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

The incidence of chronic pancreatitis in China is unknown. Endoscopic retrograde cholangiopancreatography (ERCP), surgery, and autopsy demonstrated that chronic pancreatitis in China is mainly secondary to cholelithiasis and other diseases of the bile ducts. Stones in the common bile duct, both intra- and extrahepatic, are extremely frequent in China. Such patients may have scores, even hundreds, of stones filling the common bile duct and its radicles. Biliary tract disease constitutes the etiology of chronic pancreatitis in 40-50% of our patients. The prolongation of necrosis, abscess, or pseudocyst after acute pancreatitis may also lead to chronic inflammation of the pancreas, as may a diverticulum at the second part of the duodenum. The pancreatitis observed in China is apt to be of the chronic relapsing type. Pancreatic ductal stones and ascaris lumbricoides may sometimes be associated with chronic inflammation of the pancreas; however, the cause of chronic pancreatitis is obscure in a large segment of the patients. Beside the ordinary clinical manifestation of chronic pancreatitis, such as abdominal pain, fever, jaundice, and steatorrhea, regional (splenic) portal hypertension may be observed. ERCP has been useful in diagnosis, and the major changes found in the pancreatic duct are discussed. Since the symptoms and signs of chronic pancreatitis in China are usually mild or moderate, the patient with intractable pain is uncommon, most being treated with medication. Most surgical procedures utilized to treat chronic pancreatitis are related to the biliary system, such as cholecystectomy with internal or external drainage of the choledochus. Internal drainage of a pancreatic pseudocyst, partial pancreatectomy, and pancreaticojejunostomy are also performed, as indicated, but are less frequent.
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PMID:Chronic pancreatitis in China: etiology and management. 240 36

During the last 25 years, 134 patients with chronic pancreatitis were treated surgically in our clinic. According to intraoperative measurement of the pancreatic intraductal pressure, both perfusion pressure and residual pressure in the patients with dilated pancreatic duct were significantly higher than those in control patients. Operative procedures included side-to-side pancreaticojejunostomy in 47 patients, 40%-80% caudal pancreatectomy in 28, pancreaticoduodenectomy in 16, pancreatic sphincteroplasty in 10, and others. The effect of operation on abdominal pain was noted in 97% of the patients. The study of operative effect on abdominal pain and follow-up results showed the excellent maintenance of operative benefit. Surgical treatment, however, could not help improve impaired function of the pancreas. Ten of 34 late deaths were related to the failure of controlling diabetes. Therefore, long-term follow-up care to the pancreatic dysfunction is considered to be necessary even after complete relief of abdominal pain.
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PMID:The role of surgical treatment for chronic pancreatitis. 242 Feb 94

To assess the relief of pain provided by a side-to-side lateral pancreaticojejunostomy (LPJ), we analyzed 19 patients with chronic pancreatitis operated on from 1973 to 1983. Fourteen patients were chronic alcoholics; abdominal pain was the indication for the operation in most patients; one patient died postoperatively. The pain was relieved in all 18 survivors, from 12 to 72 months in 15; in three the pain has recurred, suggesting that LPJ is effective in ablating the pain in patients with chronic pancreatitis, provided the pancreatic duct measures more than 6 mm in diameter, the length of the LPJ is at least 6 cm, and patients abstain from alcohol ingestion. CT adequately assesses pancreatic duct dilatation. One fourth of the patients also required choledochoduodenostomy to relieve biliary obstruction caused by the chronic pancreatitis.
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PMID:Lateral pancreaticojejunostomy for pain relief in chronic pancreatitis: analysis of effectiveness in 19 patients. 242 95

We studied serum elastase 1 concentrations in patients with pancreatic disease to assess its diagnostic value and compare its sensitivity and specificity with that of amylase and pancreatic isoamylase. Markedly raised concentrations of elastase 1 were found in all twenty-nine patients with acute pancreatitis (amylase was elevated in all but three and pancreatic isoamylase in all but one). Serial measurements of the three enzymes in acute pancreatitis showed that elastase remained elevated longer than amylase and pancreatic isoamylase. The majority of chronic pancreatitis patients studied during a painful relapse (16 out of 21, 76 per cent) had elastase concentrations above the upper normal limit. Amylase and pancreatic isoamylase were elevated in 11 (52 per cent) and in 13 (62 per cent), respectively. Most patients with chronic pancreatitis studied during clinical remission (39 out of 43) had serum elastase levels either within (n = 24) or below (n = 15) the control range. The latter had severe exocrine pancreatic insufficiency and steatorrhoea. In carcinoma of the pancrease, 20 out of 32 (63 per cent) had abnormal serum elastase concentrations; 16 were higher and 4 lower than the control range. Amylase was abnormal in 10 (31 per cent) (8 high, 2 low), and pancreatic isoamylase was abnormal in 16 (50 per cent) (11 high, 5 low). In 46 control patients with non-pancreatic abdominal pain, serum elastase concentrations were not significantly different from those in healthy controls. Elastase was slightly raised in two, whereas amylase and pancreatic isoamylase were elevated in seven and eight, respectively. We conclude that serum elastase 1 is a highly sensitive and specific indicator of pancreatic disease.
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PMID:Diagnostic value of serum elastase 1 in pancreatic disease. 243 58

