[The role of clinical, biochemical and echographic data in identifying the biliary pathogenesis of acute pancreatitis].
The role of clinical (biliary pain and/or jaundice), laboratory (discriminant function (DF) calculated using AST, ALT, AlkPh and GGT serum values) and ultrasonographic (US)(dilation and/or stone of common bile duct (CBD)) findings in identification of the biliary etiology of acute pancreatitis (AP) was studied in 60 patients. AP biliary etiology was defined by ERCP executed in the early phase of the disease (lithiasis and/or stenosis of CBD; endoscopic features of forced papilla in patients with gallstone). US showed the best values of sensitivity (84.6%) and diagnostic efficacy (76.7%); DF showed the best results of specificity (62.5%) and of test positive predictive value (92.8%). The statistical evaluation (McNemar test) showed a significant increase of sensitivity for US vs clinical findings and of specificity for DS vs clinical findings (p less than 0.05). The sensitivity, specificity, accuracy, test negative and positive predictive value were improved to 96.1, 87.5, 96.6, 77.1 and 92% by the combination of US and DF. Therefore the association of US and DF can provide the best non invasive method in rapidly detecting CBD pathology as an etiological factor in AP and then the enough accurate indication to early operative ERCP.
Uomo
G
G
Centro Malattie del pancreas, Ospedale Cardarelli, Napoli.
Rabitti
P G
PG
Laccetti
M
M
Marcopido
B
B
Picciotto
F P
FP
Visconti
M
M
Galloro
V
V
D000005:Abdomen / Q000000981:diagnostic imaging; D000208:Acute Disease; D001660:Biliary Tract Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis; D004796:Clinical Enzyme Tests; D006801:Humans; D010195:Pancreatitis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
Ruolo dei dati clinici, biochimici ed ecografici nella identificazione della patogenesi biliare della pancreatite acuta.