Open Access Medical Books


Edited by Luis Rodrigo .

It is a great pleasure r to be the editor of this interesting book about Acute Pancreatitis, 
written by an international group of experts, doctors, university professors, and 
investigators, experienced in this field.
Acute pancreatitis is one of the more commonly encountered etiologies in the 
emergency setting and its incidence is rising. Presentations range from a mildselflimiting 
condition which usually responds to conservative management,to one with 
significant morbidity and mortality in its most severe forms. While clinical criteria are 
necessary to make the initial diagnosis, contrast-enhanced CT is the mainstay of 
imaging and has a vital role in assessing the extent and evolution of the disease and its 
associated complications.
Disease severity is best predicted from a number of clinical scoring systems which can 
be applied at diagnosis in association with repeated clinical assessment, measurement 
of acute inflammatory markers, and CT.
Establishing a biliary etiology in acute pancreatitis is clinically important because of 
the potential need for invasive treatment, such as endoscopic retrograde 
cholangiopancreatography. The etiology of acute biliary pancreatitis (ABP) is 
multifactorial and complex. Passage of small gallbladder stones or biliary sludge 
through the ampulla of vater. seems to be important in the pathogenesis of ABP. Other 
factors such as, anatomical variations associated with an increased biliopancreatic 
reflux, bile and pancreatic juice exclusion from the duodenum, and genetic factors,
might contribute to the development of ABP. A diagnosis of a biliary etiology in acute 
pancreatitis is supported by both laboratory and imaging investigations. An increased 
serum level of alanine aminotransferase (>1.0 microkat/l) is associated with a high 
probability of gallstone pancreatitis (positive predictive value 80-90%). Confirmation 
of choledocholithiasis is most accurately obtained using endoscopic ultrasonography 
or magnetic resonance cholangiopancreatography.
Prophylactic antibiotics are not effective in reducing the incidence of (peri)-pancreatic 
infection in patients with severe disease (or even documented necrotizing 
pancreatitis). The only rational indication for antibiotics is documented infection.
Recurrent acute pancreatitis is a common clinical problem. Most cases of pancreatitis 
are identified by a careful history and physical examination. Despite advanced 
evaluation, the cause is not apparent in about 10% of cases. The etiology of recurrent 
acute pancreatitis appears to be multifactorial, with genetic and environmental 
influences playing a significant role. The strength of evidence for certain etiologies is 
highly variable, and natural history data is limited. Controversy exists regarding the 
most appropriate diagnostic and therapeutic approach. Recurrent acute pancreatitis 
often represents a continuum with chronic pancreatitis.
Although most cases of acute pancreatitis are uncomplicated and resolve 
spontaneously, the presence of complications has significant prognostic importance. 
Necrosis, hemorrhage, and infection convey up to 25%, 52%, and 80% mortality, 
respectively. Other complications such as pseudocyst formation, pseudoaneurysm 
formation, or venous thrombosis, increase morbidity and mortality to a lesser degree.

Luis Rodrigo PhD


Part 1 Etiology 1

Chapter 1 Acute Biliary Pancreatitis 3
Mehmet Ilhan and Halil Alıs

Chapter 2 Acute Pancreatitis Induced by Drugs 17
Karel Urbánek, Ilona Vinklerová, Ondřej Krystyník and Vlastimil Procházka

Chapter 3 Obesity and Acute Pancreatitis 35
Davor Štimac and Neven Franjić

Chapter 4 Acute Pancreatitis During Pregnancy 47
Tea Štimac and Davor Štimac

Chapter 5 Pancreatitis in Children 55
Alfredo Larrosa-Haro, Carmen A. Sánchez-Ramírez and Mariana Gómez-Nájera

Chapter 6 Pancreatitis in Cystic Fibrosis and CFTR-Related Disorder 67
Michael J. Coffey and Chee Y. Ooi

Chapter 7 Diabetes or Diabetes Drugs: 
A Cause for Acute Pancreatitis 91
Leann Olansky

Part 2 Pathogenesis 99

Chapter 8 Role of Peritoneal Macrophages on Local and Systemic 
Inflammatory Response in Acute Pancreatitis 101
Marcel Cerqueira Cesar Machado and Ana Maria Mendonça Coelho

Chapter 9 Molecular Biology of Acute Pancreatitis 109
Francisco Soriano and Ester C.S. Rios

Chapter 10 Oxidative Stress and Antioxidative 
Status in the Acute Pancreatitis 117
Andrzej Lewandowski, Krystyna Markocka-Mączka, Maciej Garbień, Dorota Diakowska and Renata Taboła

Chapter 11 Microcirculatory Disturbances in 
the Pathogenesis of Acute Pancreatitis 141
Dirk Uhlmann

Part 3 Diagnosis 171

Chapter 12 Endoscopic Retrograde 
Cholangiopancreatography-Related Acute Pancreatitis – Identification, Prophylaxis and Treatment 173
Alejandro González-Ojeda, Carlos Dávalos-Cobian, Elizabeth Andalón-Dueñas, Mariana Chávez-Tostado, Arturo Espinosa-Partida and Clotilde Fuentes-Orozco

Chapter 13 Endoscopic Retrograde Cholangiopancreatography 
(ERCP) Related Acute Pancreatitis 197
Zoltán Döbrönte

Chapter 14 Nutrition Assessment and 
Therapy in Acute Pancreatitis 215
Vanessa Fuchs-Tarlovsky and Krishnan Sriram

Part 4 Treatment 233

Chapter 15 Changes in the Management 
of Treatment in Acute Pancreatitis Patients 235
Juraj Bober, Jana Kaťuchová and Jozef Radoňak

Chapter 16 Hypertriglyceride Induced Acute Pancreatitis 259
Joshua Lebenson and Thomas Oliver

Chapter 17 The Role of Percutaneous Drainage in 
the Treatment of Severe Acute Pancreatitis
on the Basis of the Modified Atlanta Classification 279
Zsolt Szentkereszty, Róbert Kotán and Péter Sápy .

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