The serum behavior of amylase, pancreatic isoamylase, lipase, trypsinogen, and elastase 1 was studied in 145 patients with pancreatic disease and in 66 patients with abdominal pain of nonpancreatic origin, for the purpose of evaluating the relative diagnostic utility of their assays. In 34 patients with acute pancreatitis, serum lipase, trypsinogen, and elastase 1 were elevated in all 34, pancreatic isoamylase in 33 (97%) and amylase in 30 (88%). Ten of these acute pancreatitis patients were followed sequentially for seven days: the variations in their serum enzyme levels were parallel, although the lipase, trypsinogen, and particularly the elastase 1 elevations persisted longer than did those of amylase and pancreatic isoamylase. Among the patients with chronic pancreatitis, either in painful relapse (N = 19) or with pancreatic cysts (N = 15), the respective percentages of enzymes elevations were: 79 and 80% for elastase 1, 68 and 67% for trypsinogen, 63 and 73% for pancreatic isoamylase, 58 and 60% for lipase, 53 and 60% for amylase. In the 52 chronic pancreatitis patients studied during clinical remission, serum enzyme behavior varied greatly, and a majority of the assays (60%) were normal; even in the case of severe pancreatic exocrine insufficiency, normal as well as abnormally high and low enzyme values were seen. Highly variable enzyme behavior was also seen in the 40 patients with pancreatic cancer, and elastase I was the most frequently (35%) elevated enzyme in this group as well. Among the patients with abdominal pain of nonpancreatic origin, abnormally high enzyme levels were present in percentages ranging from 6% for lipase to 21% for trypsinogen.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Role of serum pancreatic enzyme assays in diagnosis of pancreatic disease. 279 21

Chronic intermittent abdominal pain in childhood, reported to afflict nine to 12 per cent of all children, is an enigma of such magnitude that more than 30 per cent of these patients reach adulthood with persistent problems and no definitive diagnosis. This report discusses 20 children with such pain (9 girls and 11 boys) in whom routine diagnostic evaluation failed to identify the etiology. Selected special diagnostic studies and considerable suspicion for chronic pancreatitis prompted surgical intervention in three patients. Two were unsuspected and identified at celiotomy as having pancreatitis. The morphine-neostigmine evocative test, modified in some cases to confirm its usefulness, was helpful, accurate, and definitive in all 13 patients on whom it was used. Eighteen patients were confirmed surgically to have pancreatic disease, and two patients are unoperated with continued pancreatic pain. Ductal pathology was believed present in all. Of 18 patients operated, 11 patients are asymptomatic, five patients are improved, and two patients are considered failures 6 months to 10 years following surgery.
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PMID:Chronic relapsing pancreatitis in childhood. 258 Apr 66

A new reactive strip was used in a hospital admission unit, to detect amylasuria in the urine of 76 patients consulting for abdominal pain (population A) and of 68 unselected patients (population B). Detection on admission by this method was concordant with subsequent laboratory detection in 93% of the cases. The fast test was positive for amylasuria in 17 patients: 13 (17.1%) in population A and 4 (5.9%) in population B. The 8 patients recorded as "+" had moderate amylasuria with multiple but ill-defined symptoms mostly abdominal. The 9 patients recorded as "++" had marked amylasuria highly suggestive of an abdominal disease, including 4 cases of chronic pancreatitis.
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PMID:[Detection of hyperamylasuria. Value of a quick test]. 258 5

The term "hemosuccus pancreaticus" was coined by Sandblom in 1970, to describe a syndrome manifested by massive gastrointestinal hemorrhage through the pancreatic duct and the ampulla of water. A case of hemosuccus pancreaticus which had no hematemesis and melena is reported in comparison with two previously experienced cases. A 68-year-old alcoholic man was referred to Eiju General Hospital for poor appetite and occasional colicky pain in left epigastrium. Abdominal angiography and computed tomography revealed an aneurysm at the tail of the pancreas and hemosuccus pancreaticus caused by true aneurysm was strongly suspected. Laparotomy revealed chronic pancreatitis and a pancreatic pseudocyst at the tail of the pancreas that was considered to be the cause of the pain. Resection of pancreatic tail and splenectomy was performed without complication. Histopathological diagnosis of the resected pancreas was chronic pancreatitis. He has complained no abdominal pain and melena for 6 months after operation.
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PMID:[A case of hemosuccus pancreaticus associated with chronic pancreatitis]. 259 8

A 10-year-old girl had fever, abdominal pain and a palpable mass at the left hypochondrium. She was found to have a pancreatic cystic tumour that was biopsied and removed by coeliotomy. The pathologic diagnosis was papillary cystic tumour of the pancreas with chronic pancreatitis. No pathological lesion was found elsewhere. 2 years later she is asymptomatic and without recurrence.
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PMID:Papillary cystic tumor of the pancreas. 262 53

We have made a comparative cross study of 30 patients with chronic pancreatitis and steatorrhea. The aim of the study has been to compare the effectiveness of a new galenic form of pancreatin, in pellets, with the common galenic presentation, in tablets. In all the cases the cause of pancreatic failure was alcoholism. In both groups the treatment was administered during seven days, after a period of wash out. We evaluated steatorrhea and clinical symptoms, including the typical abdominal pain. (The doses administrated were 12 tablets/day or 9 pellets/day.) Statistically there was a significant decrease of steatorrhea p less than 0.01.
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PMID:[A comparative cross-over study of pellet pancreatin and tablet pancreatin in chronic pancreatitis]. 263 38


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