Pancreatitis and Its Complications
http://www.100md.com
《新英格兰医药杂志》
The pancreas never sounds a "lub dub," makes no borborygmi, and is rarely palpable on physical examination. Nonetheless, gram for gram, it is just about the most active and efficient protein-synthesizing factory in the body. Moreover, when activated spontaneously, its vast store of digestive enzymes cannot distinguish between a hamburger and the human retroperitoneum. So when the pancreas is troubled, serious medical problems follow.
Biliary Stones Causing Acute Pancreatitis.
Wellcome Photo Library.
Pancreatitis and Its Complications is edited by Chris E. Forsmark of the University of Florida College of Medicine, who comes from a background in clinical academic research and has extensive experience in sophisticated endoscopic imaging and in treatment. The authors of various chapters of this book virtually delineate the global experts in pancreatic disease.
The text is divided into two parts, the first dealing with acute pancreatitis, and the second with chronic pancreatitis. The section on acute pancreatitis is particularly strong in its discussions of epidemiology, pathophysiology, and risk stratification. There is an extensive discussion of the pathophysiology of alcoholic acute pancreatitis and gallstone pancreatitis. Some other causes of acute pancreatitis, such as peptic ulcer disease and acute penetrating or blunt abdominal trauma, are discussed only in passing, unfortunately. The chapter on treatment of severe acute pancreatitis is exceptional, yet it has only a very limited discussion of drug therapies. Indeed, there is twice as much discussion about the role of fasting and nasogastric suction in treating acute pancreatitis as there is discussion devoted to new, albeit disappointing, drug treatments, including octreotide, aprotinin, and gabexate.
Readers should pay particular attention to an exemplary and illuminating chapter dealing with the management of pancreatic-fluid collection and pseudocysts in patients with acute pancreatitis. Excellent tables and a particularly helpful and erudite algorithm provide an intelligent and well-balanced approach to the treatment of patients with these common complications of acute pancreatitis.
The second section, on chronic pancreatitis, is also well written and very well illustrated. The tendency has always been, particularly in general medical and surgical circles, to consider chronic pancreatitis as merely the long-standing, painful consequence of multiple bouts of acute pancreatitis. The insidious, and sometimes silent, yet relentless development of chronic pancreatitis with its multiple manifestations is nicely displayed in both text and illustration format.
Four important areas are exceptionally well covered: the pathophysiology and diagnosis of chronic pancreatitis, the use of pancreatic-enzyme preparations, and the endoscopic approach to patients with chronic pancreatitis. David Whitcomb's chapter dealing with the pathophysiology of chronic pancreatitis discusses genetic mutations that are probably associated with the condition, specifically those involving the CFTR, PRSS1, and SPINK1 genes. He also discusses the possible contributions of less appreciated factors, such as tobacco smoking and renal failure, to the development of chronic pancreatitis. Forsmark's chapter on the diagnosis of chronic pancreatitis leaves one wondering why so many of the tests he mentions are simply not available in the United States, including bentiromide (NBT-PABA) and pancreaolauryl tests, triolein breath tests, and secretin and cholecystokinin (CCK) simulation tests. Reluctantly, one has to conclude that American medicine has bypassed these inexpensive and noninvasive tests of pancreatic function for the more invasive and remunerative tests, such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. An important therapeutic point mentioned by contributor Phillip P. Toskes is the use of nonenteric-coated pancreatic enzymes in the treatment of chronic pancreatitis. Unfortunately, most clinicians fail to recognize that for patients with small-duct chronic pancreatitis, the use of nonenteric-coated pancreatic enzymes such as pancrelipase (Viokase 16) can have dramatic beneficial effects on recurrent abdominal pain. Finally, the chapter by Lee McHenry, Glen Lehman, and Stuart Sherman on the endoscopic approach is particularly well written, but it suffers from the lack of color endoscopic photographs.
