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

A 47-year-old woman with stones in the gall-bladder suddenly developed severe upper abdominal pain. Cholesterol concentration was elevated, as were amylase (555 U/l) and lipase (408 U/l) concentrations, suggesting biliary pancreatitis. Endoscopic retrograde cholangiography demonstrated a cyst, about 10 cm in diameter, in the left lobe of the liver, connected to the biliary tract system. Ultrasonography and computed tomography additionally showed a smaller cyst in the right lobe. Infection with Echinococcus granulosus was proven microbiologically on bile (demonstration of hooklets and protoscolices) as well as serologically. Transpapillary cholangioscopy demonstrated daughter cysts within the echinococcal cyst. The main cyst was rinsed with 20% NaCl for 10 days via a nasocystic catheter. In addition, mebendazole (three times daily 1000 mg) was administered for 13 months. The signs if inflammation receded and the cyst shrank to a small residual volume. Surgical intervention became unnecessary.
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PMID:[Acute pancreatitis due to the rupture of an echinococcal cyst into the bile duct system]. 751 77

Acute pancreatitis is unusual in pediatric patients, and chronic pancreatitis is even less common. Between 1983 and 1988, we diagnosed 24 patients in late childhood and adolescence with chronic pancreatitis. Our review revealed that chronic pancreatitis presents as recurrent abdominal pain in late childhood and adolescence. Individual laboratory and radiological investigations may be normal during acute exacerbations of pain, but the determination of serum amylase and lipase concentrations--combined with ultrasonography--will accurately identify most patients. We found that endoscopic retrograde cholangiopancreatography is a valuable tool in the diagnosis of structural abnormalities. Surgical intervention may reduce symptoms in patients with structural abnormalities. There is a tendency toward decreased frequency and severity of pain as the patients increase in age.
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PMID:Chronic pancreatitis in late childhood and adolescence. 751 40

During an outbreak of measles in the period from May 1993 through February 1994, a 23-year-old woman with measles was admitted because of abdominal pain and vomiting. Moderately elevated levels of serum and urinary amylase were found. We investigated prospectively the next nine consecutive young adults hospitalized with severe measles. Pancreatic and other organ involvement was determined by serum and urinary amylase, serum lipase, and additional appropriate biochemical and hematological data. Four patients had elevated amylase levels in both serum and urine, whereas in one, serum amylase alone was increased. Serum lipase determined in eight patients was elevated in seven. In all patients elevated serum levels of aspartate aminotransferase and alanine aminotransferase or lactate dehydrogenase were found. In seven patients serum calcium concentrations were below the lower limit of normal. Four patients had mild to moderate thrombocytopenia. This is the first detailed report of pancreatic involvement in young adults with measles. This abnormal finding, its possible underlying mechanisms, and the clinical significance are discussed.
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PMID:Pancreatic enzyme elevation in measles. 753 76

The case of a 42-year-old woman with no previous disease admitted for abdominal pain and ascites is presented. Analysis of the ascitic fluid demonstrated high concentrations of amylase with normal lipase. The diagnosis of peritoneal mesothelioma was obtained by laparotomy. This association has not been previously described. The authors suggest that this diagnostic possibility should be considered in patients without pancreatic disease and high amylase levels in ascitic fluid.
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PMID:[Peritoneal mesothelioma with elevated amylase in the ascitic fluid]. 754 55

Excessive dosage of pancreatic enzymes in cystic fibrosis (CF) patients can be associated with irreversible colonic stricture. Predisposing factors include a young age group, previous intestinal surgery, and prolonged administration of high-dose lipase products. Prestricture symptoms include abdominal pain, diarrhea, and hematochezia. Pathological signs are ischemic denudation of the epithelium with reepithelialization, mild chronic inflammation, and extensive collagen synthesis with mural fibrosis. The lesion is distinct from Crohn's disease. Its pathophysiological mechanisms remain unknown.
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PMID:Cystic fibrosis and colonic strictures. A new "iatrogenic" disease. 756 Aug 27

The authors summarised pathophysiology and therapy possibility of the chronic alcoholic pancreatitis. They introduce a new product of pancreatin use for treatment of chronic alcoholic pancreatitis. The aim of this prospective study was to asses the efficacy of this new drug in the treatment of chronic alcoholic pancreatitis. The treatment was carried out by new pancreatin product containing 10,000 FIP U lipase, 9000 FIP U amylase, and 500 FIP E protease. During the study 30 patients--suffering from alcoholic pancreatitis--were treated. They received, two tablets three times daily in a period of two weeks. The following parameters were observed and compared before and after the period of treatment: complaints of the patients, the characteristics of the stool (daily weight, frequency, fat contents, consistency) the change of the body weight and degree of abdominal pain. These parameters were compared using a score-system, before and after the period of treatment. The authors could analyse the data of 21 patients. It was proved that there was a significant decrease in frequency, daily weight and fat contents of the stool and in abdominal pain. There was not significant change in the body weight. The authors concluded that this new product is a good pancreatin preparation which is useful and suitable for effective treatment of chronic alcoholic pancreatitis, if the patient keeps abstinence.
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PMID:[Treatment of chronic alcoholic pancreatitis with a new acid-resistant pancreatin product]. 756 38

