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Table of Content - Volume 11 Issue 2 - August 2018
A cross sectional hospital based study of assessment of clinical and biochemical parameters of acute pancreatitis
Vinod Kumar Kandala
Assistant Professor, Department of General Medicine, MNR Medical College and Hospital, Sangareddy, Telangana, INDIA. Email: drambreeshphysio@gmail.com
Abstract Background: Pancreatitis defined as the inflammation of the pancreas and is always, associated with acinar cell injury. (Singer et al) Acute pancreatitis is clinically characterized by acute onset of abdominal pain and a rise in the activity of pancreatic enzymes in the blood and urine.1 Most attacks have a benign course but severe attacks may lead to shock, renal failure, respiratory failure and death. Materials and Methods: The present study was a cross sectional study hospital based carried out among 60 indoor cases of acute pancreatitis admitted under department of general medicine in a tertiary healthcare teaching institute in Telangana during February 2018 to April 2018. All the cases of suspected acute pancreatitis admitted under department of general medicine in a tertiary healthcare institute, and fulfils the set inclusion criteria, who consented to participate in the study were included in the present study. Results: In this study it was observed that 51.66% patients had a history of chronic alcoholism, 23.33% patients had history of smoking. It was found that 61.66% of study participants were having mixed pattern of diet, while 28.33% study participants were having strict vegetarian pattern of diet (Table 3). Conclusion: Early assessment of severity and intensive care management of acute pancreatitisis of paramount importance. Lab markers especially high values of lipase and other markers could be important prognostic markers for predicting morbidity and mortality in acute pancreatitis. Key Words: Pancreatitis, acinar cell injury, morbidity, mortality
INTRODUCTION Pancreatitis defined as the inflammation of the pancreas and is always, associated with acinar cell injury. (Singer et al) Acute pancreatitis is clinically characterized by acute onset of abdominal pain and a rise in the activity of pancreatic enzymes in the blood and urine.1 Most attacks have a benign course but severe attacks may lead to shock, renal failure, respiratory failure and death. Chronic pancreatitis is characterized clinically by recurrent or persistent episodes of abdominal pain.2 Although, in some cases, chronic pancreatitis occurs without pain, evidences of functional insufficiency such as steatorrhoea or diabetes is often seen. Clinically, the first manifestation of alcoholic chronic pancreatitis can closely resemble acute pancreatitis. (Steer ML et al).3 Various aetiological factors have been known to cause pancreatitis which include: gall stones, (Gorelick FS et al.), structural lesions like Stenosis or spasm of sphincter of oddi, pancreas divisum, traumatic, microlithiasis, toxins, alcohol, drugs, (frusemide tetracycline), infection (mumps, Coxsackie B-virus, viral hepatitis, HIV, salmonella, shigella, ascariasis lumbricoides), Metabolic (hyper-lipidemia, hypercalcemia), vascular (atherosclerosis, vasculitis, SLE, Wegener’s disease. Behcet’s disease) iatrogenic (ERCP, endoscopic sphincterotomy, coronary artery bypass) cystic fibrosis etc.4,5,6Various studies have been undertaken in India and abroad about pancreatitis, its presentation and role of various laboratory and imaging techniques for diagnosis and prognostication. We have undertaken this study to know various clinical, laboratory and imaging features of acute and chronic pancreatitis in our region.
MATERIALS AND METHODS The present study was a cross sectional study hospital based carried out among 60 indoor cases of acute pancreatitis admitted under department of general medicine in a tertiary healthcare teaching institute in Telangana during February 2018 to April 2018.All the cases of suspected acute pancreatitis admitted under department of general medicine in a tertiary healthcare institute, and fulfils the set inclusion criteria, who consented to participate in the study were included in the present study. Method of Data Collection: The data was collected from cases fulfilling inclusion criteria using pre-designed, semi-structured, pre-validated proforma, in which history, clinical findings, investigation reports, were incorporated. Cases of acute pancreatitis were evaluated with detailed history, clinical signs and symptoms, the duration and investigations. Blood and urine investigations, Ultrasonography (USG) Abdomen and/or Computerised Tomography.7,8,9
RESULTS Table 1: Distribution of patients according to age group
Table 2: gender wise distribution of patients
Out of 60 study participants, 71.66% were males and 28.34% were females (Table 2). Here we observed that male participants outnumbered the female participants.
