CORRELATION OF BIOCHEMICAL PARAMETERS AND BILIARY ETIOLOGY IN ACUTE PANCREATITIS

Shrestha SK, Jha IK, Vaidya Anira

Abstract


INTRODUCTION: Acute pancreatitis is common disease presenting in emergency department. Biliary calculus and alcohol consumption are most common etiologies. Detection of biliary etiology is important because the endoscopic retrograde cholangiopancreatography associated with endoscopic sphincterotomy can prevent further complications in patients with severe biliary pancreatitisand also in order to provide definite management in form of cholecystectomy to prevent further attacks. The majority of patients experience a mild course of the disease, with no need for immediate invasive intervention.In order to aim for early endoscopic decompression early detection of gallstones and determination of the severity of acute pancreatitis is essential. Differences in biochemical investigations of acute biliary and non-biliary pancreatitis have been observed and have been used to project the etilogy of pancreatitis.

OBJECTIVES: To find out and compare biochemical parameters in acute biliary and non-biliary pancreatitis and to correlate the parameters with the biliary etiology

METHODS: It is a prospective study carried out in Bir Hospital for 1 year and 3 months period. All admitted cases of AP were included in the study. Data analysis was done using SPSS 20.Fifty nine patients admitted with diagnosis of acute pancreatitis from October 2013 to December 2014 were included in the study. The relation between etiology with age, sex, admission serum amylase and total bilirubin. direct bilirubin, AST, ALT, ALP, LDH, serum amylase  were evaluated.

RESULTS: Out of 59 patients 38(64.4%) and 21(35.6%) had biliary and non-biliary etiology respectively. Biliary pancreatitis was distributed  more in females but not significant (16 vs 22). Distribution of severity was comparable between both groups. Biliary pancreatitis group had significantly higher amylase level(2032 IU vs 855IU, p 0.002) whereas values of liver function test were higher in biliary pancreatitis though not statistically significant.

CONCLUSIONS: A simple and approximate prediction of biliary etiology of acute pancreatitis can be obtained from biochemical parameters especially serum amylase.


Keywords


biliary, amylase, acute pancreatitis,severity

Full Text:

PDF

References


Kiriyama S, Kumada T, Tanikawa M Nihon Rinsho. 2004 Nov;62(11):2035-9.Recent advances in biochemical diagnosis and assessment of severity in acute pancreatitis.

Mitchell S. Cappell, MD, PhD Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, Acute Pancreatitis: Etiology, Clinical Presentation, Diagnosis, and Therapy Med Clin N Am 92 (2008) 889–92.

Minoti V. Apte, M.D., M. Med. Sci.; Jeremy S. Wilson, M.D., Ph.D.; And Mark A. Korsten, M.D Alcohol-Related Pancreatic Damage Mechanisms and Treatment.

Gayral F. Millat B1,Acute pancreatitis associated with biliary lithiasis.Presse Med. 1993 Jan 23;22(2):72-6.

Gumaste VV, Dave PB, Weissman D, Messe J.S Lipase/amylase ratio. A new index that distinguishes acute episodes of alcoholic from nonalcoholic acute pancreatitis. Gastroenterology 1991 Nov;101(5):1361 .

Hiatt JR, Calabria RP, Passaro E Jr, Wilson SE The amylase profile: a discriminant in biliary and pancreatic disease.

Nordestgaard AG1, Wilson SE, Williams RA Am J Surg. 1987 Nov;154(5):490-2. Correlation of serum amylase levels with pancreatic pathology and pancreatitis etiology.

Smotkin J, Tenner SJ Clin Gastroenterol 2002 Laboratory diagnostic tests in acute pancreatitis.Apr;34(4):459-62.

Tenner S, Dubner H, Steinberg W.Predicting gallstone pancreatitis with laboratory parameters: a meta-analysis. Am J Gastroenterol 1994 Oct;89:1863-6.

van Geenen EJ, van der Peet DL, Bhagirath P, Mulder CJ, Bruno MJ.. Epub 2010 Aug 10. Etiology and diagnosis of acute biliary pancreatitis. Nat Rev Gastroenterol Hepatol. 2010 Sep;7(9):495-502. doi: 10.1038/nrgastro.2010.114

Vikesh K. Singh, Bechein U. Wu,Thomas L. Bollen,Kathryn Repas,Rie Maurer, Koenraad J. Moertele,and Peter A. Banks Clinical Gastroenterology Early Systemic Inflammatory Response Syndrome Is Associated With Severe Acute Pancreatitis and Hepatology 2009;7:1247–1251.

