Pancreatitis y embarazo

Pancreatitis aguda en el embarazo Acute pancreatitis in pregnancy. Pitchumoni CS, Yegneswaran B. Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ 08901, USA. pitchumoni@hotmail.com World J Gastroenterol. 2009 Dec 7;15(45):5641-6. Abstract Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10,000 pregnancies. The spectrum of AP in pregnancy ranges from mild pancreatitis to serious pancreatitis associated with necrosis, abscesses, pseudocysts and multiple organ dysfunction syndromes. Pregnancy related hematological and biochemical alterations influence the interpretation of diagnostic tests and assessment of severity of AP. As in any other disease associated with pregnancy, AP is associated with greater concerns as it deals with two lives rather than just one as in the non-pregnant population. The recent advances in clinical gastroenterology have improved the early diagnosis and effective management of biliary pancreatitis. Diagnostic studies such as endoscopic ultrasound, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography and therapeutic modalities that include endoscopic sphincterotomy, biliary stenting, common bile duct stone extraction and laparoscopic cholecystectomy are major milestones in gastroenterology. When properly managed AP in pregnancy does not carry a dismal prognosis as in the past. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789215/pdf/WJG-15-5641.pdf  Necrosis pancreática asociada con preeclampsia-eclampsia Pancreatic necrosis associated with preeclampsia-eclampsia. Parmar MS. Department of Medicine, University of Ottawa, Canada.parmar@vianet.on.ca JOP. 2004 Mar;5(2):101-4. Abstract CONTEXT: Acute pancreatitis during pregnancy is rare and commonly occurs in association with biliary disease. Preeclampsia is associated with microvascular abnormalities that may involve cerebral, placental, hepatic, renal and splanchnic circulation and rarely can cause acute pancreatitis. CASE REPORT: A case of acute pancreatitis in a patient with preeclampsia-eclampsia where the diagnosis was missed initially that resulted in a protracted course and development of organized pancreatic necrosis. The pancreatic necrosis resolved with conservative management over 8 weeks. CONCLUSIONS: The development of severe hypoalbuminemia, out of proportion to proteinuria, hypocalcemia and findings of capillary leak should alert the physician to search for other inflammatory causes, including acute pancreatitis so that early and effective management be given to avoid complications. http://www.joplink.net/prev/200403/200403_08.pdf   Pancreatitis aguda y embarazo Dra. Magali Herrera Gomar, Dr. Norberto C. Chávez-Tapia, Dr. Javier Lizardi Cervera Médica Sur  Vol. 10, núm. 2, Abril-Junio 2003 Resumen La pancreatitis aguda es una complicación rara del embarazo; habitualmente se presenta en el tercer trimestre, y el 68% de los casos se debe a litiasis vesicular. El síntoma principal de la pancreatitis, es dolor epigástrico y periumbilical irradiado a la espalda. Es común encontrar hiperamilasemia y aumento del índice depuración amilasa/creatinina, leucocitosis e hiperglucemia. La tomografía dinámica del páncreas proporciona una valiosa información acerca de la severidad y el pronóstico en algunos casos. La interrupción del embarazo no es mandatoria, depende de las condiciones del producto y de las complicaciones maternas derivadas de la pancreatitis. La mortalidad materno-fetal es superior al 37%. La decisión de cuál será el manejo debe ser individualizado, tomando en cuenta la historia de la paciente, la edad gestacional y la respuesta de la enfermedad a la terapia conservadora. http://www.medigraphic.com/pdfs/medsur/ms-2003/ms032f.pdf

Atentamente Dr. Benito Cortes-Blanco Anestesiología y Medicina del Dolor www.anestesia-dolor.org