Læknablaðið - 15.08.1991, Side 19
LÆKNABLAÐIÐ
225
í okkar rannsókn (tafla II) endurspegla
sjúkdómsástandið í þessum sjúkdómi og eru
því nothæfir til flokkunar. Horfumar versnuðu
eftir því sem jákvæðum þáttum fjölgaði.
Ekki var unnt að taka með súrefnisþrýsting
blóðs, þar sem sú mæling hafði aðeins
verið gerð í fáeinum tilfellum. Þessu var
mjög svipað háttað í áðumefndri rannsókn á
Landspítalanum (8). Þrír af sjö sjúklingum
sem dóu flokkast samkvæmt þessu með milt
sjúkdómsástand. Má meðal annars rekja það
til þess, að nánari upplýsingar skorti um þá
sem deyja mjög fljótlega eftir að bólgukastið
byrjar.
ÁLYKTUN
Orsakir bráðrar brisbólgu á íslandi virðast
vera svipaðar og í mörgum nágrannalöndum
okkar þótt sjúklingahópurinn með óskýrða
bólgu sé óvenjustór. Virðist nauðsynlegt
að bæta greiningartækni varðandi þennan
sjúkdóm. Dánartíðni og tíðni fylgikvilla er
jafnframt svipuð og annars staðar. Reynd kerfi
forspárþátta hafa ótvírætt gildi við flokkun
sjúklinga eftir horfum á fyrstu dögum eftir
innlögn á sjúkrahús.
SUMMARY
This is a retrospective study of 189 patients with
acute pancreatitis admitted to Reykjavik City
Hospital during a 10-year period, 1974-1983.
35% of cases were gallstone related, 26% were
alcohol related and 30% were idiopatic. Gallstone
related pancreatitis increased with age and was
the most frequent cause among elderly women.
Men under 60 years of age comprised most of the
alcohol related group. Mortality was 4.7%. The
complication rate was significant, comparable to
other foreign studies. There was some correlation
between high amylase levels on admission
and length of hospital stay. Six biochemical
factors as well as age proved prognostically
valuable relative to mortality and complications.
However prospective study with use of clinical
and biochemical factors will be necessary to obtain
clear answers to their real practical value and for
comparison with other similar studies.
HEIMILDIR
1. Thomson SR, Hendry WS, McFarlane GA, Davidson
AI. Epidemiology and outcome of acute pancreatitis.
Br J Surg 1987; 74: 398-401.
2. Thomson HJ. Acute pancreatitis in North and North-
East Scotland. J R Coll Surg Edinb 1985; 30: 104-11.
3. Wilson C, Imrie CW, Carter DC. Fatal acute
pancreatitis. Gut 1988; 29: 782-8.
4. Ba Bolla AD, Obeid M. Mortality in acute
pancreatitis. Ann R Coll Surg Engl 1984; 66: 184-6.
5. Sarles H, Laugier R. Alcoholic pancreatitis. Clin
Gastroenterol 1981; 10: 401-15.
6. Moody FG. Pancreatitis as a Medical Emergency in
Gastroenterology. Clin N Am 1988; 17: 433-43.
7. Malagelada JR. The Pathophysiology of acute
pancreatitis. Pancreas 1986; Vol.I, no. 3: 270-8.
8. Sigurðsson AS, Gíslason P. Bráð brisbólga á
Landspítala 1981-1986. Óbirt handrit.
9. Helgason T. Áfengisneysluvenjur og einkenni um
misnotkun 1974 og 1984. Læknablaðið 1988; 74:
129-36.
10. Cooperman M, Ferrara JJ, Carey LC, et al. Idiopathic
acute pancreatitis: The value of endoscopic retrograde
cholangiopancreatography. Surgery 1981; 90: 666-70.
11. Hamilton I, Bradley P, Lintott DJ, et al. Endoscopic
retrograde cholangiopancretography in the
investigation and management of patients after acute
pancreatitis. Br J Surg 1982; 69: 504-6.
12. Lee MJR, Choi TK, Lai ECS, et al. Endoscopic
retrograde cholangiopancreatography after acute
pancreatitis. Surg Gyn Obst 1986; 163: 354-7.
13. Katon RM, Bilbao MK, Eidemiller LR, et al.
Endoscopic Retrograde Cholangio-pancreaticography
in the diagnosis and management of non-alcoholic
pancreatitis. Surg Gyn Obst 1978; 147: 333-8.
14. Neoptolemos JP, Carr-Locke DL, London NJ,
et al. Controlled trial of urgent endoscopic
retrograde cholangiopancreatography and endoscopic
sphincterotomy versus controlled treatment for acute
pancreatitis due to gallstones. Lancet 1988; ii: 979-
83.
15. Moossa AR. Essential surgical practice. In: Cuschieri
A, Gibs R, Moossa AR, eds. London: Wright, 1988:
1094.
16. Frey GJ, Frei VT, Thirlby RC, et al. Biliary
Pancreatitis, Clinical presentation and surgical
management. Am J Surg 1986; 151: 170-5.
17. Acosta JM, Pellegrini CA, Skinner DB. Etiology and
pathogenesis of acute biliary pancreatitis. Surgery
1980; 88: 118-25.
18. Kelly TR. Gallstone pancreatitis: The Timing of
surgery. Surgery 1980; 88: 345-50.
19. Ranson JHC. The Timing of Biliary Surgery in Acute
Pancreatitis. Ann Surg 1979; 189: 654-63.
20. Poloyan D, Simonowitz D, Skinner DB. The timing
of biliary tract operations in patients with pancreatitis
associated with gallstones. Surg Gyn Obst 1975; 141:
737-9.
21. Ranson JHC, Rifkind KM, Rases DF, et al.
Prognostic signs and the role of operative
management in the acute pancreatitis. Surg Gyn Obst
1974; 139: 69-81.
22. Osbome DH, Imrie CW, Carter DC. Biliary surgery
in the same admission for gallslone-associated acute
pancreatitis. Br J Surg 1981; 68: 758-61.
23. Bank S, Wise L, Gersten M. Risk factors in acute
pancreatitis. Am J Gastroenterol 1983; 78: 637-40.