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Comparison of complication outcomes in acute pancreatitis following ERCP and conservative management at UKM medical centre: a six years retrospective study

Zamri Z, Razman J

Clin Ter, 2012 Nov;163(6):467-71.
PMID: 23306739

Acute pancreatitis is one of the common reasons for surgical admission. It is a potentially lethal disease that is increasing in its incidence. The most common causes of acute pancreatitis is from gallstones and alcohol. Other causes of acute pancreatitis include hypertriglyceridaemia, hyperparathyroidism, pancreatic malignancy, Endoscopic retrograde cholangiopancreatography (ERCP), trauma, infectious agents, drugs, autoimmunity, and hereditary. The treatment of acute pancreatitis is mainly supportive. The complication of ERCP in acute pancreatitis can be divided into local complication (pancreatic abscess, pseudocyst), systemic complications (renal failure, respiratory failure, cardiogenic shock) and biliary sepsis (acute cholangitis and acute cholecystitis). However, early ERCP and possible sphincterotomy should be kept in mind for patients with severe disease and biliary obstruction who are not improving with medical therapy. This study is done to compare the complication rate of ERCP and conservative management in acute pancreatitis for past 6 years in Pusat Perubatan UKM.

Matched MeSH terms: Pancreatitis/complications*
Endoscopic retrograde cholangiopancreatography for acute gallstone pancreatitis: Implementation of an institution safety protocol during the COVID-19 outbreak in Malaysia

Yusoff AR, Ahmad F, Obaid KJ

Med J Malaysia, 2020 11;75(6):764-766.
PMID: 33219198

Coronavirus disease 2019 (COVID-19) is a highly contagious, severe acute respiratory syndrome that poses significant health risks to healthcare providers. A delicate balance is needed between timely intervention for ill patients without apparent COVID-19 infection and the safety of healthcare personnel who provide essential treatment in the midst of the pandemic. We report our experience managing a 70-year-old man who presented with acute gallstone pancreatitis at our hospital during the COVID-19 outbreak in Malaysia. We also describe the safety protocol measures that have been implemented in our institution to protect the healthcare personnel from this disease during endoscopic retrograde cholangiopancreatography. This case illustrates the importance of meticulous planning, risk assessment, effective team communication and strict adherence to recommendations when providing treatment during an unprecedented pandemic.

Matched MeSH terms: Pancreatitis/epidemiology; Pancreatitis/therapy*
Fulltext Genome-Wide Association Study Data Reveal Genetic Susceptibility to Chronic Inflammatory Intestinal Diseases and Pancreatic Ductal Adenocarcinoma Risk

Yuan F, Hung RJ, Walsh N, Zhang H, Platz EA, Wheeler W, et al.

Cancer Res, 2020 Sep 15;80(18):4004-4013.
PMID: 32641412 DOI: 10.1158/0008-5472.CAN-20-0447

Registry-based epidemiologic studies suggest associations between chronic inflammatory intestinal diseases and pancreatic ductal adenocarcinoma (PDAC). As genetic susceptibility contributes to a large proportion of chronic inflammatory intestinal diseases, we hypothesize that the genomic regions surrounding established genome-wide associated variants for these chronic inflammatory diseases are associated with PDAC. We examined the association between PDAC and genomic regions (±500 kb) surrounding established common susceptibility variants for ulcerative colitis, Crohn's disease, inflammatory bowel disease, celiac disease, chronic pancreatitis, and primary sclerosing cholangitis. We analyzed summary statistics from genome-wide association studies data for 8,384 cases and 11,955 controls of European descent from two large consortium studies using the summary data-based adaptive rank truncated product method to examine the overall association of combined genomic regions for each inflammatory disease group. Combined genomic susceptibility regions for ulcerative colitis, Crohn disease, inflammatory bowel disease, and chronic pancreatitis were associated with PDAC at P values < 0.05 (0.0040, 0.0057, 0.011, and 3.4 × 10-6, respectively). After excluding the 20 PDAC susceptibility regions (±500 kb) previously identified by GWAS, the genomic regions for ulcerative colitis, Crohn disease, and inflammatory bowel disease remained associated with PDAC (P = 0.0029, 0.0057, and 0.0098, respectively). Genomic regions for celiac disease (P = 0.22) and primary sclerosing cholangitis (P = 0.078) were not associated with PDAC. Our results support the hypothesis that genomic regions surrounding variants associated with inflammatory intestinal diseases, particularly, ulcerative colitis, Crohn disease, inflammatory bowel disease, and chronic pancreatitis are associated with PDAC. SIGNIFICANCE: The joint effects of common variants in genomic regions containing susceptibility loci for inflammatory bowel disease and chronic pancreatitis are associated with PDAC and may provide insights to understanding pancreatic cancer etiology.

