Author/Editor		Dajčman, Davorin; Ćeranić, Davorin
Title		Avtoimunski pankreatitis s prikazom primera
Translated title		Autoimmune pancreatitis - with case report
Type		članek
Source		In: Krajnc I, Pahor A, Skok P, et al, editors. Zbornik predavanj in praktikum 22. srečanje internistov in zdravnikov družinske medicine Iz prakse za prakso; 2011 maj 20-21; Maribor. Maribor: Univerzitetni klinični center,
Publication year		2011
Volume		str. 167-74
Language		slo
Abstract		Autoimmune pancretitis is a recently described type of pancreatitis of presumed autoimmune etiology. Because of it's chronic inflammatory disorder and lack of acute attacks of pancreatitis is often misdiagnosed as pancreatic cancer. First case of autoimmune pancretatis was published in 1961, since then, autoimmune pancretatis has often been treated not as an independent clinical entity but rather as a manifestation of systemic disease. The overall prevalence and incidence are still unknown, but some small series have reported the prevalence as between 5 and 6% of all patients with chronic pancreatitis. Patient vary widely in age, but most are older than 50 years. Patients with autoimmune pancreatitis usually complain of the painless jaundice, mild abdominal pain and wight loss. There is no laboratory hallmark of the disease, even if cholestatic profiles of liver dysfunction with only mild elevation of amylase and lipase levels have been reported. Proposed diagnostic guidelines include: (1) radiologic imaging, diffuse enlargement of the pancreas and diffusely irregular narrowing of the main pancreatic duct, (2) laboratory data, elevated levels of serum-globulin and/or IgG, specially IgG4, or the presence of autoantibodies and (3) histopathologic examination, fibrotic change with dense lymphoplasmacytic infiltration in the pancreas. To make the diagnosis of autoimmune pancreatitis, criterion 1 must be present with criteria 2 and/or 3. Autoimmune pancretatis is frequently associated with rheumatoid arthritis, Sjogren's syndrome, inflammatory bowel disease, tubulointersticial nephritis, primary sclerosing cholangitis and idiopathic retroperitoneal fibrosis. Pancreatic biopsy using an endoscopic ultrasound guided fineneedle biopsy is the most important diagnostic method today. Today's best treatment are corticosteroids which leads to the resolution of pancreatic inflamation, obstruction and pancreatic duct strictures. (Abstract truncated at 2000 characters)
Summary		Avtoimuni pankreatitis spada med redke oblike kroničnega vnetja trebušne slinavke. Njegov potek se ne rezlikuje od poteka kroničnega pankreatitisa in je brez brez zagonov akutnega vnetja. Zaradi tega ga lahko zamenjamo z rakom trebušne slinavke. Prvi opisi segajo v leto 1961, vendar ga že od takrat večinoma opisujejo kot eno izmed manifestacij širše sistemske bolezni in ne samostojno bolezen. Splošna prevalenca in incidenca še nista natančno ugotovljeni. V treh manjših raziskavah poročajo o 5-6% prevalenci avtoimunega pankreatitisa med bolniki s kroničnim vnetjem trebušne slinavke. Starost bolnikov je različna, vendar so skoraj zmeraj starejši od 50 let. Za bolnike z avtoimunim pankreatitisom so značilni zlatenica brez bolečin, blage bolečine v trebuhu in hujšanje. Značilnih laboratorijskih sprememb ne poznamo, v serumu pa so prisotni zvečana aktivnost holestaznih jetrnih encimov ter blago zvečana aktivnost pankreatične amilaze in lipaze. Diagnostične smernice so: (1) radiološke slikovne preiskave; značilne so povečanje celotne trebušne slinavke ter nepravilne in razpršene zožitve glavnega izvodila, (2) laboratorijske spremembe; vključujejo zvečano koncentracijo g-globulinov in/ali IgG, še posebej IgG4, ali prisotnost avtoprotiteles in (3) patohistološki pregled; prisotna sta fibroza in limfocitna infiltracija trebušne slinavke. Za postavitev diagnoze so potrebne spremembe v prvi točki združene z drugo in/ali tretjo. Veliko vlogo v diagnostiki avtoimunega pankreatitisa ima z endoskopskim ultrazvokom vodena igelna biopsija trebušne slinavke. Bolezen lahko odkrijemo pri bolnikih z revmatoidnim artritisom, Sjoegrenovim sindromom, kronično vnetno črevesno boleznijo tubulo intersticijskim nefritisom, primarnim sklerozantnim holangitisom in idiopatsko retroperitonealno fibrozo. (Izvleček skrajšan pri 2000 znakih)
Descriptors		AUTOIMMUNE DISEASES PANCREATITIS