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Pancreatitis

From Wikipedia, the free encyclopedia

Pancreatitis
Thepancreasand surroundingorgans
Specialty
Symptoms
ComplicationsInfection, bleeding,diabetes mellitus,[1]pancreatic cancer, kidney failure, breathing problems, malnutrition[2]
DurationShort or long term[1]
Causes
Risk factorsSmoking[3][4]
Diagnostic methodBased on symptoms, bloodamylaseorlipase[5][1]
TreatmentIntravenous fluids,pain medication,antibiotics[1]
Frequency8.9 million (2015)[6]
Deaths132,700 (2015)[7]

Pancreatitisis a condition characterized byinflammationof thepancreas.[1]The pancreas is a large organ behind thestomachthat producesdigestive enzymesand a number ofhormones.[1]There are two main types:acute pancreatitis,andchronic pancreatitis.[1]

Signs and symptoms of pancreatitis includepain in the upper abdomen,nauseaandvomiting.[1]The pain often goes into the back and is usually severe.[1]In acute pancreatitis, afevermay occur; symptoms typically resolve in a few days.[1]In chronic pancreatitis weight loss,fatty stool,anddiarrheamay occur.[1][5]Complications may include infection, bleeding,diabetes mellitus,or problems with other organs.[1]

The two most common causes of acute pancreatitis are agallstoneblocking thecommon bile ductafter thepancreatic ducthas joined; and heavyalcoholuse.[1]Other causes include direct trauma, certain medications, infections such asmumps,andtumors.[1]Chronic pancreatitis may develop as a result of acute pancreatitis.[1]It is most commonly due to many years of heavy alcohol use.[1]

Other causes includehigh levels of blood fats,high blood calcium,some medications, and certaingenetic disorders,such ascystic fibrosis,among others.[1]Smokingincreases the risk of both acute and chronic pancreatitis.[3][4]Diagnosis of acute pancreatitis is based on a threefold increase in the blood of eitheramylaseorlipase.[1]In chronic pancreatitis, these tests may be normal.[1]Medical imagingsuch asultrasoundandCT scanmay also be useful.[1]

Acute pancreatitis is usually treated withintravenous fluids,pain medication,and sometimesantibiotics.[1]Typically eating and drinking are disallowed, and anasogastric tubeis placed in the stomach.[1]A procedure known as anendoscopic retrograde cholangiopancreatography(ERCP) may be done to examine the distal common bile duct and remove a gallstone if present.[1]In those with gallstones thegallbladderis often alsoremoved.[1]In chronic pancreatitis, in addition to the above, temporary feeding through a nasogastric tube may be used to provide adequate nutrition.[1]Long-term dietary changes andpancreatic enzyme replacementmay be required.[1]Occasionally, surgery is done to remove parts of the pancreas.[1]

Globally, in 2015 about 8.9 million cases of pancreatitis occurred.[6]This resulted in 132,700 deaths, up from 83,000 deaths in 1990.[7][8]Acute pancreatitis occurs in about 30 per 100,000 people a year.[3]New cases of chronic pancreatitis develop in about 8 per 100,000 people a year and currently affect about 50 per 100,000 people in the United States.[9]It is more common in men than women.[1]Often chronic pancreatitis starts between the ages of 30 and 40 and is rare in children.[1]Acute pancreatitis was first described on autopsy in 1882 while chronic pancreatitis was first described in 1946.[9]

Signs and symptoms

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The most common symptoms of pancreatitis are severeupper abdominalorleft upper quadrantburning painradiatingto the back,nausea,andvomitingthat is worse with eating. The physical examination will vary depending on severity and presence ofinternal bleeding.Blood pressuremay be elevated by pain or decreased bydehydrationor bleeding.Heartandrespiratory ratesare often elevated. The abdomen is usuallytenderbut to a lesser degree than the pain itself. As is common in abdominal disease,bowel soundsmay be reduced from reflexbowel paralysis.Feverorjaundicemay be present.Chronic pancreatitiscan lead todiabetesorpancreatic cancer.Unexplained weight loss may occur from a lack ofpancreatic enzymeshinderingdigestion.[citation needed]

