Talk:Acute pancreatitis

Bowel Rest

I feel that this section is quite misleading not inline with current evidence or bsg guidance. Currently early feeding is preferred. See BSG guidline re:pancreatitis 2005 SN R (talk) 22:32, 13 July 2012 (UTC)

Laparoscopy

I changed the text which implied that endoscopy is a treatment. It's a diagnostic procedure. Although useful to help figure out what's going on, endoscopy can actually trigger pancreatitis attacks.

The ERCP (endoscopic retrograde cholangiopancreatography) referred to later in the article is an procedure that utilizes endoscopy, but its not endoscopy. By comparison, although you might use a flashlight to change a lightbulb in a dark closet, you wouldn't say that the flashlight changed the lightbulb.

I replaced endoscopy with laparoscopy.

A specific laparoscopic treatment I know of has been used in the last decade by Dr. Peter Banks (Past President of the American Pancreatic Association, President of the International Association of Pancreatology, Past Chair of the Pancreatic Disorders Section of the American Gastroenterological Association, etc.) at Brigham and Women's Hospital in Boston. It involves making an incision in the sphincter of Oddi so that pancreatic secretions enter the descending duodenum more easily rather than accumulating and causing trouble. -- House of Scandal 14:11, 24 October 2006 (UTC)

What is the source of your assertion? Some advocate early ERCP to establish whether gallstone disease is the cause of the pancreatitis. The use of sphincterotomy should be supported with citations. Laparoscopy is not useful unless for the specific purpose of draining a pseudocyst. JFW | T@lk 21:29, 6 February 2007 (UTC)

Reply

I mentioned the sphincterotomy proceedure used by Banks here rather than in the article because I don't have citations regarding it, only personal experience. Statements made in talk pages don't need citations and without citations may be weighed accordingly.

Regarding the statement that "Laparoscopy is not useful unless for the specific purpose of draining a pseudocyst", please note:

Diagnostic laparoscopy is a minimally invasive surgical procedure that allows the visual examination of intra abdominal organs in order to detect pathology. The video image of the liver, stomach, intestines, gallbladder, spleen, peritoneum, and pelvic organs can be viewed on a monitor after insertion of a telescope into the abdomen. Manipulation and biopsy of the viscera is possible through additional ports.[1]

Heres's another description:

Diagnostic laparoscopy is a procedure that allows a health care provider to look directly at the contents of a patient's abdomen or pelvis, including the fallopian tubes, ovaries, uterus, small bowel, large bowel, appendix, liver, and gallbladder. The purpose of this examination is to actually see if a problem exists that has not been found with noninvasive tests. Inflammation of the gallbladder (cholecystitis), appendix (appendicitis), pelvic organs (pelvic inflammatory disease), or tumors of the ovaries may be diagnosed laparoscopically.[2]

Use of a search engine for "Diagnostic Laparoscopy" and similar words will return many thousands of results.

I may have missed your point if your point was that laparoscopy shouldn't be mentioned as a treatment option. My concern was that endoscopy was listed as a treatment option and looking at something isn't treatment. Laparoscopy, on the other hand, may involve cutting, etc.

However, note that there are a number of pancreatitis treatment proceedures besides the draining of a pseudocyst you mentioned and the sphincterotomy I mentioned. The most obvious of these is cholecystectomy. Based on that, the intro seems to still make sense.--House of Scandal 04:26, 14 February 2007 (UTC)

Tests

PMID 12094843 - a useful review of blood tests. JFW | T@lk 21:29, 6 February 2007 (UTC)

Antibiotics

"Prophylactic antimicrobials should not be used." is bit of a strong statement. See edits.

Epidemiology

I removed wrongdiagnosis.com as the primary reference for epidemiology. This is an unreliable site. In fact, I was unable to corrobate the USA incidence data. I added some well-established data from Europe, which is not much different.

I removed completely the claims re. prevalence. For an acute medical condition, prevalence is a completely meaningless number. This would indicate the number of people in the population presently suffering from acute pancreatitis. Prevalence becomes relevant only in more chronic conditions. JFW | T@lk 14:14, 9 July 2007 (UTC)

use of mepedrine

The information in this article concerning use of meperidine/pethidine/demerol is outdated, and contradicts information in the article on the drug, particularly regarding antispasmodic effects. In the U.S., use of demerol is actively discouraged. From what I've been able to gather, hydromorphone is commonly used to treat the pain associated with acute pancreatitis. Suspect other infomation in the article is dated as well. —Preceding unsigned comment added by 70.253.195.89 (talk) 15:00, 15 November 2007 (UTC)

