Clinical Features Of Acute Hyperlipidemic Pancreatitis

Background and Objective Acute pancreatitis is a common emergency of digestive system. It is an acute chemical inflammation because of pancreatinum released and activated by various kinds of causes. Pancreatitis caused by hyperlipidemia is called Acute hyperlipidemic pancreatitis(AHP). With the change of life style and environment, the incidence of AHP is increasing, but the research of its features is relatively rare. This article is to enhance the level of diagnosis and treatment of AHP by analyzing its clinical features. Methods 227 patients were diagnosed as acute pancreatitis and were admitted to Sir Run Run Shaw Hospital between Jan 2004 to Dec 2005. Among them.ten patients (seventeen examples) were diagnosed as AHP. Causes, clinical manifestation, lab examination, imaging outcome, local and systemic complications, treatment and turnover were recorded. Meanwhile, nineteen examples of acute lithiasic pancreatitis(ALP) were randomly selected from the 227 patients. Related index of body mass index, hemodiastase, lipid, hepatic function , acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), CT severity index(CTSI) were comparedbetween the AHP and ALP patients. The association of APACHE II, CTSI and triglycerine was analysed. The correlation of severity and frequency of AHP was also assessed. Results1 Causes and past history All attacks were after meals. Four examples had history of oily food ingestion or overeating. All patients had fatty liver, among which four had diabetes mellitus, one had drink addiction, one had long history of taking tamoxifen after operation of right mastocarcinoma.2 Clinical manifestation All examples of AHP had abdominal pain and local tenderness, five had diffused tenderness , six had local rebound tenderness, and one had diffused rebound tenderness. After treatment, all the abdominal pain relieved in varying degree.3 Laboratory Hemodiastase ranged from 64—1340u/l.There were nine examples with hemodiastase normal or less than trine of the upper limit, seven once misdiagnosised or missed diagnosised, five with blood calcium less than 1.87mmol/l. All patients had triglycerine levels more than 11.30mmol/l.4 Imaging results and local complications All patients showed fatty liver and no cholelithiasis .Thirteen examples had appearance of pancreatitis through abdominal B ultrasonography. CT showed characteristics of acute pancreatitis in all the patients. Eight examples had CTSI of class I, nine of class II and none of class III. Two examples had complications of pancreatic necrosis and two had pancreatic pseudocyst.5 Evaluation of severity Seven examples' APACHEII score was higher than 8. Nine examples were diagnosed as severe pancreatitis and among them three had fulminating pancreatitis.6 Treatment Nine examples were treated by total parenteral nutrition(TPN) and three were treated by blood purification.7 Turnover One example was discharged automatically and the others were improved .8 Compared with ALP? the levels of blood triglycerine, cholesterin and very low densitylipoprotein were all significantly higher than those of ALP(P<0. 05)?the index of heptic functions, including glutamate-pyruvatetransaminase glutamic(GPT, ALT)> glutamate- oxalacetictransaminase (GOT, ASTK alkaline phosphatase (AKPK Y-amino-glut amicacid (y— GT)> direct bilirubin(DBIL) had significant difference (P<0. 05)excepting for total bilirubin(TBIL) .(3) BMI, APACHEIIand CTSI had no significant difference(P>0. 05)9 ?Compared the level of triglycerine and cholesterin between post- and pre-treatment of AHP The level of triglycerine and cholesterin after treatment differed significantly from that before treatment of AHP. ?Compared the level of triglycerine between post-treatment of AHP and ALP There was also significant difference (P<0. 05) between post-treatment of AHP and ALP10 Correlation of the level of triglycerine and disease severity There was significant correlation between them.11 Correlation of attack frequencies and severity There was no obvious relationship between attack frequencies and severity .Conclusion AHP has its own especial clinical features and high rate of recurrence. It is meaningful to strengthen the research of AHP.