All in all, this book is an important compendium of the current state of the art and science in treating patients with pancreatitis. It is certainly a "must have" for gastroenterologists and probably for internists and surgeons as well.
John P. Cello, M.D.
University of California, San Francisco
San Francisco, CA 94143
jpcsf@aol.com
Biliary Stones Causing Acute Pancreatitis.
Wellcome Photo Library.
Pancreatitis and Its Complications is edited by Chris E. Forsmark of the University of Florida College of Medicine, who comes from a background in clinical academic research and has extensive experience in sophisticated endoscopic imaging and in treatment. The authors of various chapters of this book virtually delineate the global experts in pancreatic disease.
The text is divided into two parts, the first dealing with acute pancreatitis, and the second with chronic pancreatitis. The section on acute pancreatitis is particularly strong in its discussions of epidemiology, pathophysiology, and risk stratification. There is an extensive discussion of the pathophysiology of alcoholic acute pancreatitis and gallstone pancreatitis. Some other causes of acute pancreatitis, such as peptic ulcer disease and acute penetrating or blunt abdominal trauma, are discussed only in passing, unfortunately. The chapter on treatment of severe acute pancreatitis is exceptional, yet it has only a very limited discussion of drug therapies. Indeed, there is twice as much discussion about the role of fasting and nasogastric suction in treating acute pancreatitis as there is discussion devoted to new, albeit disappointing, drug treatments, including octreotide, aprotinin, and gabexate.
Readers should pay particular attention to an exemplary and illuminating chapter dealing with the management of pancreatic-fluid collection and pseudocysts in patients with acute pancreatitis. Excellent tables and a particularly helpful and erudite algorithm provide an intelligent and well-balanced approach to the treatment of patients with these common complications of acute pancreatitis.
The second section, on chronic pancreatitis, is also well written and very well illustrated. The tendency has always been, particularly in general medical and surgical circles, to consider chronic pancreatitis as merely the long-standing, painful consequence of multiple bouts of acute pancreatitis. The insidious, and sometimes silent, yet relentless development of chronic pancreatitis with its multiple manifestations is nicely displayed in both text and illustration format.
Four important areas are exceptionally well covered: the pathophysiology and diagnosis of chronic pancreatitis, the use of pancreatic-enzyme preparations, and the endoscopic approach to patients with chronic pancreatitis. David Whitcomb's chapter dealing with the pathophysiology of chronic pancreatitis discusses genetic mutations that are probably associated with the condition, specifically those involving the CFTR, PRSS1, and SPINK1 genes. He also discusses the possible contributions of less appreciated factors, such as tobacco smoking and renal failure, to the development of chronic pancreatitis. Forsmark's chapter on the diagnosis of chronic pancreatitis leaves one wondering why so many of the tests he mentions are simply not available in the United States, including bentiromide (NBT-PABA) and pancreaolauryl tests, triolein breath tests, and secretin and cholecystokinin (CCK) simulation tests. Reluctantly, one has to conclude that American medicine has bypassed these inexpensive and noninvasive tests of pancreatic function for the more invasive and remunerative tests, such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. An important therapeutic point mentioned by contributor Phillip P. Toskes is the use of nonenteric-coated pancreatic enzymes in the treatment of chronic pancreatitis. Unfortunately, most clinicians fail to recognize that for patients with small-duct chronic pancreatitis, the use of nonenteric-coated pancreatic enzymes such as pancrelipase (Viokase 16) can have dramatic beneficial effects on recurrent abdominal pain. Finally, the chapter by Lee McHenry, Glen Lehman, and Stuart Sherman on the endoscopic approach is particularly well written, but it suffers from the lack of color endoscopic photographs.
All in all, this book is an important compendium of the current state of the art and science in treating patients with pancreatitis. It is certainly a "must have" for gastroenterologists and probably for internists and surgeons as well.
John P. Cello, M.D.
University of California, San Francisco
San Francisco, CA 94143
jpcsf@aol.com