A study of etiological clinical biochemical and radiological profile of patients with acute pancreatitis in rural population

Authors

  • Shilpashree Channasandra Shekar Department of General Surgery, Mandya Institute of Medical Sciences, Mandya, Karnataka, India
  • Suhas Narayana Swamy Gowda Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka, India
  • Naveen Narayan Department of Plastic and Reconstructive Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka, India http://orcid.org/0000-0001-7125-5842
  • Ajay Nagraj Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka, India
  • Vishnu Venugopal Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka, India
  • Raghunandan Manjappa Kanmani Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20213587

Keywords:

Acute pancreatitis, Serum amylase, Serum lipase

Abstract

Background: Pancreatitis has been recognized since antiquity. Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other tissues or remote organ systems, presenting with variable clinical and systemic manifestations, presenting with mild self-limiting disease to severe life-threatening multi-organ failure.

Methods: This was a prospective study of 60 patients, who were admitted with the diagnosis of acute pancreatitis (AP) during the period from December 2017 to June 2019. The data was collected from the all the patients who met the inclusion criteria, and recorded in the proforma prepared for the study.

Results: Out of 60 patients 86.7% were male and 13.3% were female. The highest incidence was noted in 40-51 years age group (35%). Alcohol was the most common cause (75% patients). Abdominal pain was the most common mode of presentation (100%), and epigastric tenderness was the most common sign (100%). More than 3-fold elevation of serum amylase and lipase was seen in 26.7% and 33.3% of patients respectively. USG and CT scan was diagnostic only in 58.5% and 76.7% of patients respectively. All patients were managed conservatively. There was no mortality.

Conclusions: In AP patients one should not only rely on enzyme level elevations for diagnosing AP. Patients with only a small increase in amylase and/or lipase levels or even with normal levels may also have or develop acute pancreatitis. High degree of suspicion is required; USG, CT scan and enzyme levels study are complimentary to the clinical suspicion.

Author Biographies

Shilpashree Channasandra Shekar, Department of General Surgery, Mandya Institute of Medical Sciences, Mandya, Karnataka, India

Senior Resident, Department of General Surgery

Suhas Narayana Swamy Gowda, Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka, India

Assistant Professor, Department of General Surgery

Naveen Narayan, Department of Plastic and Reconstructive Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka, India

Associate Professor, Department of Plastic & Reconstructive Surgery

Ajay Nagraj, Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka, India

Post Graduate, Department of General Surgery

Vishnu Venugopal, Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka, India

Post Graduate, Department of General Surgery

Raghunandan Manjappa Kanmani, Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka, India

Post Graduate, Department of General Surgery

References

Fitz R. AP: a consideration of pancreatic haemorrhage, haemorrhagic, suppurative and gangrenous pancreatitis, and of disseminated fat necrosis. Boston Med Surg J. 1889;181.

Opie E. The aetiology of acute haemorrhagic pancreatitis. Bull John Hopkins Hospital. 1902;(74):398-401.

Peery AF, Dellon ES, Lund J, Crockett SD, Gowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143:1179-87.

Goldacre MJ, Roberts SE. Hospital admission for acute pancreatitis in an English population, 1963-98: database study of incidence and mortality. BMJ. 2004;328(7454):1466-9.

Quinlan JD. Acute pancreatitis. Am Fam Physician. 2014;90(9):632-9.

Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med. 1994;330(17):1198-210.

Toouli J, Smith M, Bassi C, Locke D, Telford J, Freeny P, et al. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol. 2002;17:15-39.

Matull WR, Pereira SP, O'Donohue JW. Biochemical markers of acute pancreatitis. J Clin Pathol. 2006;59(4):340-4.

Working Party of the British Society of Gastroenterology; Association of Surgeons of Great Britain and Ireland; Pancreatic Society of Great Britain and Ireland; Association of Upper GI Surgeons of Great Britain and Ireland. UK guidelines for the management of acute pancreatitis. Gut. 2005;54(3):1-9.

Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143(5):1179-87.

Büchler MW, Gloor B, Müller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg. 2000;232(5):619-26.

Choudhuri G. AP Experience at Sanjay Gandhi PGI of Medical Sciences, Lucknow, Appendix 1-B, in Management of AP, Jaslok Hospital. Path Shodh. 2006;176-8.

Kashid A. AP Experience at Manipal Hospital, Bangalore. Appendix 1-A, in Management of AP. Path Shodh. 2006;173-5.

Pupelis G. Conservative approach in the management of severe AP: eight-year experience in a single institution. HPB. 2008;10:347-55.

Entee GP, Gillen P, Peel AL. Alcohol induced pancreatitis: social and surgical aspects. Br J Surg. 1987;74(5):402-4.

Corfield AP, Cooper MJ, Williamson RC. Acute pancreatitis: a lethal disease of increasing incidence. Gut. 1985;26(7):724-9.

Thomson SR, Hendry WS, McFarlane GA, Davidson AI. Epidemiology and outcome of acute pancreatitis. Br J Surg. 1987;74(5):398-401.

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

Bhimwal RK, Makwana M, Panwar RR, Lal K. A prospective study of clinical, biochemical and radiological features in pancreatitis. Int J Adv Med. 2017;4:1386-93.

Villanueva M, Hijona E, Bañales JM, Cosme A, Bujanda L. Alcohol consumption on pancreatic diseases. World J Gastroenterol. 2013;19(5):638-47.

Imrie CW. Observations on AP. Br J Surg. 1974;61:539-44.

Kumar A. Clinical Study, Management of Complications of AP. Bangalore, Karnataka: Bangalore Medical College and Research Institute. Gandhi University of Health Sciences; 2010.

Nagesh VR. Clinical Study of AP and its Management. Karnataka, Hubli. Rajiv Gandhi University of Health Sciences; 2011.

Kurrey LK, Patel V, Gaharwar APS, Jayant V, Pandre SK, Kumar S. Clinical Study of Pancreatitis and Its Management: A Prospective Study. IJSS J Surg. 2017;3(3):27-33.

Sand J, Välikoski A, Nordback I. Alcohol consumption in the country and hospitalizations for acute alcohol pancreatitis and liver cirrhosis during a 20-year period. Alcohol Alcohol. 2009;44(3):321-5.

Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144(6):1252-61.

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

Forsmark CE, Baillie J, AGA Institute Clinical Practice and Economics Committee, AGA Institute Governing Board. AGA Institute technical review on acute pancreatitis. Gastroenterology. 2007;132(5):2022-44.

Webster PD, Spainhour JB. Pathophysiology and management of AP. Hosp Pract. 1974;9:59-66.

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

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

Abruzzo JL, Homa M, Houck JC, Coffey RJ. Significance of the serum amylase determination. Ann Surg. 1958;147:921-30.

Adams JT, Libertino JA, Schwartz SI. Significance of an elevated serum amylase. Surgery 1968;63:877-84.

Rehaman SA, Chandrashekhar S, Reuben PJ. Clinical study of AP. J Evol Med Dent Sci. 2015;4:10142-55.

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Published

2021-08-27

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Original Research Articles