Early distinction between acute alcoholic pancreatitis is important, because of possible emergency endoscopic sphincterotomy in case of biliary pancreatitis. The aim of this study was to evaluate the value of L/A ratio in the diagnosis of acute alcoholic pancreatitis. From 1990 to end 1993, 133 patients with acute pancreatitis were reviewed. Inclusion criteria were: 1) abdominal pain, 2) pathological serum amylase or serum lipase on admission or within 24 hours after beginning or abdominal pain, 3) acute pancreatitis at the echography or CT scan within 48 hours after admission. 60 patients met the inclusion criteria (31 alcoholic pancreatitis, 19 biliary pancreatitis and 10 pancreatitis of other causes). L/A ratio was studied in terms of delay from beginning of abdominal pain. There was no statistical difference between alcoholic and biliary pancreatitis at any time of the study, with the exception of admission. AST, ALT and alkaline phosphatase were higher in biliary pancreatitis than in alcoholic pancreatitis. AST and ALT were the best biochemical tests to diagnose biliary pancreatitis. Blamey's criteria can also contribute to diagnose biliary pancreatitis. These biochemical tests are the most helpful if they are collected very soon in the evolution of acute pancreatitis. It is concluded that L/A ratio is not helpful in the diagnosis of alcoholic acute pancreatitis.
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PMID:[Can the L/A ratio identify acute alcoholic pancreatitis?]. 757 83

The aim of this study was to compare the sensitivity, specificity, and diagnostic accuracy of serum interleukin-6, interleukin-8, beta 2-microglobulin, and C-reactive protein in the assessment of the severity of acute pancreatitis using commercial kits for their respective assays. Thirty-eight patients with acute pancreatitis (25 men, 13 women, mean age 59 years, range 16-97) were studied; the diagnosis was based on prolonged upper abdominal pain associated with a twofold increase of serum lipase, and it was confirmed by imaging techniques. According to the Atlanta criteria, 15 patients had severe illness and 23 had mild disease. The four serum markers were determined in all patients on admission, as well as daily for the following five days. On the first day of the disease, the sensitivity (calculated on patients with severe pancreatitis), specificity (calculated on patients with mild pancreatitis), and the diagnostic accuracy of these serum markers for establishing the severity of acute pancreatitis were 100%, 86%, and 91% for interleukin-6 (cutoff level 2.7 pg/ml); 100%, 81% and 88% for interleukin-8 (cutoff level 30 pg/ml); 58%, 81%, and 73% for beta 2-microglobulin (cutoff level 2.1 mg/liter); and 8%, 95%, and 64% for C-reactive protein (cutoff level 11 mg/dl). The results of our study indicate that, when assayed during the first 24 hr of disease onset, interleukin-6 and interleukin-8 are better markers than beta 2-microglobulin or C-reactive protein for evaluating the severity of acute pancreatitis.
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PMID:Serum interleukin-6, interleukin-8, and beta 2-microglobulin in early assessment of severity of acute pancreatitis. Comparison with serum C-reactive protein. 758 12

We investigated peripheral lymphocyte subsets in 34 consecutive acute pancreatitis patients (21 males, 13 females; mean age, 57 years; range, 16-85 years) studied within 48 h of pain onset and for 5 consecutive days to understand better the immunological response during the course of the disease. The diagnosis was based on characteristic abdominal pain associated with a twofold increase in serum lipase and confirmed by imaging techniques in all patients. Acute pancreatitis was of biliary origin in 25 patients, due to alcohol abuse in 5, due to pancreas divisum in 1, and of unknown origin in 3. Fifteen patients had severe illness and 19 had mild disease. In all patients, total lymphocyte and lymphocyte subset counts were carried out on admission, as well as on the third and fifth day of hospitalization, using a flow cytometric analysis. Twenty-three patients (13 with severe illness and 10 with mild disease) also had a repeat count 1 month after recovery. Twenty-five healthy subjects and 27 patients with nonpancreatic acute abdomen comparable for sex and age were studied as controls. On the first day of the study, the leukocyte number was significantly higher in patients with acute pancreatitis and in those with nonpancreatic acute abdomen with respect to healthy subjects, whereas the number of total and CD4+, CD8+, CD3+ DR-, and CD3- DR+ lymphocytes was significantly lower in acute pancreatitis patients than in healthy subjects or in patients with nonpancreatic acute abdomen. These subject counts persisted on the third and fifth days of the study.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Circulating lymphocyte subsets in human acute pancreatitis. 766 48

Elevated serum amylase and lipase levels have been reported in patients with renal failure. Because the diagnosis of pancreatitis is often based on elevations in serum amylase or lipase along with abdominal pain, we determined the relationship between total serum amylase, lipase, and glomerular filtration rate (GFR). Thirty-three subjects, 13 men and 20 women (age range, 21-79), were included in the study. There was a statistically significant correlation between serum amylase and the actual GFR (r = -0.43, p = 0.01). However, no such correlation was seen with lipase. No correlation between total serum amylase and lipase was observed. Three subjects had elevated amylase (240-433 U/L, normal 50-225). Three patients had slightly elevated lipase (29-31 U/dl, normal 8-28). All patients were asymptomatic. Of 11 subjects with GFR < 50 cc/min, only one had an elevated amylase and another an elevated lipase. Our data suggest that although the total serum amylase level is determined in part by the GFR, elevations in either amylase or lipase may not occur even in the presence of renal failure. Therefore, even small elevations in the total serum amylase or lipase in a patient with renal insufficiency may be clinically significant.
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PMID:Total serum amylase but not lipase correlates with measured glomerular filtration rate. 768 39


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