Gürhan ŞİŞMAN, M. Aytaç YÜKSEL, Hakan ŞENTÜRK

Gebelikte Akut Pankreatite Yaklaşım

Gebelikte akut pankreatit AP nadir gözüken tehlikeli bir hastalıktır. Artmış maternal ve fetal mortalite insidansı ile birliktelik gösterir. Gebelikte ortaya çıkan metabolik değişikliklerle pankreatik patofizyolojinin etkileşmesi sonucu tanı kolaylıkla gözden kaçabilir. Bulantı ve kusma eşlik etsin ya da etmesin üst karın ağrısı ile başvuran gebelerde ayırıcı tanıda mutlaka düşünülmelidir. Etiyolojide öne çıkan faktörler; safra taşları, hipertrigliseridemi HTG ve alkoldür. Biliyer kaynaklı AP’de prognoz non-biliyer kaynaklı AP’ye göre daha iyidir. Tanıda en temel laboratuar bulgusu serum amilaz seviyesinin normalin üst sınırının 3 katından fazla yükselmesidir. Tanıyı desteklemek için ultrason US yapılmalı, serum trigliserid TG ve iyonize kalsiyum seviyesine bakılmalıdır. TG yüksekliği olan durumlarda serum amilaz seviyesi normal olabileceği için bu durumda serum lipazı ve idrar amilazına bakmak tanıda daha faydalı olacaktır. US’nin yetersiz kaldığı vakalarda gadoliniumlu manyetik rezonans kolanjiopankreatografi MRCP yapılabilir. Radyasyon maruziyeti dolayısıyla bilgisayarlı tomografi BT ve tanısal endoskopik retrograd kolanjio pankreotografi ERCP kullanılmamalıdır. Gastrointestinal dekompresyon ve açlık tedavinin temelini oluşturmaktadır. Safra taşı nedenli AP’de erken dönemde düşük komplikasyon oranı olduğu için laparoskopik kolesistektomi planlanmalıdır. Laporoskopik kolesistektomi için en uygun zaman, uterusun cerrahi alanı kısıtlamadığı ve fetusun organogenezisinin tamamlandığı 2. trimestır olmalıdır. Seçilmiş vakalarda teröpatik ERCP’de yapılabilir. HTG’li AP’de ise yağdan fakir diyet, omega-3 yağ asitleri ve plazma değişimi tedavileri uygulanabilir

Approach To Acute Pancreatitis In Pregnancy

Acute pancreatitis AP is a dangerous disease in pregnancy but seen as rare. AP is associated with increased maternal and fetal mortality. Metabolic changes that occur in pregnancy can easily cause misdiagnosis of pancreatic pathophysiology. Differential diagnosis of the AP should be considered in pregnant women who have upper abdominal pain with or without nausea and vomitting. Main etiological factors are gallstones, hypertriglyceridemia HTG and alcohol. Non-biliary originated AP has better prognosis that the biliary AP. The main laboratory feature for diagnosis is the amylase level of the patient rises three times higher than upper limit of normal serum amylase level. To support the diagnosis, ultrasound US should be performed, and serum triglyceride TG , and ionized calcium levels should be measured. Cases with elevated TG levels serum amylase levels can be normal so in order to correct the diagnosis we should measure serum lipase and urinary amilase levels. Gadolinium magnetic resonance cholangiopancreatography MRCP cen be performed in cases of insufficient ultrasonographic findings. For avoiding the radiation exposure in pregnant women computed tomography CT and endoscopic retrograde cholangiopancreotography ERCP should not be used.Gastrointestinal decompression and hunger are basic principle of the treatment. In gallstone-induced AP laparoscopic cholecystectomy should be planned because when it is performed as soon as possibly the complication rates decreases. Second trimestre of the pregnancy is the most appropriate time for laparoscopic cholecystectomy because the uterus won’t restrict the surgical area and the fetal organogenesis is completed. Therapeutic ERCP can be performed in selected cases. In AP with HTG poor fat diet , omega -3 fatty acids and plasma exchange can be applied as treatment

Keywords:

pancreatitis, pregnancy,

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