Hepatitis aguda alcohólica asociada a pancreatitis aguda grave / Acute alcoholic hepatitis and severe acute pancreatitis

Alcohol is a common cause of hepatic and pancreatic damage. Despite the widespread alcohol consumption simultaneous presentation of acute alcoholic hepatitis and pancreatitis is uncomnon. We describe a case of a patient with alcoholic hepatitis in association acute pancreatitis, who developed multiorgan failure and died. The association of liver and pancreatic disease in clinical practice is discussed.

El alcohol es un factor etiológico común de daño hepático y pancreático. A pesar de su extenso consumo la presentación simultánea de hepatitis y pancreatitis aguda alcohólica es excepcional. Se presenta un caso de esta situación, que evolucionó hacia la falla orgánica múltiple con desenlace fatal. Se discute la asociación de daño hepático y pancreático agudo en la práctica Clínica.

Relação lipase/amilase nas pancreatites agudas de causa biliar e nas pancreatites agudas/crônicas agudizadas de causa alcoólica / Lipase/amylase ratio in biliary acute pancreatitis and alcoholic acute/acutized chronic pancreatitis

RACIONAL: Pancreatites agudas de causas alcoólica ou biliar podem necessitar de abordagens terapêuticas diferentes. OBJETIVO: Verificar a validade da relação lipase/amilase em diferenciar as causas alcoólica ou biliar na pancreatite aguda/pancreatite crônica agudizada. MÉTODOS: Foram avaliados nove pacientes com pancreatite aguda/pancreatite crônica agudizada alcoólica, todos homens, com idade média (desvio padrão) de 39,8 ± 7,0 anos (grupo I) e 29 com pancreatite aguda biliar, sendo 8 homens e 21 mulheres, com idade média de 43,6 ± 19,9 anos (grupo II). As amilasemias e lipasemias foram determinadas em pacientes com sintomatologia há, no máximo, 48 horas. A relação lipase/amilase foi calculada utilizando-se valores de amilasemia e lipasemia expressas como múltiplos de seus respectivos valores superiores de referência. RESULTADOS: As médias das lipasemias (4.814 ± 3.670 U/L) e amilasemias (1.282 ± 777 U/L) no grupo I foram semelhantes às do grupo II (2.697 ± 2.391 e 1.878 ± 1.319 U/L, respectivamente), mas a média das relações lipase/amilase foi significantemente maior no grupo I (4,4 ± 3,6) do que no grupo II (2,2 ± 2,2). Relação lipase/amilase >3 foi significantemente mais freqüente no grupo I (66,7 por cento) do que no grupo II (24,1 por cento) e diferenciou os dois grupos com sensibilidade de 67 por cento e especificidade de 76 por cento. CONCLUSÕES: 1) as amilasemias e lipasemias não diferenciaram os dois grupos avaliados; 2) relação lipase/amilase >3 é mais freqüente na pancreatite aguda/pancreatite crônica agudizada alcoólica do que na pancreatite aguda biliar, e pode ser útil na diferenciação destas duas causas de pancreatite.

BACKGROUND: Alcoholic or biliary acute pancreatitis may need different therapeutic approaches. AIM: Assessing the validity of lipase/amylase ratio in differentiating biliary from alcoholic acute pancreatitis/acutized chronic pancreatitis. METHODS: Nine male patients (mean age and standard deviation: 39.8 ± 7.0 years) with alcoholic acute pancreatitis/acutized chronic pancreatitis (group I) and 29 patients, 8 male and 21 female (mean age: 43.6 ± 19.9 years), with biliary acute pancreatitis (group II) were evaluated. Serum lipase and amylase levels were measured in patients with symptoms for no more than 48 hours. The lipase/amylase ratio was calculated based on serum lipase and amylase levels and expressed as multiples of their respective superior reference values. RESULTS: Mean levels of serum lipase (4,814 ± 3,670 U/L) and amylase (1,282 ± 777 U/L) in patients of group I were comparable to group II (2,697 ± 2,391 and 1,878 ± 1,319 U/L, respectively), but the mean lipase/amylase ratio was significantly higher in group I (4.4 ± 3.6) than in group II (2.2 ± 2.2). Lipase/amylase ratio >3 occurred at significantly higher proportions in patients of group I (66.7 percent) than of group II (24.1 percent), differentiating the two groups with sensitivity of 67 percent and specificity of 76 percent. CONCLUSIONS: 1) Amylase and lipase serum levels did not differ in the two groups evaluated; 2) the lipase/amylase ratio >3 was more often seen in alcoholic acute pancreatitis/acutized chronic pancreatitis than biliary acute pancreatitis, and it may be useful in differentiating these two causes of pancreatitis.

Fatal Pancreatic Panniculitis Associated with Acute Pancreatitis: A Case Report

Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thick shadowy wall. We herein report a case of fatal pancreatic panniculitis that was associated with acute pancreatitis in a 50-yr-old man. He presented with a 3-week history of multiple tender skin nodules, abdominal pain and distension. Laboratory and radiologic findings revealed acute pancreatitis, and skin biopsy showed pancreatic panniculitis. Despite intensive medical care, he died of multi-organ failure 3 weeks after presentation.

Descriptive study of chronic calcific pancreatitis in Sri Lanka.

OBJECTIVES: To describe the potential risk factors, clinical features, biochemical and radiological features, and management of chronic calcific pancreatitis. DESIGN: Cross-sectional descriptive study. SETTING: Tertiary care general hospital. PATIENTS: Fifty patients with pancreatic calcification referred to the Colombo South Teaching Hospital, and 50 age-matched controls from healthy relatives or friends of the patients. MEASUREMENT: Height and weight measurements, immunoreactive insulin levels and trypsin levels of duodenal aspirates were estimated. Plain abdominal xray and ultrasonography were performed. INTERVENTION: Endoscopic retrograde cholangiopancreaticography (ERCP) was attempted on all patients during which duodenal aspirates were collected. Success rates of ERCP and response to endotherapeutic procedures were recorded. RESULTS: Twenty two of the 50 chronic calcific pancreatitis (CP) patients were diagnosed to have chronic alcoholic calcific pancreatitis (CACP). Mean age of the CACP patients was significantly higher than that of the chronic calcific pancreatitis of the tropics (CCPT) patients. Severe malnutrition (BMI < 20), frequent consumption of Manihot esculenta (manioc, cassava) and a high consumption of chilli or pepper were identified as possible risk factors for both alcoholic and non-alcoholic CP. Onset of diabetes occurred at a much younger age in the CCPT group than in the CACP group. Mean serum insulin was significantly higher in the CCPT group than in the CACP group and duodenal trypsin level was significantly lower in the CCPT than in CACP group. CONCLUSIONS: Our results confirm the existence of both alcoholic (CACP) and non-alcoholic (CCPT) types of chronic calcific pancreatitis in Sri Lanka. A larger study is required to confirm the associated risk factors such as Manihot esculenta and foods with a high content of chilli or pepper.

Ascite pancreática - relato de caso / Pancreatic ascites - a case report

Ascite pancreática (AP) é considerada causa incomum de ascite e consiste em acúmulo de fluído intraperitoneal exsudativo e rico em amilase, resultante da ruptura de pseudocisto ou ducto pancreático. Relatamos um caso de AP em paciente com pancreatite crônica alcoólica tratado de maneira conservadora, e revisamos aspectos acerca da fisiopatologia, diagnóstico e tratamento desta condiçäo clínica.