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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

"Stenosing papillitis" is a descriptive term for an anatomic deformity of the papilla of Vater that is characterized by narrowing of the lower end of the bile duct and the proximal end of the duct of Wirsung. The defect is secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. Patients with papillary stenosis from gallstones may present with episodes of severe upper-abdominal pain several years after cholecystectomy. The pain is often incapacitating, and patients are often addicted to narcotic analgesics. The work-up includes abdominal ultrasonography and CT scanning and endoscopic retrograde cholangiopancreatography even though the findings usually are normal. Liver and pancreatic enzymes are not frequently elevated with the painful episodes. Transendoscopic manometry may reveal elevated pressures within the papillary portion of the distal bile duct. Some patients are relieved of their pain by transduodenal sphincteroplasty and transampullary septectomy, thereby ablating the sphincter of Oddi around the bile and pancreatic ducts and enlarging their openings.
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PMID:Stenosis of the sphincter of Oddi. 224 19

Acute pancreatitis is a disease characterized by abdominal pain, low-grade fever, abdominal tenderness and rigidity, and moderate elevation of the white blood cell count. A widely used revised classification of pancreatitis is that proposed in 1984 at Marseille. It only distinguishes between acute and chronic pancreatitis. In 61 cases were 40 men and 21 women. The mean age in the total series was 52.5 years. The etiology of the acute condition was alcoholism in 32.8% and biliary tract disease in 23%. In 9.8% the acute pancreatitis is associated with alimentary tract diseases (adipositas, hyperlipidemia). The severity of acute pancreatitis is pathological anatomy determined by three stages. In pathogenesis the process of digestion is caused by activated pancreatic enzyme with acinar cell injury. The acinar cell is normally protected from the action of its own enzymes by elaborate intracellular compartmentation of enzymes. Acute pancreatitis is triggered by pancreatic phospholipase A leading to necrosis of lipolytically active fat cells with release of membrane-toxic fatty acids with following destruction of adjacent tissue. Fat necrosis initiates an acute inflammatory reaction with immigration of granulocytes and liberation of kinins, which activate pancreatic enzyme. Pancreatic enzymes are similar to lysosomal enzymes with regard to substrate specificity. Activation will be also triggered by lysosomal enzymes of necrotic acinar cells.
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PMID:[Acute pancreatitis--etiology, pathological anatomy and pathogenesis]. 226 Mar 61

Of 100 cases of chronic pancreatitis, 20 received surgical treatment. The duration of illness before surgical treatment was less than 5 years in 75% of patients. Post-operatively, the persistent abdominal pain was relieved and serum pancreatic enzyme levels were normalized in all the patients except two who continued drinking alcohol. Exocrine and endocrine pancreatic function were unchanged or slightly improved post-operatively in most cases. In 9 of 10 patients who have been followed up post-operatively for over 4 years, pancreatic endocrine function has been maintained by diet control with no significant impairment of glucose tolerance. These results suggest that in patients with chronic pancreatitis surgical intervention is of greatest benefit in preservation of pancreatic functions when it is performed at an early stage in which these functions are relatively well maintained.
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PMID:Prognosis of pancreatic endocrine function in chronic pancreatitis: significance of surgical treatment. 227 97

We evaluated diagnostic capability and clinical usefulness of histological diagnosis of the pancreas by percutaneous biopsy controlled on ultrasound image. Thirty seven patients with pancreas carcinoma and 11 with chronic pancreatitis underwent the procedure using 21 guage-Sonopsy C1 needle (Hakko co. Ltd.). Specimens of the tissue obtained were adequate for histological interpretation in 95.8% of all the 48 patients. The histological judgement referring to the nature of the lesion corresponded in 91.3% with the final diagnosis established surgical exploration, autopsy or long follow up more than one year. In cases of pancreas carcinoma with a successful procedure of the biopsy, histological type of carcinoma was confirmed in 91.4% of the tumors. It proved accordant pathologically with the conclusion based on the resected tumors in 5 of 8 patients operated on after the biopsy. Chronic pancreatitis was histologically diagnosed in 9 of the 11 patients with the biopsy. A confident diagnosis could not be obtained by imaging modalities including ultrasound, X-ray CT, ERCP and angiography in 7 of 37 patients with pancreas carcinoma and 3 of 11 with chronic pancreatitis. Biopsy by this method was so useful as to obtain the correct diagnosis in all these cases but one. Abdominal pain happened most frequently as a adverse effect during the procedure, but disappeared soon after that. There were no serious complications requiring intensive care. In conclusion, percutaneous histological biopsy controlled on ultrasound image may be recommended as a reliable method for making a definite diagnosis providing more valuable information than cytological biopsy, when diagnostic imaging modalities are unsuccessful in elucidating pathology of the pancreas.
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PMID:[Diagnostic capability and clinical usefulness of percutaneous histological biopsy of the pancreas under control on ultrasound image using 21 gauge needle]. 227 41