Complications

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Early complications includeshock,infection,systemic inflammatory response syndrome,low blood calcium, high blood glucose, anddehydration.Blood loss, dehydration, andfluid leakinginto theabdominal cavity(ascites) can lead tokidney failure.Respiratory complications are oftensevere.Pleural effusionis usually present. Shallow breathing from pain can lead tolung collapse.Pancreatic enzymes may attack the lungs, causinginflammation.Severe inflammation can lead to intra-abdominal hypertension andabdominal compartment syndrome,further impairing renal and respiratory function and potentially requiring management with an open abdomen to relieve the pressure.[10]

Late complications include recurrent pancreatitis and the development ofpancreatic pseudocysts—collections of pancreatic secretions that have been walled off by scar tissue. These may cause pain, become infected, rupture and bleed, block the bile duct and causejaundice,or migrate around the abdomen. Acute necrotizing pancreatitis can lead to apancreatic abscess,a collection ofpuscaused bynecrosis,liquefaction,andinfection.This happens in approximately 3% of cases or almost 60% of cases involving more than two pseudocysts and gas in the pancreas.[11]

Causes

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Eighty percent of cases of pancreatitis are caused by alcohol orgallstones.Gallstones are the single most common cause of acute pancreatitis.[12]Alcoholis the single most common cause of chronic pancreatitis.[13][14][15][16][17]Triglyceride levels greater than 1000 mg/dL (11.29 mmol/L) is another cause.[18]

Medications

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There are seven classes of medications associated with acute pancreatitis:statins,ACE inhibitors,oral contraceptives/hormone replacement therapy(HRT),diuretics,antiretroviral therapy,valproic acid,andoral hypoglycemic agents.Mechanisms of these drugs causing pancreatitis are not known exactly, but it is possible that statins have direct toxic effect on the pancreas or through the long-term accumulation of toxic metabolites. Meanwhile, ACE inhibitors causeangioedemaof the pancreas through the accumulation ofbradykinin.Birth control pills and HRT causearterial thrombosisof the pancreas through the accumulation of fat (hypertriglyceridemia). Diuretics such as furosemide have a direct toxic effect on the pancreas. Meanwhile, thiazide diuretics cause hypertriglyceridemia andhypercalcemia,where the latter is the risk factor for pancreatic stones.[citation needed]

HIV infection itself can cause a person to be more likely to get pancreatitis. Meanwhile, antiretroviral drugs may cause metabolic disturbances such ashyperglycemiaandhypercholesterolemia,which predisposes to pancreatitis. Valproic acid may have direct toxic effect on the pancreas.[19]Various oral hypoglycemic agents are associated with pancreatitis includingmetformin,butglucagon-like peptide-1mimetics such asexenatideare more strongly associated with pancreatitis by promoting inflammation in combination with a high-fat diet.[20]

Atypicalantipsychoticssuch asclozapine,risperidone,andolanzapinecan also cause pancreatitis.[21]

Infection

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A number of infectious agents have been recognized as causes of pancreatitis including:[22][23][24]

Other

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Other common causes includetrauma,autoimmune disease,high blood calcium,hypothermia,andendoscopic retrograde cholangiopancreatography(ERCP).Pancreas divisumis a commoncongenital malformationof the pancreas that may underlie some recurrent cases.Diabetes mellitus type 2is associated with a 2.8-fold higher risk.[25]

Less common causes includepancreatic cancer,pancreatic duct stones,[26]vasculitis(inflammation of the smallblood vesselsin the pancreas), andporphyria—particularlyacute intermittent porphyriaanderythropoietic protoporphyria.[citation needed]