Matched MeSH terms: Pancreatitis, Chronic/genetics
Fulltext Comparative study of acute pancreatitis in different ethnic populations in a Malaysian public hospital

Thamilselvam, P., Premkumar, D., Haridass, G.

JUMMEC, 2008;11(1):18-21.
MyJurnal

Malaysia is a country consisting of people of Malay, Chinese and Indian ethnic origin and also of some Indonesian and Thai population. In this study of acute pancreatitis, the age group, sex incidence, clinical
features, complications and treatment were compared between different ethnic groups. A total of fifty-four consecutive patients admitted in Sungai Petani Hospital, Kedah, Malaysia with acute pancreatitis from 2002 to 2004 were taken for this study. There were 29 males and 25 females. The 40–60 years age group was more commonly involved. The common factors associated with acute pancreatitis were alcohol intake in males and biliary disease in females. Two females suffered from acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). One of the 54 cases died due to multi-organ failure.

Matched MeSH terms: Pancreatitis
Fulltext Acute Non-Fulminant Viral Hepatitis E Presenting with Acute Pancreatitis-An Unusual Presentation

Thakur A, Basu PP

Malays J Med Sci, 2017 Aug;24(4):102-105.
PMID: 28951695 DOI: 10.21315/mjms2017.24.4.12

Acute pancreatitis is considered to be an extremely rare extrahepatic manifestation of acute viral hepatitis E. The incidence is reported to be around 5%-6% in the available case series. It has usually been reported in non-fulminant cases of acute viral hepatitis E in the second or third week of illness, with a favourable outcome. Here, we report the case of a young male subject with acute viral hepatitis E presenting as acute pancreatitis at its onset and exhibiting a prolonged recovery phase. To the authors' knowledge, such a presentation of acute viral hepatitis E as acute pancreatitis at its inception has been only sparsely reported in the available literature.

Matched MeSH terms: Pancreatitis
Fulltext Pancreatitis leading to retroperitoneal fibrosis and ureteric obstruction

Tan HM, Khoo J, Pang KP

Med J Malaysia, 2003 Jun;58(2):286-9.
PMID: 14569752

Two patients who had acute pancreatitis subsequently developed characteristic appearance on urography of smooth extrinsic narrowing and medial deviation of the right ureter suggestive of retroperitoneal fibrosis (RPF) resulting in ureteric obstruction. Both these patients had clinical, biochemical and sonographic evidence of acute pancreatitis. CT scan of the abdomen performed on the second patient also documented acute pancreatitis. Intravenous urograms were consistent with ureteric obstruction due to retroperitoneal fibrosis. Both cases were treated conservatively. They were well after an average of 20 months. These 2 cases illustrate the uncommon association between pancreatitis and RPF.

Matched MeSH terms: Pancreatitis/complications*; Pancreatitis/diagnosis; Pancreatitis/therapy
Fulltext Tropical calcific pancreatitis

Tan CT, Kannan P, Sng KH

Med J Malaysia, 1980 Dec;35(2):150-4.
PMID: 7266409
Matched MeSH terms: Pancreatitis/diagnosis*; Pancreatitis/etiology
Unrecognised IgG4 association in progressively transformed germinal centers of lymph nodes with subsequent full-blown IgG4-related chronic fibrosing pancreatitis: A case report

