Is it pancreatitis in acute abdominal pain in acute viral hepatitis?

Nov 1 2007

Hepatitis viruses have a strong tropism for hepatocytes; viral antigen also has been detected in pancreas and gallbladder.

Acute pancreatitis is common in Fulminant hepatic failure but rarely reported in acute viral hepatitis.

124 patients with acute viral hepatitis over a three year period were involved. Acute abdominal pain was present in 24 patients, 7 had acute pancreatitis and 17 had stretching of glissons capsule as a cause. The etiology of pancreatitis was hepatitis E virus in 4 patients, hepatitis A virus in 2 and hepatitis B virus in 1.

A research article to be published on November 21 in the World Journal of Gastroenterology addresses the above issue. The research team led by Dr. Pankaj Jain and Dr. Sandeep Nijhawan from Sawai Man Singh College and Hospital, Jaipur worked on patients with acute viral hepatitis who had severe acute abdominal pain for more than three years. The large sample size allowed them to obtain significant results and draw very reliable conclusions.

Only a few case reports and one case series of symptomatic pancreatitis in the setting of acute viral hepatitis have been reported. In this study 5.65% of patients had acute mild pancreatitis. All patients recovered on conservative management with no complications and sequelae on mean follow-up of 12 (range 8-24) months.

Patients with acute viral hepatitis with severe abdomen pain should undergo serum amylase, lipase and ultrasonography or contrast-enhanced computed tomography of the abdomen to prove acute pancreatitis as a cause of abdomen pain.

Hepatitis E virus, hepatitis B virus and hepatitis A virus were the cause of acute viral hepatitis in 54, 54 and 16 patients, respectively. They are preventable if high-risk groups and health professionals are immunized, there is proper sanitation, screening of the blood products and precautionary measures are taken to prevent their spread.

Dr. Pankaj Jain (doing a fellowship in gastroenterology) and Dr. Sandeep Nijhawan (Professor of Gastroenterology) are working in Department of Gastroenterology at Sawai Man Singh College and Hospital, Jaipur.

The article describes the clinical findings of acute pancreatitis in acute viral hepatitis. The main content of the manuscript is good.