There is aninherited formthat results in the activation oftrypsinogenwithin the pancreas, leading toautodigestion.Involved genes may includetrypsin 1,which codes for trypsinogen,SPINK1,which codes for atrypsin inhibitor,orcystic fibrosis transmembrane conductance regulator.[27]

ThemnemonicGETSMASHED is often used to remember the common causes of pancreatitis: G—gallstones, E—ethanol, T—trauma, S—steroids, M—mumps, A—autoimmune pancreatitis, S—scorpion sting,H—hyperlipidemia,hypothermia, hyperparathyroidism, E—endoscopic retrograde cholangiopancreatography, D—drugs (commonlyazathioprine,valproic acid,liraglutide).[28]

Diagnosis

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Acute exudative pancreatitis on CT scan
Calcified pancreatic duct stones with some free intra-abdominal fluid

The differential diagnosis for pancreatitis includes but is not limited tocholecystitis,choledocholithiasis,perforated peptic ulcer,bowel infarction,small bowel obstruction,hepatitis,andmesenteric ischemia.[29]

Diagnosisrequires 2 of the 3 following criteria:

  • Characteristic acute onset ofepigastricor vague abdominal pain that mayradiateto the back (see signs and symptoms above)
  • Serumamylaseorlipaselevels ≥ 3 times the upper limit of normal
  • An imaging study with characteristic changes.CT,MRI,abdominal ultrasound or endoscopic ultrasound can be used for diagnosis.

Amylase and lipase are 2 enzymes produced by the pancreas. Elevations in lipase are generally considered a better indicator for pancreatitis as it has greaterspecificityand has a longer half life.[30]However, both enzymes can be elevated in other disease states. In chronic pancreatitis, the fecalpancreatic elastase-1 (FPE-1) test is a marker of exocrine pancreatic function. Additional tests that may be useful in evaluating chronic pancreatitis includehemoglobin A1C,immunoglobulin G4,rheumatoid factor,andanti-nuclear antibody.[31]

For imaging, abdominal ultrasound is convenient, simple, non-invasive, and inexpensive.[32]It is more sensitive and specific for pancreatitis from gallstones than other imaging modalities.[30]However, in 25–35% of patients the view of the pancreas can be obstructed by bowel gas making it difficult to evaluate.[29]

A contrast-enhanced CT scan is usually performed more than 48 hours after the onset of pain to evaluate for pancreatic necrosis and extrapancreatic fluid as well as predict the severity of the disease. CT scanning earlier can be falsely reassuring.[33]

ERCPor an endoscopic ultrasound can also be used if a biliary cause for pancreatitis is suspected.[citation needed]

Treatment

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The treatment of pancreatitis is supportive and depends on severity.Morphinegenerally is suitable for pain control. There are no clinical studies to suggest that morphine can aggravate or cause pancreatitis or cholecystitis.[34]

The treatment for acute pancreatitis will depend on whether the diagnosis is for the mild form of the condition, which causes no complications, or the severe form, which can cause serious complications.[citation needed]

Mild acute pancreatitis

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The treatment of mildacute pancreatitisis successfully carried out by admission to a general hospital ward. Traditionally, people were not allowed to eat until the inflammation resolved but more recent evidence suggests early feeding is safe and improves outcomes, and may result in an ability to leave the hospital sooner.[35]

Due to inflammation occurring in pancreatitis, proinflammatorycytokinessecreted into the bloodstream can causeinflammationthroughout the body, including the lungs and can manifest asARDS.Because pancreatitis can cause lung injury and affect normal lung function,supplemental oxygenis occasionally delivered through breathing tubes that are connected via the nose (e.g., nasal cannulae) or via a mask. The tubes can then be removed after a few days once it is clear that the condition is improving.

Dehydration may result during an episode of acute pancreatitis, so fluids will be provided intravenously.

