Presentation
He initially presented with alcohol-induced acute pancreatitis. Twenty days after the initial presentation, he re-presented with increasing pain and was found to have pancreatic necrosis and abscesses. Treatment was initiated with meropenem. [ncbi.nlm.nih.gov]
Entire Body System
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Fever
On the 26th day of the first intervention, the patient had fever and abdominal pain and his clinic was deteriorated. [ncbi.nlm.nih.gov]
Gastrointestinal
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Abdominal Pain
On the 26th day of the first intervention, the patient had fever and abdominal pain and his clinic was deteriorated. [ncbi.nlm.nih.gov]
Signs and symptoms [ edit ] Patients with pancreatic abscesses may experience abdominal pain, chills and fever or the inability to eat. Whereas some patients present an abdominal mass, others do not. Nausea and vomiting may also occur. [en.wikipedia.org]
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Nausea
Symptoms Abdominal mass Abdominal pain Chills Fever Inability to eat Nausea and vomiting Signs and tests Patients with pancreatic abscesses usually have had pancreatitis. However, the complication often takes 7 or more days to develop. [coordinatedhealth.com]
Nausea and vomiting may also occur. Complications [ edit ] An unremoved infected abscess may lead to sepsis. [2] Also, multiple abscesses may occur. Other complications may include fistula formation and recurrent pancreatitis. [en.wikipedia.org]
Symptoms Symptoms include: Abdominal mass Abdominal pain Chills Fever Inability to eat Nausea and vomiting Exams and Tests Most people with pancreatic abscesses have had pancreatitis. However, the complication often takes 7 or more days to develop. [ufhealth.org]
The clinical presentation of pancreatitis varies from case to case, with epigastric pain, nausea and vomiting being the commonest symptoms as observed in the present case. [ijpmonline.org]
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Epigastric Pain
Abstract A 35-year-old man sought treatment for acute epigastric pain, mild jaundice, and high fever. [ncbi.nlm.nih.gov]
The clinical presentation of pancreatitis varies from case to case, with epigastric pain, nausea and vomiting being the commonest symptoms as observed in the present case. [ijpmonline.org]
Acute pancreatitis usually presents with epigastric pain radiating to the back, nausea and vomiting, and epigastric tenderness on palpation. [amboss.com]
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Left Upper Quadrant Pain
We describe a 64-year-old Filipino woman who presented 2 weeks after elective cholecystectomy and pancreatic biopsy with left upper quadrant pain, abdominal distention, and fever. [ncbi.nlm.nih.gov]
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Abdominal Guarding
Other physical findings are nonspecific and include abnormal vital signs consistent with sepsis, abdominal guarding, and rebound tenderness. [odlarmed.com]
Cardiovascular
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Tachycardia
Capillary leakage : Release of inflammatory cytokines and vascular injury by pancreatic enzymes vasodilation and increased vascular permeability shift of fluid from the intravascular space into the interstitial space ( third space loss ) hypotension, tachycardia [amboss.com]
Resolution of fevers, tachycardia and hypotension, as well as improvement in any associated abdominal pain are all potential markers of clinical improvement in this condition, although none are specific to this diagnosis.. [clinicaladvisor.com]
Workup
They’ll also order tests, which may include: blood workup urine analysis ultrasound X-ray MRI CT scan To distinguish among cellulitis, abscess, and phlegmon, your doctor may use intravenous gadolinium with MRI to show the outline of an abscess “wall” [healthline.com]
X-Ray
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Left Pleural Effusion
There was moderate ascites, left-sided basal consolidation was noted in the left lung along with mild left pleural effusion. USG liver showed diffuse Grade 1 increase in echotexture. No local solid or cystic lesion was seen. [ijpmonline.org]
pleural effusion CT Focal or diffuse enlargement of the pancreas Heterogeneous enhancement Indistinct or shaggy margins Infiltration of the peripancreatic fat Fluid collections in the peripancreatic and anterior pararenal spaces MRI Used primarily in [learningradiology.com]
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Gastric Fistula
The spontaneous gastric fistula was heralded by a large emesis of purulent and necrotic material in one case and copious nasogastric tube secretions of a similar material in the other. [ncbi.nlm.nih.gov]
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Pancreatic Calcification
calcification 膵線維化 pancreatic fibrosis 花筵状線維化 storiform fibrosis 膵内胆管浸潤 intrapancreatic bile duct invasion 膵嚢胞 pancreatic cyst 仮性嚢胞 pseudocyst 感染性膵仮性嚢胞 infected pancreatic pseudocyst 真性嚢胞 true cyst 先天性嚢胞 congenital cyst 単純性嚢胞 simple cyst 嚢胞線維症 cystic [jsge.or.jp]
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X-Ray Abnormal
Abscesses near the diaphragm may result in chest x-ray abnormalities such as ipsilateral pleural effusion, elevated or immobile hemidiaphragm, lower lobe infiltrates, and atelectasis. CBC and blood cultures should be done. [msdmanuals.com]
Microbiology
