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Query: UMLS:C0001339 (acute pancreatitis)
 10,593 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Direct cholangiography plays an important role in the diagnosis of malignant obstructive jaundice. Endoscopic retrograde cholangiopancreatography is gradually gaining ground over percutaneous transhepatic cholangiography. Endoscopy can determine the exact location and extent of the obstruction. Typical changes of the ducts are often helpful in interpreting the causes of obstructive jaundice. Representation of the bile and pancreatic duct systems is successful in 95% of cases in the hands of an expert. Acute pancreatitis is a complication occurring in about 1% of cases. Immediate drainage can usually prevent septic complications. Endoscopic drainage is a palliative measure for inoperable patients. Compared to biliodigestive anastomoses, catheters are subject to clogging in the less-risky, nonsurgical method. Blockage causes late cholangitis which can only be recognized and remedied by regular after-care of the patient. Endoscopic placement of the prosthesis has an 85% rate of success. The rate of complications related to the procedure is 2%. The mortality rate is 1%.
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PMID:Malignant jaundice: results of diagnostic and therapeutic endoscopy. 272 67

One hundred five patients with obstructive jaundice and cholangitis (49 patients), referred for diagnostic endoscopy, were found to have inextractable bile duct stones. Median age was 76 years and three quarters were more than 72 years of age. Insertion of an endoprosthesis with or without a sphincterotomy relieved jaundice in 94% and settled cholangitis in 90%. Antibiotic cover during the procedure seems essential inasmuch as pyrexia and septicemia occurred in 6 of 57 cases where it was not given. One case was lethal. Another patient died of acute pancreatitis. The patients were old. One quarter died before the follow-up, 1 to 5 years after the initial intervention. The results indicate that the combination of endoscopic sphincterotomy, insertion of an endoprosthesis, and, if feasible, stone extraction on a later occasion when the acute phase of the illness had subsided brought the disease sufficiently under control among three quarters of the patients with large common duct stones or stenoses in the biliary tract. One quarter of the patients were treated surgically. This was accomplished without mortality, but morbidity was not negligible. A policy with a surgical approach restricted to selected cases with persistent symptoms in spite of sufficient endoscopic drainage is recommended.
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PMID:Large bile duct stones treated by endoscopic biliary drainage. 291 4

During a 20-year period 1967-86, 476 consecutive cases of severe acute pancreatitis were managed by one surgeon (GAK) and the role and results of surgical intervention in this group were reviewed. Of the 173 cases undergoing surgery, 77 were laparotomies for diagnosis, seven for the excision of necrotic pancreatic tissue and 89 for postpancreatitis complications (18 pseudocysts, 53 pancreatic abscesses, one large bowel perforation, 17 patients with persistent obstructive jaundice and one case of acute haemorrhage into a cyst causing obstructive jaundice). There were 50 deaths (11%) of whom 38 died early in the course of the disease, two died following total pancreatectomy and 10 died as a consequence of a pancreatic abscess. Based on this experience and on the current understanding of this condition, the place of surgery in severe acute pancreatitis is discussed briefly.
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PMID:Surgical intervention in severe acute pancreatitis: 476 cases in 20 years. 261 Jul 65

Acute pancreatitis associated with pancreatic carcinoma or tumour metastases in the pancreas is well documented. In this paper we show a similar association between acute pancreatitis and ampullary carcinoma. Of 41 patients with ampullary carcinoma seen at a single centre over a 25 year period (1959-83), 6 developed acute pancreatitis. Three other patients with a history of obstructive jaundice were noted to show mild transient hyperamylasaemia. Endoscopic retrograde choledochopancreatography is mandatory in the investigation of such patients.
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PMID:Acute pancreatitis associated with carcinoma of the ampulla of Vater. 359 34

A series of 46 consecutive patients with obstructive jaundice have been referred to a surgical unit with a special interest in hepatobiliary surgery. The cases were evenly divided between benign and malignant causes. The hospital mortality was 13% (six cases), and the mortality was also evenly divided between the two subgroups. A scoring system has been devised to rate 12 easily measured clinical and pathological parameters, and a regression analysis used to measure the contribution made by each parameter to hospital morbidity and mortality and to later mortality over a 5 year period. Previous bile duct trauma and liver damage were the major determinants of hospital morbidity, while bile duct trauma, liver disease, acute pancreatitis and increasing age were the significant determinants of hospital mortality. Malignancy and cirrhosis determined late mortality. A plea is made for the early referral of high risk patients to specialized units, particularly when bile duct trauma is involved.
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PMID:Obstructive jaundice in a referral unit: surgical practice and risk factors. 386 3

