06/2015, Letnik:
51, Številka:
2
Journal Article
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Akutni pankreatitis je bolest koja se sve češće dijagnosticira u dječjoj dobi. Postoje značajne razlike između akutnog pankreatitisa u djece i odraslih; bolesti se razlikuju u etiologiji,prirodnom ...tijeku i prognozi. Ipak, današnji pristup bolesti i njenom liječenju zasniva se uglavnom na istraživanjima u odraslih osoba. U tijeku su brojna istraživanja koja za cilj imaju rasvijetliti značajke bolesti dječje dobi. U ovom članku donosimo današnje spoznaje o etiopatogenezi, dijagnostici, liječenju i prognozi akutne upale gušterače u dječjoj dobi.
Acute necrotizing pancreatitis (ANP) is a severe form of acute pancreatitis that is associated with high morbidity and mortality. Thus, an adequate initial treatment of patients who present with ...acute pancreatitis (AP) based on correct interpretation of early detected laboratory and clinical abnormalities may have a significant positive impact on the disease course.
The aim of the study was to determine patient- and initial treatment-related risk factors for the development of acute necrotizing pancreatitis.
For the purpose of this study a case-control design was chosen, including adult patients treated for AP in the surgical Intensive Care Unit (sICU) of Clinical Center of Kragujevac, from January 2006 to January 2011. The cases (n=63) were patients who developed ANP, while the controls (n=63) were patients with AP without the presence of pancreatic necrosis. The controls were randomly selected from a study sample after matching with the cases by age and sex.
Significant association with the development of ANP was found for the presence of comorbidity (adjusted OR 6.614 95%CI 1.185-36.963), and the use of somatostatin (adjusted OR 7.460, 95%CI 1.162-47.833) and furosemide (adjusted OR 2710.57, 95%CI 1.996-56.035) started immediately upon admission to the sICU.
This study suggests that comorbidities, particularly the presence of serious cardio-vascular disease, can increase the risk for development of acute necrotizing pancreatitis. The probability for the development of ANP could be reduced by the avoidance of the initial use of loop diuretics and somatostatin.
Autoimuni pankreatitis (AIP) prepoznat je kao zaseban klinički entitet u sklopu kroničnog
upalnog procesa gušterače čija je podloga autoimuna bolest. Histološki i klinički razlikuju
se dva tipa ...AIP-a: tip 1 – limfoplazmocitni sklerozirajući pankreatitis sa zahvaćenošću
drugih organa i infiltracijom IgG4 pozitivnim stanicama te tip 2 – fibroza glavnog gušteračnog
kanala s infiltracijom epitela granulocitima. Ovaj oblik pogađa mlađe ljude, a drugi organski
sustavi obično nisu zahvaćeni. Najčešći simptom bolesti je opstruktivni ikterus, dok se
oštri bolovi u trbuhu vrlo rijetko javljaju. Približno polovica bolesnika pokazuje neki oblik endokrine
i/ili egzokrine disfunkcije gušterače. Iako je antinuklearno antitijelo (ANA) pozitivno
u oko 40 % bolesnika, najosjetljivijim i najspecifičnijim markerom danas se još uvijek smatra
IgG4. Dijagnoza se postavlja na osnovi dvaju kriterija: tzv. HISORt kriterija koji potječu s
Mayo klinike ili Azijskih dijagnostičkih kriterija. Diferencijalno-dijagnostički najvažnije je isključiti
karcinom gušterače, endosonografski vođenom biopsijom. Iako se odličan klinički odgovor
postiže primjenom kortikosteroida, što je i dijagnostički vrlo značajno, budući da postoji
mnogo sličnosti u kliničkoj prezentaciji bolesnika s karcinomom gušterače i AIP-a, još
uvijek ne postoji standardizirani terapijski protokol njihove primjene. Danas se ovaj oblik
kronične upale gušterače smatra vrlo rijetkom bolesti, no novijim spoznajama vjerojatno će
se u budućnosti češće postaviti dijagnoza autoimunog pankreatitisa u bolesnika s akutnim
rekuretnim bolovima u trbuhu nejasne etiologije.
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