Use of hydromorphone--from a survivor

My personal experience in pain relief for hemorrhagic pancreatits was that I was put on a 100 mcg Fentanyl patch and, following frequent IV injections of 2mg hydromorphine, a dispensing pump. Alhtough I had myself convinced that I was only using the hydromorphine for euphoria, it was because the Fentanyl would mask the pain well past the point that dependent cravings set in. It was only about a year later, on my initial attempt to stop Fentanyl (hydromorphone having been stopped six months earlier) that I discovered how much pain I was really in. In my case, due to a large dose following a rupture in a transplanted kidney, morphine was as effective as water. The main benefit I see to the Fentanyl/hydromorphone combination is that either can be stopped without withdrawal symptoms if the other is continued, and Fentanyl is probably more conducive to the weaning process. In my case I found that the hydromorphone caused hallucinations and vivid dreams which I could not distinguish from reality, as well as short periods of altered reality that I did not recognize when interacting with others: Fentanyl had no such effect.

Causes Section Needs Improvement

I do not have enough background to edit this article, but as a user I observe that the "Causes" section is of very poor quality. In particular:

The cause listed as the sole "Major Cause" is a side effect of the diabetes drug Byetta. Reading the article, this seems a decidedly uncommon cause to me. The "Causes by demographic" section notes that for adults in Western countries 85% of cases are caused by gallstones and alcoholism, yet neither of these causes is listed in either the "Major Causes" or "Minor Causes" sections.

It would be good if someone with expertise would clean up this section. —Preceding unsigned comment added by Galletto (talk • contribs) 18:00, 10 June 2009 (UTC)

FYI, I have undone an edit to the "Major Causes" section that was done five days ago. That edit deleted a listing of several major causes and left only the "Byetta" paragraph. While this list I restored is not high quality prose, it is far more informative that what was left. —Preceding unsigned comment added by Galletto (talk • contribs) 18:12, 10 June 2009 (UTC)

I agree with the above. In my opinion, Byetta should not start the "Major Causes" as it is a minor cause. Additionally, Byetta should probably just be lumped into the Drugs category of the mnemonic that is given. Lastly, I think that it would be helpful if the most common causes (Gallstones, ethanol, ERCP, Drug-related, hypertriglyceridemia, etc.) had percentages given with them to give better context. I will get to this soon if no one else beats me to it. Thoughts? justin.kirkham (talk) 23:52, 20 April 2010 (UTC)

The war within describes research on how the disease/damage develops but may be more suitable for the Pathogenesis section. - Rod57 (talk) 03:29, 10 February 2012 (UTC)

Removed the following from ERCP section

"It's not always true that people die during sleep. Sometimes, they are conscious when pain occurs but is too weak to move or ask for help."

I have no idea why this was in this article :s —Preceding unsigned comment added by 92.24.101.87 (talk) 15:29, 21 December 2009 (UTC)

British Guideline

doi:10.1136/gut.2004.057026 JFW | T@lk 15:17, 24 February 2011 (UTC)

Classification

... has been revised (modified Atlanta 2012) doi:10.1136/gutjnl-2012-302779 JFW | T@lk 21:33, 11 December 2012 (UTC)

..what about new atlanta 2013 vs balthazar vs new IMC scoring? ( view petrov et al writings) --88.10.91.189 (talk) 19:16, 1 December 2013 (UTC)

Ranson score

The Ranson score section seems copied from the Ranson criteria article (in read mode, judging by the reference numbers without link). However, the phrase

It is applicable to non-gallstone pancreatitis. For gallstone pancreatitis, the parameters are:

is changed to

It is applicable to both gallstone and alcoholic pancreatitis.

the gallstone parameters are omitted, and after the sentence

Alternatively, pancreatitis severity can be assessed by any of the following:[2]

where the original article lists APACHE score and others, here you get a section with the titel Ranson's score (the 's added because section names must be unique perhaps??)

Later in the Glasgow criteria section, one reads the Glasgow criteria is valid for both gallstone and alcohol induced pancreatitis, whereas the Ranson score is only for alcohol induced pancreatitis. Ssscienccce (talk) 19:03, 25 June 2013 (UTC)

Causes by demographic

This section makes some highly dubious unreferenced claims - alcohol is the primary etiology in 60% of US cases and only 5% of UK cases, despite broadly similar ethnicity, lifestyle and alcohol consumption? Maybe there's a good explanation, but if so we need to know about it. I've added a citation request. --Ef80 (talk) 14:35, 5 May 2015 (UTC)

Scores are still a bit weak

doi:10.7326/M16-0650 - Annals of Internal Medicine. JFW | T@lk 07:57, 26 July 2016 (UTC)

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NEJM

doi:10.1056/NEJMra1505202 JFW | T@lk 00:27, 17 November 2016 (UTC)

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