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Pancreatic Injury

Injury of Pancreas


Presentation

  • CONCLUSION: Surgical management in pancreatic trauma patients should be dictated by the degree and location of pancreatic injury, associated injuries and time from event to presentation.[ncbi.nlm.nih.gov]
  • In most cases, patients present to the emergency department with inaccurate or misleading histories; some give no history of trauma, which may delay recognition of serious abdominal injuries.[ncbi.nlm.nih.gov]
  • A case of pancreatic ascites presenting after a significant time period following initial abdominal trauma has not been reported.[ncbi.nlm.nih.gov]
  • Injured children may present to nontrauma center/nonpediatric hospitals or urgent care settings where practitioners may not be experienced in diagnosing and treating pediatric pancreatic injuries.[ncbi.nlm.nih.gov]
  • In the present study, we focused on pancreas-specific miRNAs, miR-216a and miR-216b. Laser microdissection revealed that miR-216a and 216b were predominantly expressed in acinar cells of the pancreas as compared to Langerhans' islet.[ncbi.nlm.nih.gov]
Wound Infection
  • Postoperative complications occurred in 16 cases (21 cases/times): pancreatic fistula (5 cases/times) and incisional wound infection (5 cases/times), intra-abdominal infection (3 cases/times), stress ulcer (3 cases/times), pleural effusion (3 cases/times[ncbi.nlm.nih.gov]
  • infection, ventral hernia, enteric fistula), and length of stay.[ncbi.nlm.nih.gov]
  • Call the trauma clinic or seek medical attention if your child has: Increased or worsening abdominal pain Fever 100.5 Difficulty with bowel movements Shortness of breath Nausea / vomiting Dizziness A fast heart rate Concern for wound infection (redness[cincinnatichildrens.org]
Nightmare
  • If you notice your child having nightmares, flashbacks, nervousness, irritability or any other concerning emotional symptoms please speak with the trauma surgery provider.[cincinnatichildrens.org]
Gangrene
  • The pancreatic fistula was confirmed as well as chemical peritonitis and gangrenous cholecystitis. A second laparotomy was carried out for cholecystectomy, peritoneal lavage, and drainage.[anesthesiology.pubs.asahq.org]
Epigastric Pain
  • Diagnosis requires high level of suspicion, usually initial symptoms are non specific and vague, presents with mid epigastric pain or back pain following trauma.[omicsonline.org]
  • Patients with early symptoms may report brief post-traumatic epigastric pain that has completely subsided. Pain may be absent for several days, even in the case of complete transaction with avulsion of the pancreatic duct.[med-ed.virginia.edu]
  • Pancreatic cysts are regarded symptomatic when there is hyperamylasemia, recent-onset diabetes, severe epigastric pain, weight loss, steatorrhea, or jaundice.[radiologyassistant.nl]
Chronic Abdominal Pain
  • Endoscopic retrograde cholangiopancreatography should be considered for evaluation of patients with chronic abdominal pain and prior blunt trauma to the abdomen.[ncbi.nlm.nih.gov]
Recurrent Abdominal Pain
  • Recurrent abdominal pain or gastrointestinal symptoms induced by alcohol intake. 3. Hyperamylasemia or a high serum level of any other pancreatic enzymes. 4. Abnormal findings in the pancreas by routine abdominal ultrasonography.[ncbi.nlm.nih.gov]
Epigastric Tenderness
  • Physical signs include mild epigastric tenderness in the early period to frank peritonitis features in the late presentation. Elevation of serum amylase is not a specific sign of pancreatic injury.[omicsonline.org]
Pancreatic Pain
  • Outcome measures evaluated were the incidence of acute pancreatitis, hyperamylasemia, and pancreatic pain.[ncbi.nlm.nih.gov]
Renal Stone
  • It should be considered a relative contraindication to apply extracorporeal shock wave lithotripsy in cases of right renal stone associated with large gall stones.[ncbi.nlm.nih.gov]

