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This article has been cited by other articles in PMC. Abstract Non-traumatic rhabdomyolysis is a rare complication of acute pancreatitis. One of the major risk factors of both acute pancreatitis and rhabdomyolysis is alcohol abuse.
However, only a few studies have reported the prognosis and association of severe acute pancreatitis SAP and rhabdomyolysis in alcohol abuse patients. In the present study, we report two cases presenting with SAP complicated by rhabdomyolysis following high-dose alcohol intake.
The disease onset, clinical manifestations, laboratory data, diagnosis and treatment procedure of each patient were recorded, and the association with rhabdomyolysis was analyzed. Alcohol consumption was the most predominant cause of SAP and rhabdomyolysis in these patients.
SAP-related rhabdomyolysis was primarily induced by the toxicity associated with pancreatic necrosis. The laboratory tests revealed that the concentration of serum creatine kinase CK and myoglobin increased and acute renal failure symptoms were present, which provided an exact diagnosis for SAP-induced rhabdomyolysis.
Rhabdomyolysis and subsequent hypermyoglobinuria severely impaired kidney function and aggravated hypocalcemia. The therapy of early stage SAP complicated by rhabdomyolysis involved liquid resuscitation support.
When first stage treatment fails, blood purification should be performed immediately. Both patients developed multiple organ failure MOF and succumbed to the disease. Considering the two cases presented, we conclude that alcohol-related SAP complicated by rhabdomyolysis may have a poor clinical prognosis.
Severe acute pancreatitis SAP is a dangerous and complicated disease with a high mortality rate 12. SAP has various pathophysiological manifestations, including cardiovascular, pulmonary, renal, central nervous system and metabolic disorders 3 — 5.
Certain cases even develop rhabdomyolysis, which is a complication rarely reported among the metabolic disorders induced by acute pancreatitis 67.
Rhabdomyolysis is defined as injury of skeletal muscle cells and leakage of its contents, including the enzyme creatine kinase CKelectrolytes and myoglobin. Rhabdomyolysis is a severe pathological process caused by infection, diabetic ketoacidosis, trauma, sedation drugs, muscle relaxants and hyperthermia 89.
Rhabdomyolysis induced by SAP belongs to the non-traumatic type. Alcohol abuse is associated with an increased risk of acute pancreatitis and rhabdomyolysis. The pathophysiological role of alcohol in the etiology and occurrence of acute pancreatitis is complex, but increased oxidative stress, disruption of cytosolic calcium homeostasis and changes in gene expression in the pancreas appear to be involved 10 Ethanol also causes rhabdomyolysis via disruption of adenosine triphosphatase pump function, breakdown of the muscle membrane and alteration of the sarcoplasmic reticulum However, few studies have reported the prognosis and association of SAP and rhabdomyolysis in alcohol abuse patients.
We investigated characteristic clinical manifestations, laboratory findings and treatment strategy of SAP to highlight the features of this association. Case reports Case 1 Case history A year-old male presented with acute abdominal pain and fever for 4 days after heavy alcohol consumption and was admitted to the hospital.
The patient had a history of chronic alcoholism for 10 years. The patient also had diabetes mellitus and severe fatty liver which was also observed in family members. The results of physcial examination were as follows: The conjunctivae were neither icteric nor anemic.
The lungs were clear and heart sounds were normal. Neither hepatosplenomegaly nor edema were identified. Palpation revealed a distended abdomen and muscle tenderness on the left side.
The chest roentgenogram and electrocardiogram were normal. Laboratory tests on admission indicated pancreatitis with elevated levels of serum pancreatic enzymes. Serum biochemical indicators are listed in Table I.
The Ranson score at admission was 1.
Ultrasonography and computed tomography CT of the abdomen revealed marked swelling and pancreatic effusion Fig.The Public Inspection page on vetconnexx.com offers a preview of documents scheduled to appear in the next day's Federal Register issue.
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Page 1 NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE Case Teaching Notes for “A Case of Acute Pancreatitis” by David F. Dean INTRODUCTION / BACKGROUND Th e pancreas is an organ that possesses both endocrine. Digestive Case Study: A Case Of Acute Pancreatitis Describe the Anatomical location of the Pancreas relative to the other organs in the upper portion of the abdominal cavity. The pancreas is an “elongated, tapered” organ that sits behind the . Complete the CME case-based lesson. Disease Management Clinical Decisions Pancreatitis. A year-old Baptist minister presents with a history of a sudden onset of mid-abdominal pain radiating to his back. The pain awakened him at 4 that morning Center for Continuing Education | Richmond Road, TR, Lyndhurst, OH .
The physical exam findings, together with the history of alcohol abuse and the results of a CBC, serum chemistry panel, and abdominal ultrasound, led the physician to conclude that George was suffering from a case of acute pancreatitis.
The doctor immediately initiated the appropriate medical therapy. Questions %(6). The world is full of crooks. It's your money.
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Case copyright held by the National Center for Case Study Teaching in Science, University at BuF alo, State University of New York. Originally published January 4, ±²³±. Originally published January 4, ±²³±. Migraine is a complex disorder characterized by recurrent episodes of headache, most often unilateral and in some cases associated with visual or sensory symptoms—collectively known as an aura—that arise most often before the head pain but that may occur during or afterward (see the image below).