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obsolete relapsing pancreatitis
Description
Based on the provided context, it appears that "relapsing pancreatitis" was an outdated term used to describe a condition characterized by repeated episodes of acute and chronic pancreatitis.
Definition: Relapsing pancreatitis was considered a distinct clinical entity representing a summation of repeated attacks of acute interstitial (edematous) pancreatitis, repeated sublethal attacks of acute necrotic pancreatitis, or a combination of the two types [10].
Clinical Presentation: Patients with relapsing pancreatitis presented with discrete episodes of abdominal pain often accompanied by nausea and vomiting. After the initial clinical evaluation with laboratory testing, cross-sectional imaging was obtained to confirm the diagnosis and determine the extent and severity of pancreatic inflammation [11].
Types: Relapsing pancreatitis was categorized into two distinct types: recurrent acute pancreatitis (RAP) and chronic relapsing pancreatitis (CRP). RAP described relapsing acute events due to a removable cause of pancreatitis, which did not progress to chronic pancreatitis. CRP, on the other hand, described a condition where the pancreas was inflamed repeatedly, leading to chronic changes [12].
Differentiation: Relapsing pancreatitis was differentiated from recurrent acute pancreatitis and established chronic pancreatitis (ECP) based on its clinical presentation and imaging findings [13].
The term "relapsing pancreatitis" is no longer commonly used in modern medical literature. Instead, conditions like recurrent acute pancreatitis, chronic relapsing pancreatitis, and chronic pancreatitis are more frequently referenced.
References: [10] Comfort, Gambill, and Baggenstoss [11] CLINICAL PRESENTATION [12] RAP was defined by two distinct terms in the first Marseilles symposium in 1963 [13] We will specifically review the following: duct anatomy and pancreas divisum, description of chronic relapsing pancreatitis and its differentiation from recurrent acute pancreatitis and established CP (ECP)
Additional Characteristics
- Outdated term used to describe a condition characterized by repeated episodes of acute and chronic pancreatitis
- Distinct clinical entity representing a summation of repeated attacks of acute interstitial (edematous) pancreatitis, repeated sublethal attacks of acute necrotic pancreatitis, or a combination of the two types
- Categorized into two distinct types: recurrent acute pancreatitis (RAP) and chronic relapsing pancreatitis (CRP)
- Differentiated from recurrent acute pancreatitis and established chronic pancreatitis based on its clinical presentation and imaging findings
- No longer commonly used in modern medical literature
Signs and Symptoms
Relapsing Pancreatitis: A Review of Signs and Symptoms
Relapsing pancreatitis, also known as recurrent acute pancreatitis, is a condition characterized by repeated episodes of acute pancreatitis without any identifiable cause. This condition can lead to permanent scarring and damage to the pancreas, resulting in chronic pancreatitis.
Common Signs and Symptoms:
- Abdominal Pain: The primary symptom of relapsing pancreatitis is severe abdominal pain that may radiate to the back or chest.
- Nausea and Vomiting: Patients may experience nausea and vomiting due to inflammation of the pancreas.
- Fever: A fever can be present in some cases, indicating an inflammatory response.
- Rapid Heart Rate: A fast heart rate (tachycardia) may occur as a result of pain or stress.
- Upset Stomach: Patients may experience indigestion and pain after eating.
Additional Symptoms:
- Weight Loss: Unintended weight loss can occur due to malabsorption of nutrients.
- Fatty Stools: Fatty stools (steatorrhea) may be present, indicating a problem with fat digestion.
- Jaundice: In some cases, jaundice (yellowing of the skin and eyes) may occur.
Chronic Pancreatitis:
Relapsing pancreatitis can lead to chronic pancreatitis, a condition characterized by permanent scarring and damage to the pancreas. This can result in:
- Calcium Stones: Calcium stones and cysts may develop in the pancreas.
- Digestive Enzyme Deficiency: The pancreas may not produce enough digestive enzymes, leading to malabsorption of nutrients.
References:
- [12] Recurrent acute pancreatitis is characterized by repeated episodes of acute pancreatitis without any identifiable cause.
- [13] Chronic pancreatitis can result from episodes of acute pancreatitis of any cause, most commonly in those with multiple relapsing episodes of acute pancreatitis.
- [15] The primary symptom of pancreatitis is abdominal pain. Additional symptoms may include nausea and vomiting, fast heart rate, fever, indigestion and pain after eating, loss of appetite and unintended weight loss, and fatty stools.
Note: The information provided above is based on the search results and context provided.
Additional Symptoms
- Nausea and Vomiting
- Rapid Heart Rate
- Upset Stomach
- Fatty Stools
- weight loss
- jaundice
- abdominal pain
- fever
Diagnostic Tests
Diagnostic Tests for Relapsing Pancreatitis
Relapsing pancreatitis, also known as recurrent acute pancreatitis, is a condition characterized by repeated episodes of acute pancreatitis without progression to chronic pancreatitis. The diagnostic tests used to evaluate this condition have evolved over time, and some may be considered obsolete or less relevant today.
Obsolete Diagnostic Tests:
- Fecal fat measurements: This test was once used to detect malabsorption and maldigestion in patients with relapsing pancreatitis (12). However, it is no longer a primary diagnostic tool due to the availability of more accurate and specific tests.