Opioids may be used for the pain. When the pancreatitis is due to gallstones, early gallbladder removal also appears to improve outcomes.[36]

Severe acute pancreatitis

[edit]

Severe pancreatitis can causeorgan failure,necrosis,infected necrosis,pseudocyst,andabscess.If diagnosed with severe acute pancreatitis, people will need to be admitted to ahigh-dependency unitorintensive care unit.It is likely that the levels of fluids inside the body will have dropped significantly as it diverts bodily fluids and nutrients in an attempt to repair the pancreas. The drop in fluid levels can lead to a reduction in the volume of blood within the body, which is known ashypovolemicshock. Hypovolemic shock can be life-threatening as it can very quickly starve the body of the oxygen-rich blood that it needs to survive. To avoid going into hypovolemic shock, fluids will be administered intravenously. Oxygen will be supplied through tubes attached to the nose and ventilation equipment may be used to assist with breathing. Feeding tubes may be used to provide nutrients, combined with appropriate analgesia.

As with mild pancreatitis, it will be necessary to treat the underlying cause—gallstones, discontinuing medications, cessation of alcohol, etc. If the cause is gallstones, it is likely that anERCPprocedure or removal of the gallbladder will be recommended. The gallbladder should be removed during the same hospital admission or within two weeks of pancreatitis onset so as to limit the risk of recurrent pancreatitis.

If the cause of pancreatitis is alcohol, cessation of alcohol consumption and treatment for alcohol dependency may improve pancreatitis. Even if the underlying cause is not related to alcohol consumption, doctors recommend avoiding it for at least six months as this can cause further damage to the pancreas during the recovery process.[37]

Oral intake, especially fats, is generally restricted initially but early enteral feeding within 48 hours has been shown to improve clinical outcomes.[38]Fluidsandelectrolytesare replacedintravenously.Nutritional support is initiated via tube feeding to surpass the portion of the digestive tract most affected by secreted pancreatic enzymes if there is no improvement in the first 72–96 hours of treatment.[39]

Prognosis

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Severe acute pancreatitis hasmortality ratesaround 2–9%, higher wherenecrosisof the pancreas has occurred.[40]

Several scoring systems are used to predict the severity of an attack of pancreatitis. They each combine demographic and laboratory data to estimate severity or probability of death. Examples includeAPACHE II,Ranson,BISAP, and Glasgow. The Modified Glasgow criteria suggests that a case be considered severe if at least three of the following are true:[41]

This can be remembered using the mnemonic PANCREAS:

The BISAP score (blood urea nitrogen level >25 mg/dL (8.9 mmol/L),impaired mental status,systemic inflammatory response syndrome,age over 60 years,pleural effusion) has been validated as similar to other prognostic scoring systems.[42]

Epidemiology

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Globally the incidence of acute pancreatitis is 5 to 35 cases per 100,000 people. The incidence of chronic pancreatitis is 4–8 per 100,000 with a prevalence of 26–42 cases per 100,000.[43]In 2013 pancreatitis resulted in 123,000 deaths up from 83,000 deaths in 1990.[8]

Costs

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In adults in the United Kingdom, the estimated average totaldirect and indirect costsof chronic pancreatitis is roughly £79,000 per person on an annual basis.[44]Acute recurrent pancreatitis and chronic pancreatitis occur infrequently in children, but are associated with high healthcare costs due to substantialdisease burden.[45]Globally, the estimated average total cost of treatment for children with these conditions is approximately $40,500/person/year.[45]

Other animals

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Fatty foods may causecanine pancreatitisindogs.[46]

