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VOLUME 8 , ISSUE 1 ( December, 2018 ) > List of Articles

CASE REPORT

Acute Pancreatitis as a Precipitant of Acute-on-chronic Liver Failure in a Patient with Underlying Hepatitis C-related Cirrhosis

Deepak Gunjan, Vishal Sharma

Keywords : Acute-on-chronic liver failure, Ascites, Cirrhosis, Gallstone, Hepatitis C virus, Pancreatitis

Citation Information : Gunjan D, Sharma V. Acute Pancreatitis as a Precipitant of Acute-on-chronic Liver Failure in a Patient with Underlying Hepatitis C-related Cirrhosis. J Gastrointest Infect 2018; 8 (1):46-47.

DOI: 10.5005/jp-journals-10068-0020

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

A 66-year-old male, had coronary artery disease and diabetes mellitus, presented with acute onset epigastric pain with radiation to back. He had non-bilious vomiting of 4 days duration. Initial blood investigation showed elevated serum amylase. Abdominal imaging revealed gallstones, edematous pancreatitis with per-pancreatic fat stranding, and evidence of chronic liver disease. Further etiological work-up for chronic liver disease showed anti-hepatitis C virus (HCV) reactivity. Small varices were detected on upper gastrointestinal endoscopy. During hospitalization, he developed ascites, non-cholestatic jaundice, and hepatic encephalopathy. Ascitic fluid analysis showed evidence of spontaneous bacterial peritonitis and serum-ascites albumin gradient of 1.8 g/dL. He was treated with intravenous antibiotics and syrup lactulose and discharged with the advice for maintaining salt restricted diet and was initiated on diuretics. Biliary acute pancreatitis acting as a precipitant for acute-on-chronic liver failure (ACLF) is an uncommon event. This case highlights acute pancreatitis as a noninfectious and nonhepatic insult to precipitate ACLF in previously unknown chronic liver disease related to HCV.

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