METABOLIC CHANGES IN A PATIENT DURING THE EARLY PHASE OF ACUTE-PANCREATITIS

The present paper reports on the perioperative metabolic changes in a 70-year-old female patient in whom an acute (oedematous) pancreatitis occurred during the transduodenal excision Of a villous adenoma of the duodenal papilla. Since blood was taken for metabolic investigations before, during and after surgery, data on the changes in the intermedi ary metabolism during the early phase of acute pancreatitis in humans was recorded. Raised activity of the pancreatic enzymes amylase and li pase was demonstrable just minutes after extirpation of the papillary tumour after intraoperative cholangiography had been performed via a c holedochotomy. This showed occlusion of the duodenal papilla as well a s imaging the pancreatic duct. The reflux of bile into the pancreatic duct is considered to be one of the causative factors of acute pancrea titis (Opie-syndrome). The following metabolic changes were registered at surgery and on the first day thereafter: reduction in the serum co ncentration of cholesterol ester, the triglycerides and the phospholip ids by 30 to 50% of the preoperative values respectively, as well as l actacidaemia (up to 60 mg/dl). At the same time, the serum bilirubin c oncentration and the concentrations of the amino acids alanine and glu tamate in the serum were temporarily raised. The question is, whether these metabolic changes were a direct consequence of the activity of t he pancreatic enzymes of amino acid and lipid metabolism that were rel eased into the blood, or whether reduced synthesis by the liver (lipop roteins, lecithin: cholesterol-acyl-transferase) was responsible for t hese changes.