See also

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References

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  1. ^abcdefghijklmnopqrstuvwxyzaaabacadae"Pancreatitis".niddk.nih.gov.August 16, 2012.Archivedfrom the original on 7 March 2015.Retrieved1 March2015.
  2. ^"Patient Care & Health Information > Diseases & Conditions: Pancreatitis".Mayo Clinic.4 June 2022.
  3. ^abcLankisch PG, Apte M, Banks PA (July 2015)."Acute pancreatitis".Lancet.386(9988): 85–96.doi:10.1016/S0140-6736(14)60649-8.PMID25616312.S2CID25600369.
  4. ^abYadav D, Lowenfels AB (June 2013)."The epidemiology of pancreatitis and pancreatic cancer".Gastroenterology.144(6): 1252–61.doi:10.1053/j.gastro.2013.01.068.PMC3662544.PMID23622135.
  5. ^abWitt H, Apte MV, Keim V, Wilson JS (April 2007)."Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy".Gastroenterology.132(4): 1557–73.doi:10.1053/j.gastro.2007.03.001.PMID17466744.
  6. ^abVos T, et al. (October 2016)."Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015".Lancet.388(10053): 1545–1602.doi:10.1016/S0140-6736(16)31678-6.PMC5055577.PMID27733282.
  7. ^abWang H, et al. (October 2016)."Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015".Lancet.388(10053): 1459–1544.doi:10.1016/s0140-6736(16)31012-1.PMC5388903.PMID27733281.
  8. ^abGBD 2013 Mortality Causes of Death Collaborators (January 2015)."Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013".Lancet.385(9963): 117–71.doi:10.1016/S0140-6736(14)61682-2.PMC4340604.PMID25530442.
  9. ^abMuniraj T, Aslanian HR, Farrell J, Jamidar PA (December 2014). "Chronic pancreatitis, a comprehensive review and update. Part I: epidemiology, etiology, risk factors, genetics, pathophysiology, and clinical features".Disease-a-Month.60(12): 530–50.doi:10.1016/j.disamonth.2014.11.002.PMID25510320.
  10. ^Fitzgerald JE, Gupta S, Masterson S, Sigurdsson HH (April 2013)."Laparostomy management using the ABThera™ open abdomen negative pressure therapy system in a grade IV open abdomen secondary to acute pancreatitis".International Wound Journal.10(2): 138–44.doi:10.1111/j.1742-481X.2012.00953.x.PMC7950789.PMID22487377.S2CID2459785.
  11. ^Pancreatic abscessateMedicine
  12. ^NIDDK (July 2008)."Pancreatitis".National Digestive Diseases Information Clearinghouse.U.S. National Institute of Diabetes and Digestive and Kidney Diseases. 08–1596. Archived fromthe originalon 2007-01-07.Retrieved2007-01-05.
  13. ^"Pancreatitis".A.D.A.M., Inc.Archivedfrom the original on 2012-12-30.Retrieved2013-01-05.
  14. ^Apte MV, Pirola RC, Wilson JS (June 2009). "Pancreas: alcoholic pancreatitis—it's the alcohol, stupid".Nature Reviews. Gastroenterology & Hepatology.6(6): 321–2.doi:10.1038/nrgastro.2009.84.PMID19494819.S2CID6580794.
  15. ^Yadav D, Hawes RH, Brand RE, Anderson MA, Money ME, Banks PA, et al. (June 2009)."Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis".Archives of Internal Medicine.169(11): 1035–45.doi:10.1001/archinternmed.2009.125.PMC6785300.PMID19506173.
  16. ^"Pancreatitis Explained".Better Health Channel.State Government of Victoria. 2011. Archived fromthe originalon 2010-05-13.
  17. ^Johnson CD, Hosking S (November 1991)."National statistics for diet, alcohol consumption, and chronic pancreatitis in England and Wales, 1960–88".Gut.32(11): 1401–5.doi:10.1136/gut.32.11.1401.PMC1379177.PMID1752477.
  18. ^Rawla P, Sunkara T, Thandra KC, Gaduputi V (December 2018). "Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies".Clinical Journal of Gastroenterology.11(6): 441–448.doi:10.1007/s12328-018-0881-1.PMID29923163.S2CID49311482.
