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

A patient with pancreatic ascites is presented who had neither a pseudocyst nor demonstrable pancreatic duct disruption, despite the presence of both calculi and strictures in a dilated duct of Wirsung. Concurrently, the patient exhibited intractable abdominal pain characteristic of end-stage chronic alcoholic pancreatitis. The pancreatic ascites responded only briefly to nonoperative management with hyperalimentation. Side-to-side pancreticojejunostomy with caudal pancreatectomy relieved the patient of both pain and ascites, suggesting that this more direct approach may be worthy of consideration in patients with similar findings.
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PMID:Pancreatic ascites: management by caudal pancreatectomy and side-to-side pancreaticojejunostomy. 49 60

An analysis of 89 cases with chronic pancreatitis revealed 56% of chronic alcoholic pancreatitis (AP). The sex ratio was 47 males to 3 females and the mean age at onset was 42.4 years in AP and 49.3 years in chronic non-alcoholic pancreatitis (NAP). The 'total amount' of alcohol consumption was correlated to the onset. In AP, the abdominal pain was apt to relapse and severe in nature, furthermore painless pancreatitis was seen in 6%. The association with diabetes or calcification (38%) were more frequently seen in AP. The calcifications in AP appeared to be smaller in size and distributed diffusely or localized in cephalic portion. A striking frequency of liver dysfunctions (39 cases) were demonstrated, however, cirrhosis was rare in AP. The P-S test dysunctions in NAP were frequently reversible in the follow up study, while even some of chronic asymptomatic alcoholics developed clinical signs of pancreatitis during the observed period and proceeded to definite AP, of whom pancreatic dysfunctions showed fluctuation and eventual progression. In other words, even pain free intervals the pancreatic inflammation in susceptible persons may proceed to ultimated destruction of the pancreas. The fatality from chronic pancreatitis was rare (12.3%), which was related diabetes mellitus.
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PMID:A clinical investigation of chronic pancreatitis--comparative study between alcoholic pancreatitis and non-alcoholic pancreatitis--. 66 97

Twelve patients with prior episodes of alcoholic pancreatitis and hyperlipemia were admitted to a metabolic ward during a quiescent period. By lipid feeding (316 to 894 Gm. per day), significant hypertriglyceridemia (greater than 600 mg. per 100 ml.) was induced in 11 of the 12 patients. Seven of the 11 patients with hypertriglyceridemia developed abdominal pain similar to but not as severe as that experienced during prior attacks of pancreatitis. Four of the seven patients with abdominal pain developed serum amylase elevations, and, of the remaining three, one had a serum lipase elevation and one a urinary amylase elevation. Alcohol ingestion is known to increase serum triglyceride levels in many individuals. A prior study demonstrated that 41 percent of the patients presenting to our hospital with alcoholic pancreatitis had serum triglyceride elevations. The data from the present study suggest that increased serum triglycerides act as an important intermediary in the pathogenesis of acute pancreatitis in some alcoholic patients.
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PMID:A pathogenesis for alcoholic pancreatitis. 114 40

To determine whether the lipase:amylase ratio differentiates alcoholic from nonalcoholic pancreatitis, we conducted a retrospective review of charts with the diagnosis of acute pancreatitis at the George Washington University Medical Center between January 1988 and July 1990. A total of 446 charts were reviewed. For a patient to be included in the subsequent analysis, the following criteria were met: 1) the patient had typical symptoms of pancreatitis, 2) serum amylase and lipase were analyzed on admission, and 3) a computerized tomographic (CT) scan or ultrasound of the abdomen was obtained within 72 h of admission. Forty-seven charts satisfied the requirements for inclusion in the study. Data collected from the charts included history of alcohol consumption, age, sex, race, admission serum amylase and serum lipase (from this the amylase:lipase ratio was calculated), peak serum amylase and serum lipase, and number of days of abdominal pain before admission. Patients with alcoholic pancreatitis had significantly lower serum amylase levels and significantly higher lipase:amylase ratios than those with nonalcoholic pancreatitis (p < 0.01). There was no difference in the serum lipase between the groups. The higher the lipase:amylase ratio, the greater the specificity of alcohol as the etiology of acute pancreatitis. Only patients with alcoholic acute pancreatitis had lipase:amylase ratios > 5.0 (sensitivity 31%, specificity 100%). Our data point to the clinical utility of the lipase:amylase ratio in differentiating alcoholic from nonalcoholic acute pancreatitis. Prospective studies will be needed to confirm the clinical utility of this ratio.
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PMID:The admission serum lipase:amylase ratio differentiates alcoholic from nonalcoholic acute pancreatitis. 128 Apr 5

A 48-year-old patient presented with a 24 hour history of diffuse abdominal pain and diarrhea. Based on elevated serum amylase and lipase levels, a CT-scan, and a history of chronic alcohol intake, acute alcoholic pancreatitis was diagnosed. The patient clinically improved under conservative therapy, but after restarting enteral nutrition on the fourth day, he developed full blown mechanical ileus. Intraoperatively, an adhesive band and acute edematous pancreatitis and fat necrosis was found. Retrospectively, the initial clinical symptoms and plain abdominal x-ray findings suggest coincidence of obstructive ileus and acute pancreatitis. We hypothesize that obstructive ileus had triggered pancreatitis.
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PMID:Obstructive ileus and acute pancreatitis. 239 51

