Acute pancreatitis with normal serum lipase: a case series.

CONTEXT: Acute pancreatitis is diagnosed on the basis of clinical features, biochemical tests and imaging studies. Normal serum amylase level has been reported in the setting of acute pancreatitis but normal serum lipase level in acute pancreatitis is extremely rare. CASE REPORT: Herein, we present a case series of acute pancreatitis with normal serum lipase levels along with a review of the topic. CONCLUSION: In appropriate clinical setting, the diagnosis of acute pancreatitis should be entertained even with normal serum amylase and lipase levels.

Transient pancreatic hiatal herniation causing acute pancreatitis--a literature review.

Acute pancreatitis is a common cause for hospitalization; in the majority of cases, there is an identifiable etiology. However, a significant number of cases remain idiopathic. Herniation of the pancreas through a diaphragmatic hiatal hernia is an extremely rare condition reported in only five cases in the English literature. Herein, we provide a review of this topic, which includes our experience with a case of documented transient pancreatic herniation causing acute pancreatitis.

Impact of patient education on quality of bowel preparation in outpatient colonoscopies.

BACKGROUND: High-quality bowel preparation is essential for successful outpatient colonoscopy. Currently, the rate of adequate bowel preparation for outpatient colonoscopy in the USA is low. Patients often fail to adhere to recommended preparation instructions. Limited literature exists on evaluating educational intervention as a means of improving the quality of bowel preparation prior to outpatient colonoscopy. OBJECTIVE: Our objective was to determine the effect of an educational intervention on the quality of outpatient colonoscopy preparation. The secondary objective was to determine whether the quality of bowel preparation improves overall colonoscopy outcomes as measured by rate of polyp detection and caecal intubation time. METHODS: A single-blinded, prospective, randomised, controlled trial was conducted in two inner-city gastroenterology clinics in the USA. One hundred and sixty-four subjects were enrolled and randomly assigned to one of two groups. The control group subjects received verbal and written instructions for colonoscopy. The intervention group subjects received the same instructions and were then asked to answer a questionnaire. The subjects' responses were reviewed and an additional explanation of the preparation process provided. An attending gastroenterologist determined the quality of each bowel preparation at the time of colonoscopy using the Universal Preparation Assessment Scale. RESULTS: The educational intervention had no impact on the overall quality of bowel preparation (P=0.12). However, the type of food (liquid vs solid) consumed during the 24 hours prior to the procedure (P=0.04) and the time since the last solid meal (P=0.03) did have an impact on preparation quality. Other significant factors included elapsed time to first bowel movement from the initiation of bowel preparation (P=0.05) and age younger than 55 (P=0.02). Adequate bowel preparation was associated with shorter total procedure (P=0.001) and caecal intubation (P=0.01) times. CONCLUSION: Our study failed to demonstrate any effect of an educational intervention on the quality of colonoscopy preparation. However, adherence to simple dietary instructions did have a significant impact on the quality of bowel preparation. Adequate bowel preparation was associated with shorter procedure time and caecal intubation time.