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Salmonella Typhi
Isolated involvement of the pancreas in Salmonella typhi bacteraemia is rare. A case of pancreatic abscess due to S. typhi is reported which was managed conservatively. [ncbi.nlm.nih.gov]
Pancreatic abscess due to Salmonella typhi. Postgrad Med J 1992; 68:294-5. [PMID 1409199] Eliashiv A, Olumide F, Norton L, Eiseman B. Depression of cell-mediated immunity in diabetes. Arch Surg 1978; 113:1180-3. [PMID 309322] [pancreas.imedpub.com]
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Eikenella
Eikenella corrodens, a slowly growing gram-negative bacillus that is a normal inhabitant of dental plaque, has been recognized as an infrequent cause of invasive disease. [ncbi.nlm.nih.gov]
Treatment
The EUS-guided treatment was effective for improvement of severe inflammation of the pseudocyst as an initial treatment. However, drainage tube placement limitations pertained because the pseudocyst was present with multilocular infection. [ncbi.nlm.nih.gov]
However, CT-guided drainage is the option treatment for patients who may not tolerate an open procedure. Endoscopic treatment is at the same time a treatment option that increased in popularity over the last years. [en.wikipedia.org]
Prognosis
The prognosis may be worse in obese patients, after trauma, after organ transplantation, after coronary artery bypass surgery, or in idiopathic AP. [3] Morbidity/mortality In the first 48-72 hours after the onset of acute pancreatitis using the Sepsis-Related [emedicine.medscape.com]
On the basis of this experience, it is possible to establish a relationship between the gross appearance of the collection and the underlying pancreatic disease with differences in terms of prognosis, morbidity, and mortality. [ncbi.nlm.nih.gov]
Etiology
A case of pancreatic abscess with pancreaticobiliary fistula manifesting as obstructive jaundice of occult etiology is presented. Diagnosis was made preoperatively by skinny needle percutaneous transhepatic cholangiography. [ncbi.nlm.nih.gov]
Our own experience with liver abscesses shows that diabetes mellitus is an important risk factor for abscesses without other etiologies. [pancreas.imedpub.com]
Epidemiology
Survey Research Expert Houston, Texas Academic Physicians Madison, Wisconsin Clinician Educator New Haven, Connecticut Tenure-Track Assistant or Associate Professor Department of Epidemiology Baltimore, Maryland View all jobs [academic.oup.com]
Epidemiology References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
The purposes of this study were to ascertain the clinical significance of viridans streptococcal bacteremia and to determine the epidemiological, clinical, and microbiological features. [annlabmed.org]
You are (*) If you have selected the Other category, please specify which type of user you are: * Email address: * Topic of your comment * Epidemiology data Summary and related texts Related genes Clinical signs Nomenclature and/or coding Your message [orpha.net]
Stimac D, Mikolasevic I, Krznaric-Zrnic I, et al ; Epidemiology of Acute Pancreatitis in the North Adriatic Region of Croatia during the Last Ten Years. Gastroenterol Res Pract. 20132013:956149. doi: 10.1155/2013/956149. Epub 2013 Feb 14. [patient.info]
Pathophysiology
Corresponding to the lack of pathophysiologic effects of AP per se, pulmonary and renal insufficiencies occur in only 33.3% and 16.7%, respectively, and mortality in these patients is 22.2%. [ncbi.nlm.nih.gov]
This volume summarizes several important updates in abdominal surgery and pathophysiology. [books.google.com]
Pathophysiology ANP is the most severe end of a spectrum of inflammation associated with pancreatitis. Inflammation causes cell death with resultant devitalized tissue, which is likely to become infected. [odlarmed.com]
References: [1] [2] [3] [4] Pathophysiology Sequence of events leading to pancreatitis : Intrapancreatic activation of pancreatic enzymes : secondary to pancreatic ductal outflow obstruction (e.g., gallstones, cystic fibrosis ) or direct injury to pancreatic [amboss.com]
There has been great improvement in knowledge of the natural course and pathophysiology of acute pancreatitis over the past decade. 1– 4 The clinical course of acute pancreatitis varies from a mild transitory form to a severe necrotising disease. [gut.bmj.com]
Prevention
Also, it is recommended that patients who have a prolonged clinical response are tested repeatedly as a prevention method to avoid the development of an abscess that may rupture. [4] Prevention [ edit ] In some cases, abscesses may be prevented by draining [en.wikipedia.org]
However, in many cases, the disorder is not preventable. Barshak MB. Pancreatic infection. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. [nlm.nih.gov]
Prevention Draining a pancreatic pseudocyst may help prevent some cases of pancreatic abscess. However, in many cases the disorder is not preventable. [coordinatedhealth.com]
It is suggested that retrograde infection from the fistula was prevented by the single fistulization to the acidic duodenal bulb, which is not supposed to allow most bacterial growth. [ncbi.nlm.nih.gov]
Prevention Draining a pancreatic pseudocyst may help prevent some cases of pancreatic abscess. However, in many cases the disorder is not preventable. Images References Barshak MB. Pancreatic infection. In: Bennett JE, Dolin R, Blaser MJ, eds. [ufhealth.org]