Evaluation of General Clinical Examination Effectiveness for Early Detection of Acute Pancreatitis
Introduction. Until nowadays many problems connected with acute pancreatitis (AP) are not solved. The main difficulties are associated with verification of special patients group with the severe form of this acute pathology at early stages.
Despite some progress in improving of acute pancreatitis detection diagnostic mistakes in hospital reach 26 %, and 17.2 % of patients with AP are operated on suspicion of other acute surgical diseases.
The objective of the research is to make better the treatment results of the patients with acute pancreatitis by improving its early detection.
Materials and Methods. The research was being conducted on the basis of Poltava 2nd municipal clinical hospital and Poltava regional clinical hospital named after Sklifosovsky from 2011 to 2012. The diagnosis of acute pancreatitis and the severity of disease were based on classification that was proposed at the Atlanta International Symposium (1992).
All necessary diagnostic and therapeutic measures were carried out for the patients with the preliminary diagnosis of AP on hospital admission according to the Ministry of Public Health order № 297 dated 02.04.2010. Ultrasound of abdominal organs was carried out on the 1st day after hospital admission. During the last years in Ukraine the express test «Actim Pancreatitis» (Medix Biochemica) by distributor company Farmasko is widely used for AP early diagnosis based on the detection of tripsinogen-2 high concentration in urine (pancreas specific marker).
Results and Discussion. There were analyzed 33 indices to determine the prognostic significance of certain laboratory parameters in patients of the I and II groups; they display the characteristics of the basic life support systems functionality on admission and 2–3 days after hospitalization.
The assessment of significant differences between the parameters mentioned above among the patients of the first and the second groups has been carried out during the stage of the statistical data processing using the Student’s t-test. There were 10 laboratory parameters with the significant difference (Р < 0.05) among 33 analyzed ones. The correlation analysis of all these criteria has been carried out as the next step to determine significant prognostic parameters. The incidence of AP development has been stated to be the resulting function. The factors correlating with the resulting parameters with the index no less than 0.7 (expressing intense correlation) have been considered to be statistically significant.
Conclusion. 1. The presence of trypsinogen-2 apart from other laboratory parameters on hospital admission gives evidence of acute pancreatitis in 80 % of the I group patients (moderate pancreatitis) and 85.3 % of the II group observations (acute pancreatitis). The identification of trypsinogen-2 apart from other laboratory parameters on the 2–3 day was positive in 84 % of the I group patients and 86.6 % of the II group observations.
2. When determining blood glucose level, urine diastase and trypsinogen-2 on admission diagnosis AP has been confirmed in 88 and 90 % of cases in the I and II groups, respectively.
3. There was a correlation of such indices as the number of leukocytes, urine diastase level, trypsinogen-2 level, blood glucose level and hematocrit when the laboratory results were re-estimated at the 2nd day. AP diagnosis was confirmed in 92 and 100 % of the I (moderate AP) and the II group (acute AP), respectively; it testifies a high diagnostic value of determining trypsinogen-2 level and the laboratory parameters mentioned above for the early diagnosis of acute pancreatitis.
4. There were 13 patients (43.3 %) with acute pancreatitis who had difficulties with pancreas visualization due to meteorism resulting in reduction of the sonography diagnostic value in case of acute pancreatitis during the first day of the disease onset.
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