Son HJ, Lee H, Kim JH, Yu IK, Han HY

Malays J Pathol, 2018 Apr;40(1):73-78.
PMID: 29704388

Progressively transformed germinal centers (PTGC) is a benign process characterised by a morphological variant of reactive follicular hyperplasia in lymph nodes. It was recently shown that some cases of PTGC are associated with IgG4-related disease (IgG4-RD) or increased IgG4 plasma cells. Five years ago, a 57-year-old woman presented with enlargement of multiple lymph nodes in the left parotid, submandibular, and neck areas, pathologically diagnosed as PTGC after excisional biopsy. Since then, she has experienced numbness in her extremities, especially the left shoulder and arm, pruritus on the left side of the face and intermittent facial palsy, for which she has been receiving regular symptomatic treatment. Recently the patient developed diabetes mellitus (approximately seven months ago). In routine follow-up scans, a mass was detected in left kidney and magnetic resonance imaging of the abdomen prior to surgery revealed a slightly enhanced bulky mass replacing the pancreatic tail and uncinate process. The mass in left kidney was diagnosed as clear cell renal cell carcinoma, and the pathological features of the pancreatic lesion were those of IgG4-related chronic fibrosing pancreatitis. Retrograde examination of the neck lymph node diagnosed as PTGC showed increased deposition of IgG4-positive plasma cells.

Matched MeSH terms: Pancreatitis, Chronic/complications; Pancreatitis, Chronic/immunology; Pancreatitis, Chronic/pathology*
The acute abdomen and the obstetrician

Sivanesaratnam V

Baillieres Best Pract Res Clin Obstet Gynaecol, 2000 Feb;14(1):89-102.
PMID: 10789262

An acute abdomen in pregnancy can be caused by pregnancy itself, be predisposed to by pregnancy or be the result of a purely incidental cause. These various conditions are discussed. The obstetrician often has a difficult task in diagnosing and managing the acute abdomen in pregnancy. The clinical evaluation is generally confounded by the various anatomical and physiological changes occurring in pregnancy itself. Clinical examination is further hampered by the gravid uterus. The general reluctance to use conventional X-rays because of the pregnancy should be set aside when faced with the seriously ill mother. A reluctance to operate during pregnancy adds unnecessary delay, which increases morbidity for both mother and fetus. Such mistakes should be avoided as prompt diagnosis and appropriate therapy are crucial. A general approach to acute abdominal conditions in pregnancy is to manage these problems regardless of the pregnancy.

Matched MeSH terms: Pancreatitis/diagnosis; Pancreatitis/therapy
A case of acute haemorrhagic pancreatitis following consumption of durians and alcohol

Singh P

Journal of the Malaya Branch of the British Medical Association, 1941;5:62-3.

Matched MeSH terms: Pancreatitis, Alcoholic
Fulltext Safe delivery of two parturient women in severe metabolic acidosis

Shariffuddin II, Rai V, Chan YK, Muniandy RK

BMJ Case Rep, 2014;2014.
PMID: 24862427 DOI: 10.1136/bcr-2014-205135

Care of an acutely ill parturient is particularly difficult when we have to balance the needs of both mother and the fetus to survive. The literature suggests there should be emphasis on stabilising the mother's condition. In dealing with metabolic acidosis, however, we believe delivering the baby early might not only relieve the threat of the acidosis on the mother, it may be the only way to deliver a live baby. We report two parturient women with severe metabolic acidosis which was considerably reduced very soon after the delivery and how our timely delivery resulted in the birth of two neurologically intact babies.

Matched MeSH terms: Pancreatitis/etiology
Fulltext Acute pancreatitis with electrocardiographic changes mimicking acute coronary syndrome: a diagnostic conundrum

Shamala N., Faizal, A.H.

