| Controversias en las etiologías de la pancreatitis aguda |
Controversies in the etiologies of acute pancreatitis.
Khan AS, Latif SU, Eloubeidi MA.
Department of Medicine, the University of Alabama in Birmingham, Birmingham, AL 35294-0007, USA
JOP. 2010 Nov 9;11(6):545-52.
Introduction
Acute pancreatitis is a potentially life threatening acute inflammatory condition of the pancreas with an annual incidence in the United States estimated to be 40 cases per 100,000 adults which is one of the highest in the world. There is also a rising trend in the incidence of acute pancreatitis in the United States which has been observed over the past several decades. Though most cases are mild with mortality below 1%, there is a subset classified as severe pancreatitis in which the mortality can reach as high as 30%. The direct medical cost of hospitalization for acute pancreatitis is estimated to be $2.2 billion at a mean cost per hospital day of $1,670 which is likely an underestimation. To determine the etiology of the acute pancreatitis is crucial to the management of this potentially fatal condition. Even though a wide variety of etiologies have been proposed, the exact role of the some of these still remains controversial and in some cases ill-defined. A cause is not clinically determined in up to 30% of cases which are labeled idiopathic pancreatitis. This review attempts to re-visit some of the controversies surrounding these etiologies, discuss the current understanding of the mechanisms that underlie them and to identify areas requiring further research.
http://www.joplink.net/prev/201011/201011_17.pdf
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| Manejo invasivo mínimo del tracto biliar en enfermedad aguda durante el embarazo |
Minimally invasive management of acute biliary tract disease during pregnancy.
Chiappetta Porras LT, Nápoli ED, Canullán CM, Quesada BM, Roff HE, Alvarez Rodríguez J, Oría AS.
Department of Surgery, Cosme Argerich Hospital, Almirante Brown 240, Buenos Aires 1155, Argentina.
HPB Surg. 2009;2009:829020. Epub 2009 Jul 12.
Abstract
BACKGROUND: Acute biliary diseases during pregnancy have been classically managed conservatively. Advances in minimally invasive surgery and the high recurrence rate of symptoms observed changed this management. METHODS: This is a prospective observational study. Initial management was medical. Unresponsive patients were treated with minimally invasive techniques including gallbladder percutaneous aspiration or cholecystostomy, endoscopic retrograde cholangiography, and laparoscopic cholecystectomy, depending on the pregnancy trimester and underlying diagnosis. RESULTS: 122 patients were admitted. 69 (56.5%) were unresponsive to medical treatment. Recurrent gallbladder colic was the most frequent indication for minimally invasive intervention, followed by acute cholecystitis, choledocholithiasis, and acute biliary pancreatitis. 8 patients were treated during the first trimester, 54 during the second, and 7 during the last trimester. There was no fetal morbidity or mortality. Maternal morbidity was minor with no mortality. CONCLUSION: Acute biliary tract diseases during pregnancy may be safely treated with minimally invasive procedures according to the underlying diagnosis and to the trimester of pregnancy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709716/pdf/HPB2009-829020.pdf |
| Pancreatitis en el embarazo |
Pancreatitis in pregnancy.
Eddy JJ, Gideonsen MD, Song JY, Grobman WA, O'Halloran P.
University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, Eau Claire, Wisconsin 54703, USA.jjemdg@sbcgolbal.net
Obstet Gynecol. 2008 Nov;112(5):1075-81.
Abstract
OBJECTIVE: To estimate the incidence, cause, and complications of pancreatitis in pregnancy and to identify factors associated with adverse outcomes. METHODS: This study was a chart review of all pregnant patients diagnosed with pancreatitis from 1992-2001 at 15 participating hospitals. Information was collected on presentation, management, and outcome, along with the number of deliveries at each hospital. RESULTS: During the 10 years of the study, 101 cases of pancreatitis occurred among 305,101 deliveries, yielding an incidence of one in 3,021 (.03%). There were no maternal deaths; perinatal mortality was 3.6%. Eighty-nine women had acute pancreatitis, and 12 women had chronic pancreatitis. The majority (66%) of cases of acute pancreatitis were biliary in origin, and they were associated with better outcomes than nonbiliary causes. Cases of gallstone pancreatitis that received surgical or endoscopic intervention during pregnancy had lower rates of preterm delivery and recurrence than those that were conservatively managed, but this difference was not significant (P=.2). Alcohol was responsible for 12.3% of acute pancreatitis cases and 58% of chronic pancreatitis cases and was associated with increased rates of recurrence and preterm delivery. A calcium level, triglycerides, or both was not obtained in half of cases identified as idiopathic. CONCLUSION: Pancreatitis is a rare event in pregnancy, occurring in approximately 3 in 10,000 pregnancies. Although it is most often acute and related to gallstones, nonbiliary causes should be sought because they are associated with worse outcomes.
LEVEL OF EVIDENCE: III.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2833089/pdf/nihms166128.pdf |
| Pancreatitis aguda durante el embarazo |
Acute Pancreatitis During Pregnancy
SHOU-JIANG TANG, EDMUNDO RODRIGUEZ-FRIAS, SUNDEEP SINGH, MARLYN J. MAYO, SAAD F. JAZRAWI, JAYAPRAKASH SREENARASIMHAIAH, LUIS F. LARA, and DON C. ROCKEY
Department of Gastroenterology, Hepatology & Endoscopy, Trinity Mother Frances Hospitals and Clinics, Tyler, Texas; Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:85-90
BACKGROUND & AIMS: Acute pancreatitis is rare during pregnancy; limited data are available about maternal and fetal outcomes. We investigated the effects of acute pancreatitis during pregnancy on fetal outcome. METHODS: This retrospective cohort study, performed at a single academic center, included consecutive pregnant women who presented with (n 96) or developed acute pancreatitis in the hospital (n 7) in 2000-2006 (mean age, 26 y). Patient histories and clinical data were collected from medical records. RESULTS: Of the 96 patients with spontaneous pancreatitis, 4 had complications: 1patient in the first trimester had acute peripancreatic fluid collection, and 3 patients in the third trimester developed disseminated vascular coagulation (DIC). None of these patients achieved term pregnancy, and 1 of the patients with DIC died. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 23 patients with acute pancreatitis; post-ERCP pancreatitis was diagnosed in 4 patients (a total of 11patients developed ERCP-associated pancreatitis). Term pregnancy
was achieved in 73 patients (80.2%). Patients who developed pancreatitis in the first trimester had the lowest percentage of term pregnancy (60%) and highest risks of fetal loss (20%) and preterm delivery (16%). Of the patients with pancreatitis in the second and third trimesters, only one had fetal loss. Fetal malformations were not observed. CONCLUSIONS: The majority of pregnant patients with acute pancreatitis did not have complications; most adverse fetal outcomes (fetal loss and preterm delivery) occurred during the first trimester. Acute pancreatitis, complicated by DIC, occurred most frequently in the third trimester and was associated with poor fetal and maternal outcomes.http://www.pancreasdoctors.com/Media/Clin%20Gastro%20Hep%202010-pancreatitis%20in%20pregnancy-Tang%5B1%5D.pdf
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