Assuntos
Pâncreas/patologia , Pancreatite Alcoólica/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Neoplasias Pancreáticas/diagnóstico , Pancreaticoduodenectomia , Pancreatite Alcoólica/diagnóstico por imagem , Pancreatite Alcoólica/patologia , Pancreatite Alcoólica/cirurgia , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios XRESUMO
Patients with chronic pancreatitis may have abnormal gastrointestinal transit, but the factors underlying these abnormalities are poorly understood. Gastrointestinal transit was assessed, in 40 male outpatients with alcohol-related chronic pancreatitis and 18 controls, by scintigraphy after a liquid meal labeled with (99m)technetium-phytate. Blood and urinary glucose, fecal fat excretion, nutritional status, and cardiovascular autonomic function were determined in all patients. The influence of diabetes mellitus, malabsorption, malnutrition, and autonomic neuropathy on abnormal gastrointestinal transit was assessed by univariate analysis and Bayesian multiple regression analysis. Accelerated gastrointestinal transit was found in 11 patients who showed abnormally rapid arrival of the meal marker to the cecum. Univariate and Bayesian analysis showed that diabetes mellitus and autonomic neuropathy had significant influences on rapid transit, which was not associated with either malabsorption or malnutrition. In conclusion, rapid gastrointestinal transit in patients with alcohol-related chronic pancreatitis is related to diabetes mellitus and autonomic neuropathy.
Assuntos
Trânsito Gastrointestinal/fisiologia , Intestino Delgado/fisiopatologia , Pancreatite Alcoólica/fisiopatologia , Pancreatite Crônica/fisiopatologia , Adulto , Doenças do Sistema Nervoso Autônomo/diagnóstico por imagem , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Teorema de Bayes , Índice de Massa Corporal , Ceco/diagnóstico por imagem , Ceco/fisiopatologia , Neuropatias Diabéticas/diagnóstico por imagem , Neuropatias Diabéticas/fisiopatologia , Humanos , Síndromes de Malabsorção/diagnóstico por imagem , Síndromes de Malabsorção/fisiopatologia , Masculino , Pessoa de Meia-Idade , Compostos de Organotecnécio , Pancreatite Alcoólica/diagnóstico por imagem , Pancreatite Crônica/diagnóstico por imagem , Ácido Fítico , Cintilografia , Esteatorreia/diagnóstico por imagem , Esteatorreia/fisiopatologiaRESUMO
CONTEXT: Purtscher-like retinopathy with bilateral loss of vision is a rare and severe complication that may follow acute pancreatitis. CASE REPORT: The case of a 35-year-old patient with acute alcoholic pancreatitis who developed sudden loss of visual acuity is described. The ophthalmoscopic examination revealed diffuse retinal whitening of the posterior pole with confluent cotton-wool spots. Fluorescein angiogram showed retinal arteriolar occlusion. The findings were compatible with Purtscher-like retinopathy. Computed tomography of the abdomen demonstrated enlarged liver and pancreas with edema and inflammation. The pathogenesis of this form of retinopathy still remains uncertain and there is no specific treatment available.