Clinical study and outcome of alcoholic and nonalcoholic acute pancreatitis presenting to a tertiary care center
Dr. Kemparaj T, Dr. Mridul GS
Introduction: Acute pancreatitis is a common condition involving the pancreas. The estimated incidence is about 3% of cases presenting with pain abdomen1. Gall stones and sustained alcohol abuse together account for 80% of acute pancreatitis. So the study is undertaken to study the various etiological factors and clinical factors of alcoholic and nonalcoholic acute pancreatitis and to assess the prognosis, outcome, management of an alcoholic and nonalcoholic acute pancreatitis. Methodology: This study assess the various etiological factors and clinical factors of alcoholic and nonalcoholic acute pancreatitis and assess the prognosis, outcome, management of an alcoholic and nonalcoholic acute pancreatitis. A total of 60 cases that meet the inclusion and exclusion criteria are included, Patients from Bowring and Lady Curzon and Victoria hospital attached to Bangalore Medical College and Research Institute selected during the study period from November 2015 to June 2017. Results: In our study total 60 patients with acute pancreatitis were enrolled, 55% were alcoholic and remaining 45% were nonalcoholic. The mean age of presentation in our study was 39.2 years and in alcoholic it was 39.42 years, and nonalcoholic it was 39.07 years. In our present study there was a male predominance with males accounting for 90 percent in which 61.1 % are alcoholic and 38.9 percent are nonalcoholic with 9:1 male to female ratio. In our study 100 % of patients had tenderness, 3 % of alcoholic and 7.4 % of nonalcoholic presented as mass abdomen, and 21.2 % alcoholic and 7.4 % of nonalcoholic presented as ascites. In our present study 31.6 % present with hyperglycemia in which hyperglycemia is more in alcoholic (36.6 %) than nonalcoholic( 25.9 %), 56 % of patient presented with hypocalcemia in more in nonalcoholic (59.5%) than alcoholic (54.54%), and 35 % had serum amylase level more than 600IU/L which is more raised in nonalcoholic (37%) than alcoholic (33.3%), 11.6% has WBC count >15000 cells/mm3 which is more in alcoholic (15.1%) than nonalcoholic (7.04%) and 10 % has AST level > 200mg/dl which is more in nonalcoholic (11.1%) than alcoholic (9 %). USG abdomen was diagnostic in 93.3 % of the patients in our study. Total of 18 patients developed complications 5% developed acute fluid collection among which, 13.3 % developed pseudocyst, 15 % had ascitis, 13.3 % had pleural effusion and 6.6 % developed pancreatic necrosis. Acute fluid collection and pseudocyst and pancreatic necrosis is more common in nonalcoholic than alcoholic. Ascites, pleural effusion is more common in alcoholic than nonalcoholic. One patient of nonalcoholic died of MODS and one of alcoholic died of GI bleeding. All of them managed conservatively, Of the 8 patient of biliary pancreatitis 7 underwent interval cholecystectomy, and 1 underwent ERCP + ES. There were 13 recurrence of pancreatitis in which alcoholic pancreatitis recurrence is common than nonalcoholic pancreatitis. The mean hospital stay was 7.59 day, duration of stay in mild cases being 5.78, The duration of stay for severe cases being 9.4 day. Duration of stay is almost equal in alcoholic and nonalcoholic pancreatitis Conclusion: Acute pancreatitis is a common cause of acute abdomen in patients presenting to the surgical emergency department. Alcohol being the most common cause of acute pancreatitis in our study. Nonalcoholic pancreatitis contribute to a significant proportion of etiology of pancreatitis. Unless dealt with judiciously, they lead to recurrent episodes of pancreatitis and accompanying comorbidities. Prompt identification and diagnostic work up to identify the etiology of pancreatitis followed by appropriate treatment results in cure and prevention of untoward complications.