Acute alcoholic pancreatitis is a clinical diagnosis made in patients who have acute upper abdominal pain, emesis, and hyperamylasemia soon after ingesting alcohol. We sought to determine whether the clinical diagnosis of pancreatitis was supported by elevated serum levels of pancreatic isoamylase, currently the most specific test for pancreatitis. Serum lipase levels and urinary amylase/creatinine clearance ratios were examined for comparison with pancreatic isoamylase concentrations. Potential sources for salivary isoamylasemia were explored with technetium scans of the parotid glands. Of 19 patients with a clinical diagnosis of alcoholic pancreatitis, 16 had elevated levels of pancreatic isoamylase, and 17 had salivary hyperamylasemia. The diagnostic specificity of the serum lipase level or the urinary amylase/creatinine clearance ratio was excellent compared to that of the pancreatic isoamylase level. Three patients had elevated levels of salivary isoamylase only. Scans of the parotid glands in the study group revealed significantly higher uptake values than scans in nonalcoholic control subjects, suggesting one possible source of elevated levels of salivary isoamylase.
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PMID:Alcoholic pancreatitis and parotitis: utility of lipase and urinary amylase clearance determinations. 242 37

We treated 35 patients with endoscopic stent placement across the major or minor papilla in an attempt to relieve suspected partial obstruction to pancreatic duct drainage in patients with pancreatitis. The patients subsequently have been followed for periods ranging from 6 months to 3 years (mean, 14 months). Endoscopic stents were successfully placed across the minor papilla in 19 of 22 patients with pancreas divisum associated with acute recurrent pancreatitis (19) and severe abdominal pain (3). 17 patients had symptomatic improvement manifested by a decrease in frequency of attacks of pain and emergency admission. Stents were placed through the major papilla in 14 of 15 patients with recurrent pancreatitis related to a variety of causes. 8 of the 14 patients improved during the follow-up period, including 4 of 5 patients with alcoholic pancreatitis complicated by a segmental stricture.
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PMID:Preliminary experience with endoscopic stent placement in benign pancreatic diseases. 335 Feb 98

One thousand five hundred twenty-nine pancreatograms were obtained between 1973 and 1985. Complete pancreas divisum was demonstrated in 41 patients, for an incidence of 2.7 percent, and incomplete pancreas divisum in 14 cases, for an incidence of 0.9 percent. No increased incidence of pancreas divisum was found in any of four groups: an incidental group, a group with alcoholic pancreatitis, a group with unexplained upper abdominal pain, and an idiopathic pancreatitis group. The majority of patients (80 percent) were found to have pancreas divisum as an incidental finding or in association with alcoholic pancreatitis. Of 82 patients with idiopathic pancreatitis, only 2 had pancreas divisum. The three patients with pancreas divisum who had sphincteroplasty of the minor papilla were not helped by the procedure. We conclude that pancreas divisum is a normal anatomic variant and is very seldom a cause of pancreatic pain.
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PMID:Pancreas divisum: is it a normal anatomic variant? 379 94

We operated on 102 patients (89 men and 13 women) who had chronic pancreatitis. The mean age at the time of surgery was 45 1/2 years. Of these patients, 77 had resections (57 distal pancreatectomies, 17 duodenopancreatectomies, an three total pancreatectomies) and 25 had diversion procedures (15 Puestow operations and 10 internal drainage of cysts). The indication for surgery was abdominal pain in 88% and the presence of jaundice in 21%. Our patients had severe pancreatic disease: 64% had pseudocysts, 41% had calcifications, and 26% had calculi in the duct of Wirsung. The postoperative mortality rate was low (3%), but morbidity occurred in 18% (mostly after resection procedures). The incidence of diabetes after surgery was high after resection (57%) but it also occurred after diversion procedures (10%). The quality and length of survival was similar after resections and after diversions, although patients with alcoholic pancreatitis had the worst long-term prognosis. Reoperations were performed in 16% of all patients; the incidence was lower after duodenopancreatectomy.
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PMID:Surgery for chronic pancreatitis. 381 Apr 83

We evaluated the efficacy of nasogastric suction for alcohol-related pancreatitis by performing a randomized, controlled study. Twenty-one patients with pancreatitis associated with alcohol ingestion received either nasogastric suction or nothing by mouth in addition to intravenous fluids and meperidine as needed. Twenty patients completed the treatment to which they were assigned. There were no statistically significant differences between the group that received nasogastric suction and the group that did not in duration of abdominal pain, anorexia, abdominal tenderness, ileus, presence of abdominal masses, or elevated serum amylase and lipase activities and the ratio of the renal clearance of amylase to creatinine; or the number of meperidine injections requested per subject. Patients receiving nasogastric suction complained of significantly longer duration of nausea and vomiting. We conclude that nasogastric suction is not effective in the treatment of uncomplicated alcoholic pancreatitis.
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PMID:An evaluation of the efficacy of nasogastric suction treatment in alcoholic pancreatitis. 616 98


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