Table 3: Distribution of patients according to their personal history
In this study it was observed that 51.66% patients had a history of chronic alcoholism, 23.33% patients had history of smoking. It was found that 61.66% of study participants were having mixed pattern of diet, while 28.33% study participants were having strict vegetarian pattern of diet (Table 3).
Table 4: Distribution of participants according to their clinical presentation
The clinical presentation of cases of acute pancreatitis observed as per the present study was as given in Table 5. Almost all patients (81.66%) with PP presented with abdominal pain and lump in abdomen (92%). 50% had complaints of fever, 38.33% presented with nausea and vomiting. 33.33% cases complained of weight loss. (Table 4).
Table 5: Patient distribution according to General examination positive findings
Among the 60 Patients with acute pancreatitis, it was found that 48.33% were febrile, 36.66% patients were having raised respiratory rate, 33.33% were having pallor whereas 21.66% cases presented with icterus inlocal examination, 65% cases had tenderness. It was found that 26.66% cases presented with hypertension rest all had blood pressure within normal range. (Table 5).
Table 6: Blood investigations observations
DISCUSSION Age Incidence: Out of 60 study participants, 71.66% were males and 28.34% were females. Here we observed that male participants outnumbered the female participants Crisanto BA et al11, in their study found mean age of participants as 38.8 years (47). Khaled YS et al12 reports 55 years as a mean age of study subjects (50). Hauters P et al13 observes that the median age of 46 years (range: 30-72) (46). Similarly study by Simo KA et al14 reports the median age of the cohort was 49.5 ± 12 years (range = 18-71) (49).Personal History In this study it was observed that 54% patients had a history of chronic alcoholism, 24% patients had history of smoking. It was found that 70% of study participants were having mixed pattern of diet, while 10 30% study participants were having strict vegetarian pattern of diet. Crisanto BA et al,15 in their study found that 29% cases gave history of alcoholism (47). Park et al found history of alcoholism in 18.5% cases, while Hamza et al,16 Mori et al17 and Hauters P et al18 found that 30% cases had history of alcoholism (52)(46)(54).19Clinical Presentation of Pancreatic Pseudocyst The clinical presentation of cases of acute pancreatitis observed as per thepresent study was as given in Table 5. Almost all patients (96%) with PP presented with abdominal pain and lump in abdomen (92%). 62% had complaints of fever, 46% presented with nausea and vomiting. 40% cases complained of weight loss. BA Crisanto-Campos et al4 in their study reported that out of 17 cases, 15 complained of epigastric pain, 6 cases reported with early satiety, 3 cases reported with weight loss and 2 cases reported with infected pancreatic pseudocyst (47).General Findings Among the 50 Patients with acute pancreatitis, it was found that 56% were febrile, 40% patients were having raised respiratory rate, 36% were having pallor whereas 24% cases presented with icterus In local examination, 76% cases had tenderness. It was found that 32% cases presented with hypertension rest all had blood pressure within normal range. Investigations Findings In present study, it was found that 12 cases presented with haemoglobin less than 10 mg/dl (Anaemia), In 40 cases raised TLC was observed (More than 12000), same cases presented with fever. 20Rest of the cases were having TLC less than 12000. Random blood sugar estimation was done among the cases of acute pancreatitis, it was found that 18 cases were having BSR more than 200 mg/dl. Serum bilirubin estimation was also done, 42 cases were found with serum bilirubin more than 1.5 mg. Serum lipase values were found to be elevated in majority of cases (39), which is considered to be suggestive of pancreatitis.
CONCLUSION Early assessment of severity and intensive care management of acute pancreatitisis of paramount importance. Lab markers especially high values of lipase and other markers could be important prognostic markers for predicting morbidity and mortality in acute pancreatitis. REFERENCES
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