  19. ^Kaurich T (January 2008)."Drug-induced acute pancreatitis".Proceedings.21(1): 77–81.doi:10.1080/08998280.2008.11928366.PMC2190558.PMID18209761.
  20. ^Jones MR, Hall OM, Kaye AM, Kaye AD (2015)."Drug-induced acute pancreatitis: a review".The Ochsner Journal.15(1): 45–51.PMC4365846.PMID25829880.Various oral hypoglycemic agents used in the treatment of diabetes are linked to acute pancreatitis. While some association exists between the occurrence of pancreatitis and biguanide agents such as metformin, as well as with dipeptidyl peptidase 4 inhibitors, including sitagliptin, vildagliptin, and saxagliptin, current research suggests that the only oral hypoglycemic agents with a disproportionately increased risk of pancreatitis are the glucagon-like peptide-1 (GLP-1) mimetics. Of particular concern is exenatide that was linked to 36 postmarketing reports of acute pancreatitis soon after its introduction. Further inquiry has estimated a 6-fold increase in the risk of pancreatitis with the use of exenatide compared to other therapies. The pathogenesis of GLP-1 analog-induced pancreatitis is unclear, but current evidence suggests an additive or synergistic exacerbation of pancreatitis when GLP-1 analogs are used in the presence of a high fat diet. The sequence of injury appears to begin with acinar cell hypertrophy, progress to proinflammatory cytokine induction, and culminate in pancreatic vascular injury
  21. ^Koller EA, Cross JT, Doraiswamy PM, Malozowski SN (September 2003)."Pancreatitis associated with atypical antipsychotics: from the Food and Drug Administration's MedWatch surveillance system and published reports".Pharmacotherapy.23(9): 1123–30.doi:10.1592/phco.23.10.1123.32759.PMID14524644.S2CID39945446.Archivedfrom the original on 2011-02-08.
  22. ^Rawla P, Bandaru SS, Vellipuram AR (June 2017)."Review of Infectious Etiology of Acute Pancreatitis".Gastroenterology Research.10(3): 153–158.doi:10.14740/gr858w.PMC5505279.PMID28725301.
  23. ^Parenti DM, Steinberg W, Kang P (November 1996). "Infectious causes of acute pancreatitis".Pancreas.13(4): 356–71.doi:10.1097/00006676-199611000-00005.PMID8899796.
  24. ^Economou M, Zissis M (2000)."Infectious cases of acute pancreatitis"(PDF).Annals of Gastroenterology.13(2): 98–101. Archived fromthe original(PDF)on 2017-08-09.Retrieved22 November2017.
  25. ^Noel RA, Braun DK, Patterson RE, Bloomgren GL (May 2009)."Increased risk of acute pancreatitis and biliary disease observed in patients with type 2 diabetes: a retrospective cohort study".Diabetes Care.32(5): 834–8.doi:10.2337/dc08-1755.PMC2671118.PMID19208917.Archivedfrom the original on 2012-06-10.
  26. ^Macaluso JN (August 1997)."Editorial Comment".J. Urol.158(2): 522.doi:10.1016/S0022-5347(01)64525-7.onMatthews K, Correa RJ, Gibbons RP, Weissman RM, Kozarek RA (August 1997). "Extracorporeal shock wave lithotripsy for obstructing pancreatic duct calculi".The Journal of Urology.158(2): 522–5.doi:10.1016/s0022-5347(01)64524-5.PMID9224338.
  27. ^Whitcomb D (2006)."Genetic Testing for Pancreatitis".Archived fromthe originalon 2017-10-16.
  28. ^"Causes of pancreatitis (mnemonic)".Radiopaedia.org.Retrieved26 June2021.
  29. ^ab"Clinical manifestations and diagnosis of acute pancreatitis".uptodate.Archivedfrom the original on 2015-12-08.Retrieved2015-12-08.
  30. ^abHospitalist Handbook(4th ed.). Department of Medicine University of California, San Francisco. 2012. pp. 224–25.