A 38 year-old man presented with migratory joint arthropathy. He complained of abdominal pain, diarrhea and weight loss for 2 years. Periarticular needle aspiration yielded cytosteatonecrosis. The diagnosis of chronic pancreatitis was based on the results of ultrasound, CT scan, and endoscopic retrograde pancreatography. The latter showed a dilated and moniliform main pancreatic duct. Failure of symptomatic medical treatment of arthritis led to perform pancreaticojejunostomy which was followed immediately by complete relief of arthritic symptoms. During pancreatic disease, whether malignant or benign, joint involvement is often associated with bone, cutaneous, serosal, and multiorgan involvement. The pathogenesis and therapy of joint lesions in pancreatic disease are controversed. Surgical treatment of the causative disease, and especially pancreaticojejunostomy should undoubtedly be considered more often.
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PMID:[Invalidating polyarthritis in chronic pancreatitis. Recovery by pancreaticojejunostomy]. 228 61

Fifteen children and 23 adults with complications of chronic pancreatitis were managed in Zaria, Nigeria from 1971 to 1987. They comprised 26 patients with chronic pseudocysts, 9 with chronic abdominal pain, and 3 with obstructive jaundice. Internal drainage was performed for 22 (85%) of the pseudocysts, with resection and external drainage, respectively, in 2 each. A longitudinal pancreaticojejunostomy was performed in a child with juvenile tropical pancreatitis syndrome and biliary bypass was performed in the jaundiced patients. The cause of chronic pancreatitis was known only in 8 (31%) of the patients.
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PMID:Surgery for chronic pancreatitis in Zaria, Nigeria. 230 87

In 141 patients with chronic pancreatitis and an inflammatory enlargement of the head of the pancreas, a duodenum-preserving resection of the head of the pancreas was performed within a 16-year period. The hospital mortality was 0.7%; the late mortality was 5%. Seventy-seven percent of the patients were completely free of abdominal pain; 67% returned to their former occupation. After a follow-up period of 3.6 years, glucose metabolism was unchanged in 81.7% of the patients, in 10.1% it deteriorated, and in 8.3% it improved permanently. In patients with severe chronic pancreatitis and an inflammatory mass in the head of the pancreas, a duodenum-preserving resection of the head of the pancreas is an alternative procedure to the Whipple operation. The surgical technique of the duodenum-preserving resection includes 2 major steps: first, subtotal resection of the head of the pancreas conserving the duodenum; second, restitution of the exocrine pancreatic secretory flow from the body and tail of the pancreas by using the first jejunal loop as an interposition. In comparison to the Whipple procedure, the duodenum-preserving resection of the head of the pancreas in chronic pancreatitis spares the patient a gastric resection, a duodenectomy, and a common bile duct resection. With respect to long-lasting pain relief and preservation of the endocrine function of the pancreas, duodenum-preserving resection of the head is a highly effective surgical procedure with a low early and late morbidity and mortality due to the limited surgical resection.
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PMID:Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head. 230 90

A very rare case of obstructive jaundice caused by the incarceration of pancreatic stones in the ampulla of papilla Vater is reported. A forty-eight-year-old man, who had been taking alcohol daily for 10 years, was admitted to our hospital because of recurrent attacks of upper abdominal pain. Biochemical analysis demonstrated typical pattern of chronic pancreatitis. US, CT and ERCP showed a markedly dilated pancreatic duct and pancreatic calcifications. Cholecystolithiasis, or dilatation of the choledochus was not noted. Conservative treatment was performed under the diagnosis of chronic calcifying pancreatitis for one month. Then, obstructive jaundice, severe epigastralgia, and high fever occurred. Obstructive jaundice with sudden onset and existence of pancreatic stones suggested incarceration of pancreatic stones in the bile duct, and cephalic pancreaticoduodenectomy was performed. The largest pancreatic stone was incarcerated into the ampulla of papilla Vater. Histopathological analysis of the pancreas showed severe chronic pancreatitis. No report of the similar case can be found in the literature. Incarceration of pancreatic stones into biliary system might be very rare, however, should not be forgotten in differential diagnoses of obstructive jaundice in chronic pancreatitis patients.
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PMID:[A case of obstructive jaundice caused by incarceration of pancreatic stones in the ampulla of papilla Vater]. 231 79

The association between histopathological changes and the incidence of abdominal pain in patients with chronic pancreatitis was reviewed from published reports, and compared with that in our own series (n = 65). Recurrent tissue necrosis caused by autodigestion, and the formation of pseudocysts, are the likely causes of the intermittent pain that marks the early stages of chronic pancreatitis. In contrast, the persistent pain of advanced chronic pancreatitis is associated with incomplete duct obstruction in a pancreas that is still able to secrete. The cause of persistent pain may therefore be segmental distension of the walls of the duct as a result of focally increased pressure. Perineural scarring has been seen in both painful and painless chronic pancreatitis.
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PMID:Pathology of chronic pancreatitis and pancreatic pain. 234 44

Published reports have been reviewed and the results compared in an attempt to differentiate between pancreatic pain and abdominal pain from other causes, and between the pain of acute pancreatitis and that of chronic pancreatitis and pancreatic carcinoma. The role of pain as a diagnostic sign has been assessed, as have the patterns of pain in chronic pancreatitis.
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PMID:Diagnosis of abdominal pain. How to distinguish between pancreatic and extrapancreatic causes. 234 46


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