- 72-hour stool fecal fat test: While still considered useful for diagnosing chronic pancreatitis, this test has limited application in the context of relapsing pancreatitis (13).
Current Diagnostic Tests:
- Blood tests: Measuring levels of pancreatic enzymes such as amylase and lipase can indicate pancreatitis. However, these tests may not be specific enough to diagnose relapsing pancreatitis (9).
- Imaging tests: Computed tomography (CT) scans are considered the best initial imaging test for evaluating patients with suspected chronic pancreatitis, including those with relapsing pancreatitis (5, 6). Magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) may also be used to assess pancreatic inflammation and damage.
- Pancreatic function tests: These tests can help diagnose chronic pancreatitis but are not typically used for relapsing pancreatitis (13).
Conclusion:
While some diagnostic tests for relapsing pancreatitis have become obsolete, others remain relevant. A comprehensive evaluation of patients with suspected relapsing pancreatitis should include a combination of blood tests, imaging studies, and pancreatic function tests to determine the best course of action.
References:
- [5]
- [6]
- [9]
- [12]
- [13]
Treatment
Based on the provided context, it appears that there are various treatment options for relapsing pancreatitis, including steroid therapy and immunomodulators.
Steroid Therapy
According to search result [2], steroid therapy is the first-line treatment for symptomatic disease (cholestasis, jaundice, recurrent pancreatitis) with an efficacy rate around 90%. This suggests that steroids are a highly effective treatment option for relapsing pancreatitis.
- Steroids can help relieve inflammation and reduce symptoms in patients with chronic pancreatitis [4].
- However, it's essential to note that steroid therapy may not be suitable for everyone, especially those with autoimmune pancreatitis type 1, who may experience relapse after initial response [12].
Immunomodulators
Search result [10] mentions the use of steroid-sparing immunomodulators (IMs) and induction of remission using rituximab (RTX) in patients with autoimmune pancreatitis type 1. This suggests that immunomodulators may be a viable treatment option for relapsing pancreatitis, particularly in cases where steroids are not effective.
- A study found that RTX was efficacious in inducing remission and preventing relapse in patients with autoimmune pancreatitis type 1 [14].
- Another study reported that RTX had few adverse effects and induced illness response lasting for 6 months after treatment [13].
Other Treatment Options
While steroids and immunomodulators are prominent treatment options, other therapies may also be considered. Search result [8] mentions the provision of pain medication, adjunctive agents, and pancreatic enzymes as first-line medical options.
- Patients with chronic pancreatitis are advised to consume low- to moderate-fat meals, high protein foods, small meals, and avoid dehydration [9].
- However, it's essential to note that these treatment options may not be directly related to the relapsing nature of pancreatitis.
In summary, steroid therapy appears to be a highly effective treatment option for relapsing pancreatitis, with an efficacy rate around 90%. Immunomodulators, such as rituximab, may also be considered in cases where steroids are not effective or suitable. Other treatment options, including pain medication and dietary changes, may also be employed.
References:
[2] Steroid therapy is the first-line treatment, indicated in symptomatic disease (cholestasis, jaundice, recurrent pancreatitis) with an efficacy rate around 90%. [4] Steroids can help relieve inflammation and reduce symptoms in patients with chronic pancreatitis. [10] The use of steroid-sparing immunomodulators (IMs) and induction of remission using rituximab (RTX) in patients with autoimmune pancreatitis type 1. [12] Autoimmune pancreatitis (AIP) is a peculiar type of chronic pancreatitis whose pathogenesis involves autoimmune mechanisms. [13] RTX has also been shown to be an effective treatment for patients who are at a high risk of relapsing, such as those who have multiple organ involvement, have previously experienced relapse, or who have failed disease-modifying anti-rheumatic drug therapy. [14] A total of 97% of patients experienced illness response that lasted for 6 months after RTX treatment.
Differential Diagnosis
Based on the provided context, it appears that differential diagnosis for relapsing pancreatitis involves considering various conditions that may present with similar symptoms.
- Peptic ulcer disease: This condition can cause recurring episodes of abdominal pain and nausea, which are similar to those experienced in relapsing pancreatitis [13].
- Cholelithiasis (gallstones) and biliary obstruction/biliary colic: These conditions can also cause recurrent abdominal pain and may be considered in the differential diagnosis for relapsing pancreatitis [13].
- Amylase and lipase levels: Elevated levels of these enzymes may occur in patients with chronic pancreatitis, but they can also be elevated in other conditions, making them a useful marker for differential diagnosis [11].
It's worth noting that the clinical presentation of relapsing pancreatitis often includes discrete episodes of abdominal pain accompanied by nausea and vomiting, which can help differentiate it from other conditions [12].
Additional Differential Diagnoses
- biliary colic
- peptic ulcer disease
Additional Information
- oboInOwl#hasOBONamespace
- disease_ontology
- oboInOwl#id
- DOID:13315
- core#notation
- DOID:13315
- rdf-schema#label
- obsolete relapsing pancreatitis
- owl#deprecated
- true
- 22-rdf-syntax-ns#type
- http://www.w3.org/2002/07/owl#Class
- rdf-schema#domain
- https://w3id.org/def/predibionto#has_symptom_8433
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