Medicine & Health, 2018;13(2):195-201.
MyJurnal

Electrocardiographic abnormalities can be associated with acute pancreatitis. However, data regarding the actual causative factor still remains elusive. Many previous cases were reported on non-specific ST and T wave abnormalities concurrent with acute pancreatitis but rarely with an increasing trend of cardiac markers. We describe the case of a 70-year-old female who presented with one such conundrum. Our patient had typical presentation of acute pancreatitis but had dynamic ECG changes with markedly increased cardiac markers. Subsequently after initiation of treatment for acute pancreatitis and observation for the course of several days, the ECG returned to the baseline as pre admission. This substantiates the fact that acute pancreatitis can mimic both biochemical and electrical manifestation of an acute coronary syndrome. Thus, Emergency Physicians should consider acute pancreatitis as a possible diagnosis in patients who present with abnormal electrocardiograms.

Matched MeSH terms: Pancreatitis
Perspectives in pancreatic pain

Salim AS

HPB Surg, 1997;10(5):269-77.
PMID: 9298380

This review describes some of the mechanisms which are thought to be important in the causation of pain in chronic pancreatitis. Both medical and surgical techniques for treating this pain are described.

Matched MeSH terms: Pancreatitis/complications*
ERCP induced complications

Rupa B, Rao GV, Nageshwar DR

Med J Malaysia, 2005 Jul;60 Suppl B:140.
PMID: 16108197
Matched MeSH terms: Pancreatitis/etiology
Calcific pancreatitis: the Indian plague

Rupa B, Rao GV, Nageshwar R

Med J Malaysia, 2005 Jul;60 Suppl B:99-100.
PMID: 16108186
Matched MeSH terms: Pancreatitis/classification; Pancreatitis/diagnosis*; Pancreatitis/physiopathology
Fulltext Knowledge, Perception, and Antibiotic Prescribing Practice in the Intensive Care Unit: Findings from the Malaysian Public Setting

Rozali MA, Abd Rahman NS, Sulaiman H, Abd Rahman AN, Atiya N, Wan Mat WR, et al.

J Pharm Bioallied Sci, 2020 Nov;12(Suppl 2):S804-S809.
PMID: 33828380 DOI: 10.4103/jpbs.JPBS_266_19

Introduction: Approach to managing infection in the intensive care unit (ICU) often varies between institutions and not many readily adapt to available local guidelines despite it was constructed to suite local clinical scenario. Malaysia already has two published guidelines on managing infection in the ICU but data on its compliance are largely unknown.
Objectives: A cross-sectional survey was carried out and sent to a total of 868 specialists working primarily in the ICU. The aim of this study was to explore knowledge, perception, and the antibiotic prescribing practice among specialists and advanced trainees in Malaysian ICU.
Materials and Methods: A cross-sectional survey was used, consisted of three sections: knowledge, perception, and antibiotic prescribing practice in ICU. Three case vignettes on hospital-acquired pneumonia (HAP), infected necrotizing pancreatitis (INP), and catheter-related bloodstream infection (CRBSI) were used to explore antibiotic prescribing practice.
Results: A total of 868 eligible subjects were approached with 104 responded to the survey. Three hundred eighty-nine antibiotics were chosen from seven different classes in the case vignettes. All respondents acknowledged the importance of pharmacokinetic/pharmacodynamic (PK/PD) in antibiotic optimization and majority (97.2%) perceived that current dosing is inadequate to achieve optimal PK/PD target in ICU patients. Majority (85.6%) believed that antibiotic dose should be streamlined to the organisms' minimum inhibitory concentration (MIC). In terms of knowledge, only 64.4% provided the correct correlations between antibiotics and their respective PK/PD targets. Compliance rates in terms of antibiotic choices were at 79.8%, 77.8%, and 27.9% for HAI, INP, and CRBSI, respectively.
Conclusion: Malaysian physicians are receptive to use PK/PD approach to optimize antibiotic dosing in ICU patients. Nonetheless, there are still gaps in the knowledge of antibiotic PK/PD as well as its application in the critically ill, especially for β-lactams.

