31 research outputs found
Classification of acute pancreatitis- 2012: revision of the Atlanta classification and definitions by international consensus.
No full textNew directions in diagnosis and treatment of canine acute pancreatitis
No full textAcute pancreatitis is an important disease in companion animal medicine, and diagnostic methodology available to veterinary practitioners is often limited. Evidence based principles for the management of this common disease are also lacking. This thesis explores the current diagnostics of canine pancreatitis and management of this condition, reviewing the literature across both the veterinary and human medical fields.
Assessment of the specificity of canine pancreatic-specific lipase (cPL) was made in a post-mortem study and calculated to be 82-92%, with a correlating sensitivity of 45-55%. A multi-centre study of dogs presenting with clinical signs consistent with acute pancreatitis to assess a new laboratory test, serum canine pancreatic elastase-1 (cPE-1) was also performed. This test had a sensitivity ranging from 66-79%, with a specificity of 92%. The sensitivity of both laboratory tests was greater in dogs with severe disease.
To assess potential treatment options, a clinical severity score was established, with gut health, respiratory complications, cardiac complications, and blood pressure determining the final score. Retrospectively, plasma administration did not appear to be associated with treatment success, but this conclusion was limited by the retrospective nature of the study and small numbers of dogs. Out of the other factors, fasting for 3 or more days was the one most significantly associated with mortality. To begin assessment of nutritional modalities, pancreatic responses in healthy dogs to varying dietary fat composition (ranging from 4%DW to 16% DW) was assessed, with no statistical difference determined. On the basis of this, a pilot study of 10 dogs with severe pancreatitis was undertaken, with 5 dogs fed enterally and another 5 dogs were given total parenteral nutrition (TPN). No differences in mortality or days of hospitalisation between the two were found, but there were significantly less episodes of vomiting or regurgitation in the dogs given food (p < 0.001). There were also more severe complications (4/5) in the TPN group compared to the enteral feeding group (2/5).
In all, this thesis supports the new premise of enteral feeding of dogs with acute pancreatitis early in the course of disease, determines the sensitivity and specificity of two diagnostic tests and has established an objective marker of disease severity
Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus
No full textItem does not contain fulltextBACKGROUND AND OBJECTIVE: The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. METHODS: A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. RESULTS: The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. CONCLUSIONS: This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption
Imaging of acute pancreatitis and its complications. Part 2: Complications of acute pancreatitis
No full textAbstractThe Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Major changes include subdividing acute fluid collections into “acute peripancreatic fluid collection” and “acute post-necrotic pancreatic/peripancreatic fluid collection (acute necrotic collection)” based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into “pseudocyst” and “walled of pancreatic necrosis”. Appropriate use of the new terms describing the fluid collections is important for management decision-making in patients with acute pancreatitis. The purpose of this review article is to present an overview of complications of the acute pancreatitis with emphasis on their prognostic significance and impact on clinical management and to clarify confusing terminology for pancreatic fluid collections
Imaging of acute pancreatitis and its complications. Part 1: Acute pancreatitis
No full textAbstractAcute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical settting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality
ACR Appropriateness Criteria(R) acute pancreatitis
No full textThe American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The Atlanta Classification by the Acute Pancreatitis Classification Working Group recently modified the terminology for the clinical course and the morphologic changes identified on imaging, primarily contrast- enhanced multidetector computed tomography (MDCT). The two distinct clinical courses of the disease are classified as (1) early phase, which lasts approximately 1 week, and (2) late phase, which starts after the first week and can last for months after the initial episode. The two, primary, morphologic changes are acute, interstitial edematous and necrotizing pancreatitis. Timing of imaging, primarily MDCT, is based on the clinical phases and is, therefore, important for these imaging guidelines. Ultrasound's role is to detect gallstones after the first episode. MDCT plays a primary role in the management of acutely ill patients, only after a minimum of 48-72 hours and generally after one week. MR plays a supplementary role to MDCT. Follow-up MDCT guides management and therapy: percutaneous aspiration of fluid collections and/or placement of large caliber catheters in infected necrosis
Reporting Standards for Chronic Pancreatitis by Using CT, MRI, and MR Cholangiopancreatography: The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer
No full textChronic pancreatitis is an inflammatory condition of the pancreas with clinical manifestations ranging from abdominal pain, acute pancreatitis, exocrine and/or endocrine dysfunction, and pancreatic cancer. There is a need for longitudinal studies in well-phenotyped patients to ascertain the utility of cross-sectional imaging findings of chronic pancreatitis for diagnosis and assessment of disease severity. CT and MR cholangiopancreatography are the most common cross-sectional imaging studies performed for the evaluation of chronic pancreatitis. Currently, there are no universal reporting standards for chronic pancreatitis. Several features of chronic pancreatitis are applied clinically, such as calcifications, parenchymal T1 signal changes, focal or diffuse gland atrophy, or irregular contour of the gland. Such findings have not been incorporated into standardized diagnostic criteria. There is also lack of consensus on quantification of disease severity in chronic pancreatitis, other than by using ductal features alone as described in the Cambridge classification. The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) was established by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute in 2015 to undertake collaborative studies on chronic pancreatitis, diabetes mellitus, and pancreatic adenocarcinoma. CPDPC investigators from the Adult Chronic Pancreatitis Working Group were tasked with development of a new consensus approach to reporting features of chronic pancreatitis aimed to standardize diagnosis and assessment of disease severity for clinical trials. This consensus statement presents and defines features of chronic pancreatitis along with recommended reporting metrics