After a two-year history of recurrent abdominal pain, an 84-year-old man presented with acute pancreatitis and obstructive jaundice. An endoscopic retrograde cholangiogram demonstrated two filling defects approximately 1.0 cm in diameter, in a dilated common bile duct. Endoscopic papillotomy was performed which resulted in a polypoid tumour delivering itself into the wound followed by a free flow of bile. In addition, a single 1.0 cm gallstone was removed from the common bile duct, above the tumour, using a Dormia basket. The patient recovered completely. Histological examination of biopsies of the tumour taken on three subsequent occasions showed it to consist only of inflammatory tissue (an inflammatory polyp) and later, regenerating bile duct mucosa. After six months this tumour had completely regressed.
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PMID:Extrahepatic biliary obstruction by a common bile duct inflammatory polyp in association with a gallstone, and treatment by endoscopic sphincterotomy. 395 41

The incidence of periampullary carcinoma is increased in patients with familial polyposis coli or the Gardner syndrome. Patients with familial polyposis coli and ampullary tumors usually present with obstructive jaundice or abdominal pain. We report the case of a 41-year-old woman with the Gardner syndrome in whom relapsing acute pancreatitis was the presenting manifestation of an ampullary neoplasm. A diagnosis of ampullary neoplasm should be considered in any patient with familial polyposis coli or the Gardner syndrome and pancreatitis, even in cases of relapsing acute pancreatitis.
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PMID:Relapsing acute pancreatitis as the presenting manifestation of an ampullary neoplasm in a patient with familial polyposis coli. 402 80

Of 451 patients with cholelithiasis, 273 suffered from 396 preoperative complications; the common ones were acute cholecystitis (n = 120), jaundice (n = 135), and acute pancreatitis (n = 52). Of the 195 patients under the age of 50 years 48% had complications, compared with 70% of the 256 above the age of 50 years. For acute cholecystitis and acute pancreatitis, an interval cholecystectomy was carried out 3-6 wk after initial conservative treatment. Except in the 33 cases with obstructive jaundice of indeterminate etiology (n = 15) or jaundice associated with uncontrollable cholangitis (n = 18), surgery in icteric patients was deferred until serum bilirubin became normal or reached a plateau. Routine intraoperative radiology detected unsuspected stones in common bile ducts in 11 cases. In all, 139 choledochotomies were carried out; the frequency of ductal exploration rose after the age 50 years. Operative elimination of sphincter of Oddi (by sphincteroplasty or by choledochoduodenostomy) was required in 82 cases. Bile culture was positive in only 17 of 178 cases without preoperative complications but in 97 of 273 with preoperative complications. Of the 21 cases who died, 19 had preoperative complications and 66% had positive bile culture. Nine of 139 requiring choledochotomy died. Mortality after 60 years was 15 of 119.
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PMID:Preoperative complications of gallstones and their relevance to treatment and prognosis: experience with 451 cases. 402 82

The study of a group of 151 patients confirms the diagnostic value of elevated ACCR in pancreatitis, it was positive in 89.4% of them, of the group, 30 were normal, 19 exhibited acute pancreatitis and 102 had various other pathologies. Serious pancreatitis has shown coincide with a long-lasting rise of ACCR, and its rise in the course of the disease was a sign of a new outburst of progressive necrosis. Total unreliability when abnormal creatinine clearance is present was ascertained. The possible mechanism of increase in ACCR has been considered also in connection with the study of the results obtained on a group of patients exhibiting renal insufficiency, gastrointestinal bleeding, acute colecystitis, vesicular lithiasis and obstructive jaundice.
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PMID:[Correlation of the clearance of amylase and creatinine in acute pancreatitis and other pathologies]. 617 47

In a survey the present possibilities are outlined to get knowledge about diseases of inner organs with the help of enzyme determinations in the urine. Here it is remarkable that changes of the enzyme excretion appear not only in renal disease with acute renal failure, pyelonephritis, glomerulonephritis, renal infarction and nephroptosis but are also to be observed in primarily extrarenal diseases such as diabetes mellitus, hyperthyroidism, thesaurismoses, myocardial infarction, hypertension, acute pancreatitis, epidemic hepatitis, liver cirrhosis, obstructive jaundice and rheumatoid arthritis. The causes of the changes of enzyme excretions are various. Since enzymes of different origin and localisation behave themselves variably, the simultaneous determination of a brush border marker (e.g. alanine aminopeptidase), a lysosomal enzyme (e.g. beta-glucuronidase or N-acetyl glucosaminidase) and a low molecular enzyme (e.g. lysozyme) is of use for the recognition of renal alterations. By the control of activities of urinary enzymes it is possible to get without risk informations about pathobiochemical processes in the kidney which are not to be gained by means of other methods.
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PMID:[Urinary enzyme excretion in diseases of the internal organs]. 636 87


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