Pancreatic infections

Pancreatic infection may result from increased intestinal permeability and translocation of colonic bacteria. 

Some clinicians believe that antibiotic prophylaxis is necessary in patients with severe AP in order to prevent pancreatic infection, while others believe that this practice is unnecessary. Antibiotic use in AP remains controversial in patients without definite proof of an infection. Patients with severe AP complicated by necrosis should receive prophylactic treatment with a broad-spectrum antibiotic. 

Gloor B, Muller CA, Womi M, et al. Pancreatic infection in severe pancreatitis The role of fungus and multiresistant organisms. Arch Surg 2001 136 592-596. 

On the other hand, EFN-a may also be involved in the activation of autoreactive T-cells as has been proposed for type I diabetes. An DFN-a inducible superantigen, encoded by the truncated envelope gene of a human endogenous retrovirus and specifically activating V 37 T-cells, has been detected in pancreatic lesions from type I diabetes patients, infiltrated by V 37 T-cells. Since IFN-a expression could be detected in pancreatic (3 cells in conceit with persistent viral infections, there is a clear link between viral infections and autoimmunity via IFN-a-stimulated superantigen expression. 

The nurse instructs patients to report any symptoms of infection such as an elevated temperature (even a slight elevation), sore throat, difficulty breathing, weakness, or lethargy. The patient must be aware of possible signs of pancreatitis (nausea, vomiting, abdominal pain, jaundice [yellow discoloration of the skin or eyes]) and peripheral neuritis (tingling, burning, numbness, or pain in the hands or feet). Any indication of pancreatitis or peripheral neuritis must be reported at once. 

Cystic fibrosis (CF) is a recessive genetic disorder prevalent among whites in North America and certain parts of northern Europe. It is characterized by chronic bacterial infections of the airways and sinuses, fat maldigestion due to pancreatic exocrine insufficiency, infertility in males due to abnormal development of the vas deferens, and elevated levels of chloride in sweat (> 60 mmol/L). 

Excessive secretion of gastric acid, associated with Helicobacter pylori infection, can result in the development of gastric and duodenal ulcers small changes in the composition of bile can result in crystallization of cholesterol as gallstones failure of exocrine pancreatic secretion (as in cystic fibrosis) leads to undernutrition... 

Superior mesenteric artery syndrome Enteric infections Inflammatory bowel diseases Pancreatitis Appendicitis Cholecystitis Biliary colic Gastroparesis Postvagotomy syndrome Intestinal pseudo-obstruction Functional dyspepsia Gastroesophageal reflux Peptic ulcer disease Hepatitis Peritonitis Gastric malignancy Liver failure... 

Acute pancreatitis can progress to several distinct consequences. Pancreatic fluid collections and pancreatic abscesses can form during the course of acute pancreatitis. Pancreatic necrosis can occur when pancreatic enzymes damage the pancreatic tissue or when pancreatic abscesses become secondarily infected. This infection is usually due to bacteria that are normally found in the gastrointestinal tract, including Escherichia coli, Enterobacteriaceae, Staphylococcus aureus, viridans group streptococci, and anaerobes. 

Pancreatic necrosis is a diffuse inflammation of the pancreas with infectious etiology. Pancreatic necrosis occurs within the first 2 weeks of acute pancreatitis and develops in 10% to 30% of patients with acute pancreatitis. The necrotic pancreas can become secondarily infected with enteric gramnegative bacteria (such as E. coli), and disseminated infection may result from pancreatic necrosis.7,8... 

Antibiotics are appropriate for pancreatic necrosis, which can be infected initially or be susceptible to a secondary infection.21 Selected intravenous antibiotic regimens are shown in Table 20-2. If necrosis is confirmed, antibiotics are insufficient as sole therapy surgical debridement is necessary for cure. 

Extraintestinal C. jejuni infection, including septic arthritis, cholecystitis, pancreatitis, meningitis, endocarditis, osteomyelitis, and neonatal sepsis, can present in three different ways ... 

O Primary peritonitis develops in up to 25% of patients with alcoholic cirrhosis.3 Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) average one episode of peritonitis every 2 years.4 Secondary peritonitis may be caused by perforation of a peptic ulcer traumatic perforation of the stomach, small or large bowel, uterus, or urinary bladder appendicitis pancreatitis diverticulitis bowel infarction inflammatory bowel disease cholecystitis operative contamination of the peritoneum or diseases of the female genital tract such as septic abortion, postoperative uterine infection, endometritis, or salpingitis. Appendicitis is one of the most common causes of intraabdominal infection. In 1998, 278,000 appendectomies were performed in the United States for suspected appendicitis.5... 

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