Редкое наблюдение эндоскопического транслюминального дренирования зон панкреатогенной деструкции при инфицированном некротизирующем панкреатите
No full textNecrotizing forms of acute pancreatitis, as the most severe in terms of prognosis, occur in 25–30% of cases with a mortality rate of 27–32%, while in most cases these are adults of working age, which emphasizes the social significance of this problem. This article presents a rare observation of endoscopic intraluminal drainage of zones of pancreatogenic destruction in severe necrotizing pancreatitis. The multidisciplinary individual approach we have chosen makes it possible to treat this group of patients most effectively, which confirms the presented clinical observation.Некротизирующие формы острого панкреатита, как наиболее тяжелые в прогностическом плане, встречаются в 25–30% случаев с летальностью 27–32%, при этом в большинстве случаев это лица взрослого трудоспособного возраста, что подчеркивает социальную значимость данной проблемы. В данной статье представлено редкое наблюдение эндоскопического внутрипросветного дренирования зон панкреатогенной деструкции при тяжелой форме некротизирующего панкреатита. Выбранный мультидисциплинарный индивидуальный подход позволяет наиболее эффективно лечить данную группу пациентов, что подтверждает представленное клиническое наблюдение
Genetic risk variants in intestinal inflammatory disorders
No full textPhDThis thesis includes work on the genetics of intestinal inflammatory disorders, concentrating
on coeliac disease and Crohn’s disease. It explores how common genetic variants influence
risk of complex phenotypes including immunological intolerance to gluten (coeliac disease)
and intolerance to therapeutic agents (azathioprine and mercaptopurine) used in the
treatment of intestinal inflammatory diseases. Finally it presents work aiming to move from
genetic associations with complex phenotypes to understanding of how these variants
modulate immunological processes.
Results of a large genome wide association study that identified more than 13 new genetic risk
regions influencing susceptibility to coeliac disease are presented. Results of a genome wide
association study of azathioprine and 6-mercaptopurine-induced pancreatitis in inflammatory
bowel disease-affected individuals are presented. Finally, a cell cytokine release assay for the
prostaglandin EP4 receptor was developed, with a view to investigating how SNPs associated
with Crohn’s disease in the 5p13.1 region influence EP4 receptor signalling and contribute to
disease pathogenesis. This work highlights some of the challenges in moving from SNP-disease
associations identified in GWASs to understanding how genetic variants change biological
processes
КТ и МРТ в диагностике фазового течения панкреонекроза (обзор литературы)
No full textAcute pancreatitis is one of the most common acute conditions in abdominal cavity with a broad spectrum of clinical symptoms, which range in severity from mild interstitial inflammation to severe forms with significant regional and systemic complications. Despite overall progress in treatment methods and critical care of the acute pancreatitis, this condition remains to be associated with a high mortality rate. Contrast-enhanced CT has been the golden standard in the diagnosis of the acute pancreatitis for a long time, but despite that there’s still a certain degree of inaccuracy in terminology, pertinent to both the literature and the guidelines, which in turn impacts treatment and prognosis. This work is dedicated to the radiological terminology and classification of the characteristic findings in the acute pancreatitis and necrotizing pancreatitis. Recommendations and indications for use of the CT and MRI has been discussed, as well as their methodology. The provisions of the review are illustrated by CT and MRI images of the most striking and significant changes in the framework of the disease from the authors' archive for greater clarity.The main goal of this study is to consolidate data found in both foreign and domestic research in order to form a comprehensive understanding of development stages of acute pancreatitis. This is mainly achieved by their radiologic characterization, as well as possible complications.Острый панкреатит является одним из самых часто встречающихся острых заболеваний органов брюшной полости с широким спектром симптомов, которые варьируются по тяжести от легкого интерстициального воспаления железы до тяжелых форм со значительными региональными и системными осложнениями. Несмотря на улучшения в лечении и оказании неотложной помощи, тяжелый острый панкреатит по-прежнему связан с высокими показателями смертности. “Золотым стандартом” его диагностики уже долгое время является компьютерная томография (КТ) с внутривенным контрастированием. Несмотря на это, в современной литературе и методических рекомендациях сохраняются неточности в терминологии выявляемых изменений, часто влияющих на выбор метода лечения и прогноз заболевания.В нашей работе рассматривается рентгенологический аспект терминологии и классификации характерных проявлений острого панкреатита и панкреонекроза. Обсуждены рекомендации и показания к проведению КТ- и МРТ-исследований, а также их методология. Положения обзора проиллюстрированы КТ- и МРТ-изображениями наиболее ярких и значимых изменений в рамках заболевания из архива авторов для большей наглядности.Цель данного исследования – структурировать различные данные отечественной и зарубежной литературы для формирования более полной и четкой картины различных фаз течения острого панкреатита, главным образом, за счет характеристики их проявлений и осложнений с помощью лучевых методов исследования.