  31. ^Greenberger NJ, Wu B, Conwell D, Banks P (eds.). "Chronic Pancreatitis".Gastroenterology, Hepatology, & Endoscopy.Current Medical Diagnosis and Treatment.p. 301.
  32. ^Tierney LW, McPhee SJ (2005-02-16).Medicine.McGraw-Hill.ISBN978-0071444415.
  33. ^Türkvatan A, Erden A, Türkoğlu MA, Seçil M, Yener Ö (2015-02-01)."Imaging of acute pancreatitis and its complications. Part 1: Acute pancreatitis".Diagnostic and Interventional Imaging.96(2): 151–160.doi:10.1016/j.diii.2013.12.017.ISSN2211-5684.PMID24512896.
  34. ^Helm JF, Venu RP, Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Arndorfer RC (October 1988)."Effects of morphine on the human sphincter of Oddi".Gut.29(10): 1402–7.doi:10.1136/gut.29.10.1402.PMC1434014.PMID3197985.
  35. ^Vaughn VM, Shuster D, Rogers MA, Mann J, Conte ML, Saint S, Chopra V (June 2017). "Early Versus Delayed Feeding in Patients With Acute Pancreatitis: A Systematic Review".Annals of Internal Medicine.166(12): 883–892.doi:10.7326/M16-2533.PMID28505667.S2CID2025443.
  36. ^Moody N, Adiamah A, Yanni F, Gomez D (October 2019). "Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis".The British Journal of Surgery.106(11): 1442–1451.doi:10.1002/bjs.11221.PMID31268184.S2CID195787962.
  37. ^Balentine JR, Stöppler MC."Symptoms and Signs of Acute and Chronic Pancreatitis Differences".E Medicine Health.
  38. ^Li JY, Yu T, Chen GC, Yuan YH, Zhong W, Zhao LN, Chen QK (Jun 6, 2013)."Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis".PLOS ONE.8(6): e64926.Bibcode:2013PLoSO...864926L.doi:10.1371/journal.pone.0064926.PMC3675100.PMID23762266.
  39. ^Muddana V, Whitcomb DC, Papachristou GI (August 2009). "Current management and novel insights in acute pancreatitis".Expert Review of Gastroenterology & Hepatology.3(4): 435–44.doi:10.1586/egh.09.27.PMID19673630.S2CID207210094.
  40. ^Munoz A, Katerndahl DA (July 2000)."Diagnosis and management of acute pancreatitis".American Family Physician.62(1): 164–74.PMID10905786.Archivedfrom the original on 2012-10-08.
  41. ^Corfield AP, Cooper MJ, Williamson RC, Mayer AD, McMahon MJ, Dickson AP, et al. (August 1985). "Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices".Lancet.2(8452): 403–7.doi:10.1016/S0140-6736(85)92733-3.PMID2863441.S2CID46327341.
  42. ^Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, Whitcomb DC (February 2010). "Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis".The American Journal of Gastroenterology.105(2): 435–41, quiz 442.doi:10.1038/ajg.2009.622.PMID19861954.S2CID41655611.
  43. ^Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015). "Chapter 370 Approach to the Patient with Pancreatic Disease".Harrison's Principles of Internal Medicine(19th ed.). McGraw Hill Professional.ISBN978-0071802161.
  44. ^Hall TC, Garcea G, Webb MA, Al-Leswas D, Metcalfe MS, Dennison AR (June 2014). "The socio-economic impact of chronic pancreatitis: a systematic review".Journal of Evaluation in Clinical Practice.20(3): 203–7.doi:10.1111/jep.12117.PMID24661411.
  45. ^abTing J, Wilson L, Schwarzenberg SJ, Himes R, Barth B, Bellin MD, et al. (March 2016)."Direct Costs of Acute Recurrent and Chronic Pancreatitis in Children in the INSPPIRE Registry".Journal of Pediatric Gastroenterology and Nutrition.62(3): 443–9.doi:10.1097/MPG.0000000000001057.PMC4767646.PMID26704866.
  46. ^ Calderone J (July 30, 2016)."8 Toxic Foods for Dogs".Consumer Reports.Archivedfrom the original on February 11, 2017.
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