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Infection can complicate different stages of acute pancreatitis.The probability of infection is related to the existence and extent ofpancreatic necrosis: up to 30% of patients with pancreatic necrosis develop infection.The timing of infection is variable and usually peaks in the second to fourth week after the onset of pancreatitis.IPN(infected pancreatic necrosis)is the most common type of secondary pancreatic infection.Infectious complications in severe acute pancreatitis are associated with considerable morbidity and mortality.Antimicrobial therapy is one of the fundamental elements of therapy.Diagnosis of secondary pancreatic infection is challenging and radiologic characteristic (air bubble sign) and CT guided fine-needle aspiration (FNA) are reliable diagnostic strategies.Antibioticuse should be rational in terms of a rational indication, a rational spectrum, and a rationalduration.Prophylactic antibiotics are not beneficial in improving prognosis.The only rational indication for antibiotics is documented infection.The empirical antibiotics should cover common microbials of hospital-acquired intra-abdominal infection and with good pancreatic penetration.Also, fungal infections are often present in thesepatients, and early diagnosis and antifungal coverage should be considered.Duration is in fact largely determined by the presence and efficacy of source control.When there is no or minimal residual infection left after a source control procedure, a duration of 7 to 10 days is probably sufficient.On the other hand, if the source of infection has not been removed completely, prolonged courses until the residual necrosis has been sterilized are necessary.
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Objective To investigate whether emodin(1,3,8-trihydroxy-6-methylanthraquinone) can attenuate inflammatory response in rats' lungs with acute necrotic pancreatitis (ANP). Method Acute necrotic pancreatitis model was induced by injection of 3% sodium taurocholic acid into the subcapsular of pancreas and emodin was administered by intestine perfusion. Plasma amylase of 3, 6 and 12 h with acute necrotic pancreatitis was measured together with the detection of IL-1β, IL-6 and IL-10 mRNA expressions in rats' lungs by semi-quantitative RT-PCR. Immunohistochemistry was detected the expression of IL-1β converting enzyme (ICE) in the rats' lungs. Result Plasma amylase of 3, 6 and 12 h with acute necrotic pancreatitis groups are obviously high as compared with normal group(P＜0.05). Plasma amylase was (1 611.20±218.72)IU/L in normal group. Plasma amylase of 3, 6 and 12 h with acute necrotic pancreatitis groups were (1 981.40±56.81)IU/L, (3 287.40±612.37)IU/L and (4 914.60±746.82)IU/L. Plasma amylase of 3, 6 and 12 h with acute necrotic pancreatitis after treatment with emodin groups were obviously low as compared with acute necrotic pancreatitis groups. The plasma amylase was(1 617.20±136.80)IU/L,(2 323.40±318.19) IU/L and (2 670.20±390.03)IU/L respectively. The study showed that the mRNA expression of pro-inflammatory cytokin IL-1β and the expression of IL-6, as well as the expression of IL-1β converting enzyme(ICE) were decreased and IL-10 was increased. Conclusion The study demonstrates that emodin plays an important role in reducing plasma amylase level. Emodin exerts anti-inflammatory effects in acute necrotic pancreatitis rats' lungs by downregulating the mRNA expression of IL-1β and IL-6 and upregulating the mRNA expression of IL-10.
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Study on 70 acute pancreatitis patients (40 males, 30 females, aged 19 - 76) operated in Viet Duc Hospital from January 1999 to May 2002. Exclusive criteria: edema acute pancreatitis, necrotic pancreatitis without operation, necrotic pancreatitis was operated in basic settings. The results: the most of necrotic pancreatitis had no clear causes (74.28%). Mechanic causes included gallstone, worm (17.15%), acute pancreatitis after gall-pancreas area operation (1.43%). The disease was common in adults, mainly in 41-60 years old. In necrotic pancreatitis, pancreas could be necrotic very fast during the first 24 hours with shock, multi-organs failure, tympanites, vomit, peritoneum reaction and induction signs. The common symptoms were : increased blood amylase and urine amylase, leukocyte, blood urea, blood glucose; decreased blood calcium. CT scanner with a high accuracy rate (100%), was a gold criterion in diagnosis of necrotic pancreatitis. In operation, should minimized intervention. It is necessary to perform jejunotomy to decrease the expense due to intravenous feeding regularly.
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Pancreatitis , TherapeuticsABSTRACT
OBJECTIVE:To observe the pharmacological effect of Ulinastatin on acute necrotizing pancreatitis in rats.METHODS:Animal models were divided into3groups:group A,sham operation;group B,acute necrotic pancreatitis given no treatment;group C,acute necrotic pancreatitis treated with Ulinastatin.The changes of AMS and TNF-?were compared at different time among3groups.RESULTS:AMS and TNF-?in group C were significantly different from those in group A and in group B.CONCLUSION:Ulinastatin could remarkably improve the prognosis of acute necrotic pancreatitis.
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Objective To explore the protective effects of peritoneal dialysis on tissue and organ damage induced by acute hemorrhagic necrotic pancreatitis (AHNP) . Methods Thirty-four AHNP patients were randomly divided into PD group ( n = 21) and control group (n=13). Control group was treated with conventional therapy, while PD group was treated with conventional therapy companied by intermittent peritonea] dialysis (IPD). Urinary and serum amylase, the plasma levels of TNF and IL-1, faecal occult blood test and serum leucocyte were examined. Functions of brain, kidney , liver and heart were observed. Results The protective effect was better in PD group than that in normal group (P
ABSTRACT
The surgical management and the nutritional support in patients with AHNP were reported.We consider that the necrosis of the pancreas complicated with infection should be operated and that parenterally nutritional support could be helpful to patients with AHNP.