Talk:Acute pancreatitis
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[edit] Laparoscopy
I changed the text which implied that endoscopy is a treatment. It's a diagnostic procedure. Although useful to help figure out what's going on, endoscopy can actually trigger pancreatitis attacks.
The ERCP (endoscopic retrograde cholangiopancreatography) referred to later in the article is an procedure that utilizes endoscopy, but its not endoscopy. By comparison, although you might use a flashlight to change a lightbulb in a dark closet, you wouldn't say that the flashlight changed the lightbulb.
I replaced endoscopy with laparoscopy.
A specific laparoscopic treatment I know of has been used in the last decade by Dr. Peter Banks (Past President of the American Pancreatic Association, President of the International Association of Pancreatology, Past Chair of the Pancreatic Disorders Section of the American Gastroenterological Association, etc.) at Brigham and Women's Hospital in Boston. It involves making an incision in the sphincter of Oddi so that pancreatic secretions enter the descending duodenum more easily rather than accumulating and causing trouble. -- House of Scandal 14:11, 24 October 2006 (UTC)
- What is the source of your assertion? Some advocate early ERCP to establish whether gallstone disease is the cause of the pancreatitis. The use of sphincterotomy should be supported with citations. Laparoscopy is not useful unless for the specific purpose of draining a pseudocyst. JFW | T@lk 21:29, 6 February 2007 (UTC)
[edit] Reply
I mentioned the sphincterotomy proceedure used by Banks here rather than in the article because I don't have citations regarding it, only personal experience. Statements made in talk pages don't need citations and without citations may be weighed accordingly.
Regarding the statement that "Laparoscopy is not useful unless for the specific purpose of draining a pseudocyst", please note:
Diagnostic laparoscopy is a minimally invasive surgical procedure that allows the visual examination of intra abdominal organs in order to detect pathology. The video image of the liver, stomach, intestines, gallbladder, spleen, peritoneum, and pelvic organs can be viewed on a monitor after insertion of a telescope into the abdomen. Manipulation and biopsy of the viscera is possible through additional ports.[1]
Heres's another description:
Diagnostic laparoscopy is a procedure that allows a health care provider to look directly at the contents of a patient's abdomen or pelvis, including the fallopian tubes, ovaries, uterus, small bowel, large bowel, appendix, liver, and gallbladder. The purpose of this examination is to actually see if a problem exists that has not been found with noninvasive tests. Inflammation of the gallbladder (cholecystitis), appendix (appendicitis), pelvic organs (pelvic inflammatory disease), or tumors of the ovaries may be diagnosed laparoscopically.[2]
Use of a search engine for "Diagnostic Laparoscopy" and similar words will return many thousands of results.
I may have missed your point if your point was that laparoscopy shouldn't be mentioned as a treatment option. My concern was that endoscopy was listed as a treatment option and looking at something isn't treatment. Laparoscopy, on the other hand, may involve cutting, etc.
However, note that there are a number of pancreatitis treatment proceedures besides the draining of a pseudocyst you mentioned and the sphincterotomy I mentioned. The most obvious of these is cholecystectomy. Based on that, the intro seems to still make sense.--House of Scandal 04:26, 14 February 2007 (UTC)
[edit] Tests
PMID 12094843 - a useful review of blood tests. JFW | T@lk 21:29, 6 February 2007 (UTC)
[edit] Antibiotics
"Prophylactic antimicrobials should not be used." is bit of a strong statement. See edits.
[edit] Epidemiology
I removed wrongdiagnosis.com as the primary reference for epidemiology. This is an unreliable site. In fact, I was unable to corrobate the USA incidence data. I added some well-established data from Europe, which is not much different.
I removed completely the claims re. prevalence. For an acute medical condition, prevalence is a completely meaningless number. This would indicate the number of people in the population presently suffering from acute pancreatitis. Prevalence becomes relevant only in more chronic conditions. JFW | T@lk 14:14, 9 July 2007 (UTC)
[edit] use of mepedrine
The information in this article concerning use of meperidine/pethidine/demerol is outdated, and contradicts information in the article on the drug, particularly regarding antispasmodic effects. In the U.S., use of demerol is actively discouraged. From what I've been able to gather, hydromorphone is commonly used to treat the pain associated with acute pancreatitis. Suspect other infomation in the article is dated as well. —Preceding unsigned comment added by 70.253.195.89 (talk) 15:00, 15 November 2007 (UTC)
[edit] Use of hydromorphone--from a survivor
My personal experience in pain relief for hemorrhagic pancreatits was that I was put on a 100 mcg Fentanyl patch and, following frequent IV injections of 2mg hydromorphine, a dispensing pump. Alhtough I had myself convinced that I was only using the hydromorphine for euphoria, it was because the Fentanyl would mask the pain well past the point that dependent cravings set in. It was only about a year later, on my initial attempt to stop Fentanyl (hydromorphone having been stopped six months earlier) that I discovered how much pain I was really in. In my case, due to a large dose following a rupture in a transplanted kidney, morphine was as effective as water. The main benefit I see to the Fentanyl/hydromorphone combination is that either can be stopped without withdrawal symptoms if the other is continued, and Fentanyl is probably more conducive to the weaning process. In my case I found that the hydromorphone caused hallucinations and vivid dreams which I could not distinguish from reality, as well as short periods of altered reality that I did not recognize when interacting with others: Fentanyl had no such effect.