Treatment

  • ERCP was first reported as a diagnostic tool in the settings of pancreatic injury but has in recent years been used increasingly as a treatment option with promising results.[ncbi.nlm.nih.gov]
  • Equally important is to attempt to find out a simple management plan particularly in the era of increasing conservative treatment of injured patients. There were 22 cases of pancreatic injury.[ncbi.nlm.nih.gov]
  • Treatment of blunt injury of the pancreas in children remains controversial. Some prefer non-surgical treatment, whereas others prefer surgical management in selected cases.[ncbi.nlm.nih.gov]
  • In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases (97.6%) were cured (including 40 cases receiving surgical operation and one case receiving the conservative treatment).[ncbi.nlm.nih.gov]
  • The treatment of chronic pancreatitis involves attention to its three cardinal features: pain, maldigestion and diabetes.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSIONS: For a good prognosis, the first operation time after injury should be decreased and surgical technique should be simplified by damage control surgery to reduce complications as well as to prevent exacerbation of the general condition in patients[ncbi.nlm.nih.gov]
  • Pancreas Trauma Prognosis The outlook of pancreatic trauma depends on the severity of the injury and how soon medical attention is sought. Minor injury usually has a good outcome.[healthhype.com]
  • Therefore, isolated pancreatic injury would be expected to have low morbidity and mortality rather than associated injury with other organs; however, there are few reports related to its prognosis due to the low incidence.( 5, 6 ) Recently, Krige et al[jtraumainj.org]
  • Severe injuries have poor prognosis due to frequent association with other injuries [3] . Complications of pancreatic injury are bleeding, pancreatic abscess, recurrent pancreatitis, fistula formation and pancreatic pseudocysts.[ijri.org]
  • Most of these lesions are benign or slow growing and the prognosis is significantly better than with pancreatic adenocarcinoma.[bcm.edu]

Etiology

  • These injuries can result from atraumatic etiologies and blunt abdominal trauma. Atraumatic pancreatic injuries in the athlete are diagnosed and treated in a similar manner to the nonathletic patient.[ncbi.nlm.nih.gov]
  • Pancreatic fistulas: etiology, consequences and treatment. Gastroenterologist 4: 238 - 244. Google Scholar Medline Kudsk KA, Temizer D, Ellison EC, Cloutier CT, Buckley DC, Carey LC. 1986.[doi.org]
  • Pancreatic injuries were mostly blunt trauma (63%) and the etiology was dominated by motor vehicle accident in 46% of the cases, followed by stab wounds in 37% and falls or crushing in 17% of the cases.[hbsn.amegroups.com]

Epidemiology

  • Sports specific epidemiologic data collection and analysis are important elements in the development of evidence-based interventions.[ncbi.nlm.nih.gov]
  • METHODS: Forty AAA patients consecutively treated with either EVAR (GI, 20 pts) or OR (GII, 20 pts) were prospectively evaluated in terms of epidemiology, comorbidities and technical details.[ncbi.nlm.nih.gov]
  • “We need smart screening and individualized treatments based on family history, epidemiology, biomarkers and genetics.”[hopkinsmedicine.org]
  • […] pancreatic injury, judicious resection and adequate drainage can significantly diminish morbidity and mortality. 3,4 The relative dearth of data on pancreatic trauma in international literature is compounded by a virtual absence of information about the epidemiology[jpma.org.pk]
Sex distribution
Age distribution

Pathophysiology

  • BACKGROUND: Premature activation of pancreatic digestive enzymes and profound changes of levels of certain biochemical compounds have been implicated in the pathophysiology of acute pancreatitis.[ncbi.nlm.nih.gov]
  • To the Editor: The article by Fernández-del Castillo et al. implicating calcium administration in the development of pancreatic cellular injury (Aug. 8 issue) 1 was of interest but was misleading on pathophysiologic and biostatistical grounds, since defining[nejm.org]
  • Unlike others on this topic, this text demonstrates how the endoscope incorporates pathophysiology, diagnostic, and treatment modalities into endoscopic practice.[books.google.com]
  • The activation of the renin-angiotensin system may play an important role in cellular pathophysiological processes. Angiotensin II enhances the formation of reactive oxygen species via the activation of xanthine oxidase or NAD(P)H oxidase.[ncbi.nlm.nih.gov]

Prevention

  • BACKGROUND: The identification of therapeutic agents that can prevent the pancreatic injury after endoscopic retrograde cholangiopancreatography (ERCP) is of considerable importance.[ncbi.nlm.nih.gov]
  • With the aim of early diagnosis and prevention of alcoholic CP, we here propose "alcoholic pancreatopathy" as a new category of pancreatic disorder induced by alcohol intake.[ncbi.nlm.nih.gov]
  • The prevention of pancreatic and other intra-abdominal injuries is an evolving area of sports medicine research. Sports specific epidemiologic data collection and analysis are important elements in the development of evidence-based interventions.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: For a good prognosis, the first operation time after injury should be decreased and surgical technique should be simplified by damage control surgery to reduce complications as well as to prevent exacerbation of the general condition in patients[ncbi.nlm.nih.gov]
  • The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries[ncbi.nlm.nih.gov]

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