A prospective study of clinical, biochemical and radiological features in pancreatitis

Authors

  • Raj Kumar Bhimwal Department of Medicine, Dr S. N. Medical College, Jodhpur, Rajasthan, India
  • Mohan Makwana Department of Paediatrics, Dr S. N. Medical College, Jodhpur, Rajasthan, India
  • Rewat Ram Panwar Department of Medicine, Dr S. N. Medical College, Jodhpur, Rajasthan, India
  • Kanwar Lal Department of Zoology, Jai Narayan Vyas University, Jodhpur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20174289

Keywords:

Computed tomography scan, Pancreatitis, Ultrasonography

Abstract

Background: Pancreatitis is quite common problem, it may present either as abdominal emergency with fulminant course or as an indolent process leading to long-term medical as well as surgical complications often leading to poor prognosis if not intervened timely.

Methods: The present study conducted in the department of medicine, Dr. S. N. medical college, Jodhpur. Participants after understanding the study protocol and procedure, asked to give their written consent for the study. A cross sectional hospital based study in patients admitted in various medical wards of Dr. S. N. medical college, Jodhpur. 50 patients with acute and chronic pancreatitis were studied.

Results: In the present study, most common cause of acute pancreatitis is biliary disease (50%) followed by alcoholism (37.5%) and in chronic pancreatitis is alcoholism (80%). Acute pancreatitis was more common in males (62.5%, 25 males) whereas chronic pancreatitis in males (80%, 8 male). Abdominal pain is the most common symptom (97.5%) followed by nausea-vomiting (92.5%) in acute pancreatitis. The history of previous abdominal pain in 100% of cases followed by epigastria pain in 90% of cases, in chronic pancreatitis. The amylase and lipase were elevated in 90% of cases. The amylase and lipase levels did not correlate with the severity. 66.6% of patients had severe pancreatitis with a positive predictive value of 66.6%. The ultrasonography imaging of pancreas was helpful in 70% and 100% in acute and chronic pancreatitis respectively. The CT scan was a better imaging modality as compared to ultrasonography in acute pancreatitis, where as it scored over ultrasonography imaging in chronic pancreatitis with complications.

Conclusions: Relevant clinical history, ultrasonography and computed tomography scan of pancreas are helpful in diagnosis of pancreatitis. The computed tomography scan was a better imaging modality as compared to ultrasonography.

References

Singer MV, Gyr K, Sarles H. Revised classification of pancreatitis. Gastroenterol. 1985;89:683.

Steer ML. Classification and pathogenesis of pancreatitis. Surg Clin North America. 1989;69(3):467-80.

Karne S, Gorelick FS. Etiopathogenesis of acute pancreatitis. Surgical Clinics North America. 1999;79(4):699-710.

McMahon MJ, Playforth MJ, Pickford IR. A comparative study of method for prediction of severity of attacks of acute pancreatitis. Br J Surg. 1980;67:22-5.

Greenberger NJ, Tosker PP, Isselbacher KJ. Acute and Chronic pancreatitis. 14th edition. Harrisons (Principles of internal medicines. 1998:1741-1752.

McEntee GP, Gillen P, Peel AL. Alcohol induced pancreatitis Social and Surgical aspects. Br J Surg. 1987;74:402-4.

Corfield AR, Cooper MJ, Williamson RW. Acute pancreatitis- a lethal disease of increasing incidence. Gut. 1985;26:724-9.

Balaji LN, Tandon RS, Tandon BN, Banks PA. Prevalence and clinical feature of chronic pancreatitis in southern India. Int Pancreatol. 1994;15(1):29-34.

Thomson SR, Hendry WS, Mc Farlane GA, Davidson A. Epidemiology and outcome of acute pancreatitis. Br J Surg. 1987;74:398-401.

Gillesie WJ. Observation on acute pancreatitis. Br J Surg. 1973;60:63-5.

Imrie CW, Whyte AS. A prospective study of acute pancreatitis. Brit J Surg. 1975;62:490-4.

Blarney SL, Imrie CW, Weill JO, Gilmour WH, Carter DC. Prognostic factor in acute pancreatitis. Gut. 1984;25(12):1340-6.

Park J, Fromkes J, Cooperman M. Acute pancreatitis in elderly patients: pathogenesis and outcome. Am J Surg. 1986;152:638-42.

Jacobs ML, Daggett WM, Civette JM, Vasu MA, Lawson DW, Warshaw AL, et al. Acute pancreatitis: analysis of factors influencing survival. Ann Surg. 1977;185(1):43.

Aranha GV, Prinz RA, Freeark RJ, Greenlee HB. The spectrum of biliary tract obstruction from chronic pancreatitis. Arch Surg. 1984;119(5):595-600.

Johnson CD, Imre CW, Verlag S. Chronic calcifying pancreatitis in temperate countries. Pancreatic Disease Progress Prospects. 1991:171-82.

Sarles H, Bernard JP, Johnson C. Pathogenesis and epidemiology of chronic pancreatitis. Annual Review Med. 1989;40:453-68.

Albo R, Silen W, Goldman L. A critical clinical analysis of acute pancreatitis. Arch Surg. 1963;86(6):1032-8.

Saxona A, Reynolds JT, Doolas A. Management of pancreatic abscess. Ann Surg. 1981;194:545-51.

Rai RR, Acharya SK, Nundy S, Vashisht S, Tandon RK. Chronic calcific pancreatitis: clinical profile in northern India. J Gastroenterol. 1988;23(2):195-200.

Lankisch PH, Seidensticker F, Lohr-happe A, Otto J, Creutzfoldt W. The course of pain is the same alcohol and non-alcohol induced chronic pancreatitis-pancreas. 1995;4:338-41.

Pezzilli R, Billi P, Migliori M, Gullo L. Clinical value of pancreatitis- associated protein in acute pancreatitis. Am J Gastroenterol. 1997;92(10):1887-90.

Lifton LJ, Slickers KA, Pragay DA, Katz LA. Pancreatitis and lipase: a re-evaluation with a five-minute turbidimetric lipase determination. JAMA. 1974;229(1):47-50.

Patt HH, Kramer SP, Woel G, Zeitung D, Seligman AM. Seligman Baltimore. Serum Lipase Determination in Acute Pancreatitis. Clinical Appraisal New Method. Arch Surg. 1966;92(5):718-23.

Lawson TL. Sensitivity of pancreatic ultrasonography in the detection of pancreatic disease. Radiol. 1978;128:733-6.

Husband JE, Merle HB, Kreel L. Comparison of ultrasonography and computer assisted tomography is pancreatic diagnosis. Brit J Radiol. 1977;50:855-62.

Silverstein W, Isikoff MB, Hill MC, Barkin J. Diagnostic imaging of acute pancreatitis: prospective study using CT and sonography. Am J Roentgenol. 1981;137(3):497-502.

Ferrucci JT, Wittenberg J, Black EB, Kirkpatrick RH, Hall DA. Computed body tomography in chronic pancreatitis. Radiol. 1979;130:175-82.

Hill MC, Barkin J, Isikoff MB, Silverstein W, Kalser M. Acute pancreatitis: clinical vs. CT findings. American J Roentgenol. 1982;139(2):263-9.

Block S, Maier W, Bittner R, Buchler M, Malfertheiner P, Beger HG. Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging. Gut. 1986;27(9):1035-42.

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Published

2017-09-22

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