Matched MeSH terms: Pancreatitis
Fulltext Pancreatic tuberculosis presenting with recurrent acute pancreatitis

Redha S, Suresh RL, Subramaniam J, Merican I

Med J Malaysia, 2001 Mar;56(1):95-7.
PMID: 11503305

Tuberculosis, in its extrapulmonary form, though emerging as a common clinical problem, rarely affects the pancreas. Its indolent course, vague symptomatology along with its non-specific laboratory and radiographic findings call for greater vigilance. We report a case of pancreatic tuberculosis, previously managed as recurrent alcohol related pancreatitis which showed symptomatic improvement following commencement of antituberculosis drugs. The diagnosis of pancreatic tuberculosis in this case was based on the abdominal CT scan findings, response to anti-tubeculous chemotherapy and overall laboratory and radiological work-up.

Matched MeSH terms: Pancreatitis/etiology*
The role of nutritional support in acute pancreatitis: a review and proposal of a clinical pathway for management

Ramanujam TM

JUMMEC, 1999;4:81-87.

The aim of this review is to critically analyse the available literature and to propose a rational, safe and cost-effective clinical pathway to provide nutritional support in acute pancreatitis. This pathway is proposed based on assessment of peer reviewed literature and existing generally accepted knowledge. Acute pancreatitis is a heterogeneous disease and the outcome is variable. The role of nutritional support is controversial. Acute mild pancreatitis (80%) usually does not require nutritional support unless the pre-existing nutritional is poor or complications occur. Contrary to this acute severe pancreatitis is associated with severe catabolism and a high complication rate. Nutritional depletion rapidly occurs. It is logical to support the nutrition once the patient is haemodynamically stable. Although enteral nutrition should be administered whenever feasible, it is not always possible or advisable. Aggressive, hypercaloric parenteral nutrition administered via central venous line is not recommended. A combination of initial peripheral parenteral nutrition with fat in appropriate amount, and gradually switching over to enteral feedings is safer and cost-effective. It also avoids central line associated sepsis. The roles of newer specific therapeutic diets to enhance the immune status in patients with acute pancreatitis are not well established. KEYWORDS: Acute pancreatitis, Enteral nutrition, Parenteral nutrition, Immunonutrition.

Matched MeSH terms: Pancreatitis
Fulltext Acute pancreatitis in north-eastern peninsular Malaysia: an unusual demographic and aetiological pattern

Raj SM, Lopez D, Thambidorai CR, Kandasamy P, Toufeeq Khan TF, Mohamad H, et al.

Singapore Med J, 1995 Aug;36(4):371-4.
PMID: 8919148

A survey of 142 cases of acute pancreatitis was undertaken in two major hospitals serving the state of Kelantan in Malaysia. Females outnumbered males by a ratio of more than 3:1. The incidence among females peaked in the third decade of life. Twenty-one percent (23/109) of the females were pregnant. Ultrasonography revealed gallstones in only 9.4% (13/138). However, abnormalities of serum transaminases were found in 35% (35/100), suggesting that occult gallstones or microlithiasis may be the cause in a significant proportion of patients. Alcohol was virtually absent as an aetiological factor. There was a higher frequency of Ascaris infection in this group than a control hospital population (11/35 vs 33/242; p < 0.02) suggesting that ascariasis may be an important cause of acute pancreatitis in Kelantan. Only 8.4% fell into the category of severe pancreatitis. The overall mortality rate was 2.1%.

Matched MeSH terms: Pancreatitis/etiology*; Pancreatitis/epidemiology
Fulltext Characteristics of acute pancreatitis in University Kebangsaan Malaysia

Nadesan S, Qureshi A, Daud A, Ahmad H

Med J Malaysia, 1999 Jun;54(2):235-41.
PMID: 10972035

We analyzed the characteristics of patients presenting with acute pancreatitis to our unit. A total of 71 patients were admitted to the Surgical Department at University Kebangsaan Malaysia (UKM) over a period of seven years, between January 1990 to December 1996 with acute pancreatitis. There was a fourfold increase in incidence of acute pancreatitis in our hospital from January 1990 to December 1996. The commonest identifiable aetiology was gallstones followed by alcohol. There were two deaths. We conclude that acute pancreatitis is increasingly being diagnosed in our local population. This may be due to either greater awareness or changes in lifestyle of the population.

Matched MeSH terms: Pancreatitis/complications*; Pancreatitis/epidemiology; Pancreatitis/surgery

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