Pezzilli R1, Fantini L.Lipase/amylase ratio and liver function tests for the etiological assessment of acute pancreatitis: facts and fiction. Recenti Prog Med. 2006 Sep;97(9):477-80.

Banks PA. Epidemiology, natural history, and predictors of disease outcome in acute and chronic pancreatitis. Gastrointest Endosc. 2002 Dec;56(6 Suppl):S226–30.

van Geenen EJ, van der Peet DL, Bhagirath P, Mulder CJ, Bruno MJ Nat Rev Gastroenterol Hepatol. 2010 Sep;7(9):495-502. doi: 10.1038/nrgastro.2010.114. Epub 2010 Aug 10. Etiology and diagnosis of acute biliary pancreatitis.

Ardengh JC, Coelho DE, dos Santos JS, Módena JL, Eulalio JM, Coelho JF.Unexplained acute pancreatitis: the microlithiasis must be searched?Rev Col Bras Cir. 2009 Oct;36(5):449-58.

Norton SA, Alderson D.Endoscopic ultrasonography in the evaluation of idiopathic acute pancreatitis. Br J Surg. 2000 Dec;87(12):1650-5.

Alexakis N, Lombard M, Raraty M, Ghaneh P, Smart HL, Gilmore I, Evans J, Hughes M, Garvey C, Sutton R, Neoptolemos JP. When is pancreatitis considered to be of biliary origin and what are the implications for management? Pancreatology. 2007;7(2-3):131-41. Epub 2007 Jun 21.

Vila JJ, Borda F, Jiménez FJ .Rev Esp Enferm Dig. 2008 Feb;100(2):90-7.The role of endoscopic ultrasonography in the etiological evaluation of idiopathic acute pancreatitis.

van Brummelen SE, Venneman NG, van Erpecum KJ, VanBerge-Henegouwen GP. Acute idiopathic pancreatitis: does it really exist or is it a myth? Scand J Gastroenterol Suppl. 2003;(239):117-22.

Chan T, Yaghoubian A, Rosing D, Lee E, Lewis RJ, Stabile BE, De Virgilio C. Total bilirubin is a useful predictor of persisting common bile duct stone in gallstone pancreatitis. Am Surg. 2008 Oct;74(10):977-80.

Stimac D, Rubinić M, Lenac T, Kovac D, Vcev A, Biochemical parameters in the early differentiation of the etiology of acute pancreatitis.Miletic D Am J Gastroenterol. 1996 Nov;91(11):2355-9.

Renner IG, Savage WT, Pantoja JL, et al. Death due to acute pancreatitis: a retrospective analysis of 405 autopsy cases. Dig Dis Sci 1995;30:1005–18.

Wong Renner IG, Savage WT, Pantoja JL, et al. Death due to acute pancreatitis: a retrospective analysis of 405 autopsy cases..Gallstone pancreatitis.Patti MG1, Pellegrini CA Dig Dis Sci 1995;30:1005–18.) BC, Wong J.59 Surg Clin North Am. 1990 Dec;70(6):1277-95.

Renner IG, Savage WT, Pantoja JL, et al. Death due to acute pancreatitis: a retrospective analysis of 405 autopsy cases. Dig Dis Sci 1995;30:1005–18.

Liu CL, Fan ST, Lo CM, Tso WK, Wong Y, Poon RT, Lam CM, Aliment Pharmacol Ther. 2005 Sep 1;22(5):423-31.Clinico-biochemical BMJ. 2004 Jun 19;328(7454):1466-9.Hospital admission for acute pancreatitis in an English population, 1963-98: database study of incidence and mortality.Goldacre MJ, Roberts SE.Prediction of biliary cause of acute pancreatitis in the era of endoscopic ultrasonography.


Refbacks

  • There are currently no refbacks.