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

Laparoscopic cholecystectomy is one of the most commonly awaited general surgical procedures in the UK. However, many patients awaiting a cholecystectomy are admitted with recurrent gallstone related symptoms while on the waiting list, resulting in significant morbidity. The aim of this study was to quantify this problem, and also to analyse the cost implications of these admissions for the NHS. A retrospective study was performed of all patients who underwent an elective cholecystectomy by three consultants in a district general hospital between January 1999 and January 2000. The demographic details, indications for surgery, details of the emergency admissions while on the waiting list, and the treatment given during these episodes were recorded. One hundred and fifty six patients were included in the study, of which 122 (78%) were females. The mean (SD) age of the patients was 54 (5) years. The mean waiting time for surgery in these patients was 12 (3) months. Thirty seven patients (23.7%) were admitted as an emergency due to gallstone related symptoms and complications while awaiting surgery. There were 47 episodes of admissions in total, of which 32 were for biliary colic, 13 were for acute cholecystitis, and two were for acute pancreatitis. In addition to routine blood tests, 20 abdominal radiographs, 10 chest radiographs, three endoscopic retrograde cholangiopancreatography tests, five ultrasonograms, and one computed tomogram were carried out in these patients. The mean duration of each episode of admission was three days. The cost of treatment per episode was pound 946 and the total cost of treating the 37 patients was calculated to be pound 44 462. Performing early laparoscopic cholecystectomy for acute cholecystitis may help to reduce costs by preventing recurrent emergency admissions in these patients. Further studies to identify risk factors associated with recurrent symptoms and complications in patients with gallstone disease may help to prioritize them for early surgery.
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PMID:Costs of waiting for gall bladder surgery. 1249 22

The possibilities and the limits of transabdominal ultrasonography (US) in the diagnosis of bilio-pancreatic diseases are reviewed here in the light of the last 10 years' research. US remains the method of choice for the diagnosis of gallstones and is generally accepted as an initial imaging technique in gallstone complications, such as acute cholecystitis. Moreover the method can be useful for the detection of the biliary complications after laparoscopic cholecystectomy and after liver transplantation. US is still considered the first diagnostic procedure when stones are suspected in the common bile duct. The use of color Doppler can provide a differential diagnosis of gallbladder cancer with respect to other benign inflammatory or polypoid lesions. Color Doppler US allows to detect vascular complications of acute pancreatitis such as pseudoaneurysms. US is still considered useful for the initial screening of the pancreatic cancer. However, for staging other imaging techniques must be employed. With US useful informations are obtained in the diagnosis of cystic tumors of the pancreas and of pancreatic metastases. US is generally of little use for the diagnosis of endocrine tumors.
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PMID:The role of ultrasound in biliary and pancreatic diseases. 1257 83

Biliary sludge develops commonly in critically ill patients and may be associated with biliary colic, acute pancreatitis or acute cholecystitis. Sludge often resolves upon resolution of the underlying pathogenetic factor. It is generally diagnosed on sonography. Treatment of sludge itself is unnecessary unless further complications develop. Acute acalculous cholecystitis also develops frequently in critically ill patients. It may be difficult to diagnose in these patients, manifesting only as unexplained fever, leukocytosis or sepsis. Sonography and hepatobiliary scintigraphy are the most useful diagnostic tests. Management decisions should take into account the underlying co-morbid conditions. For many patients, percutaneous cholecystostomy may be the best management option. Cholecystostomy may also provide definitive drainage as patients recover and underlying critical illness resolves.
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PMID:Gastrointestinal disorders of the critically ill. Biliary sludge and cholecystitis. 1276 3

Biliary sludge is a mixture of particulate matter which has precipitated from bile. It generally consists of cholesterol monohydrate crystals, calcium bilirubinate or other calcium salts. In a clinical setting, biliary sludge is almost always an ultrasonographic diagnosis. Although it is less clinically applicable, direct microscopic examination of gallbladder bile is far more sensitive than ultrasonography into sludge detection, and has to be regarded as the diagnostic gold standard. The overall prevalence of sludge in the general population is relatively low. However, several clinical conditions are associated with a particularly high prevalence of biliary sludge, including pregnancy, rapid weight loss, total parenteral nutrition, octreotide therapy, bone marrow or solid organ transplantation. The clinical course of biliary sludge varies, and complete resolution, a waxing and waning course, and progression to gallstones are all possible outcomes. It may cause complications usually associated with gallstones, such as biliary colic, acute cholecystitis, and acute pancreatitis. The main pathogenic mechanism involved in sludge formation is probably gallbladder dismotility, and in selected patients measures aimed to maintain adequate gallbladder contractions has been shown to effectively prevent sludge development.
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PMID:Biliary sludge: the sluggish gallbladder. 1297 9

Biliary lithiasis is a widespread disease all over the world; one-third of the white population presents with stones in the biliary ducts. In Chile, it is present in 47% of adult females. The most common complications of this pathology are acute cholecystitis, choledocholithiasis, acute pancreatitis, retained common bile duct (CBD) stones, and gallbladder cancer; these constitute a serious health problem in Chile. The aim of this study was to update the information related to choledocholithiasis after 10 years of laparoscopic biliary surgery. To achieve this objective, we retrospectively analyzed the last 100 cases of choledocholithiasis admitted to the University of Chile Clinical Hospital in 2000. Prevalence by sex and age was determined. Clinical diagnosis was demonstrated to be effective in 92.3% of the cases; laboratory tests and ultrasound were effective in 81% and 90% of the cases, respectively. Diagnosis of cholelithiasis and choledocholithiasis as one unique entity corresponded to 53% of the sample; 47% of the remaining choledocholithiasis cases corresponded to retained CBD stones in patients previously cholecystectomized. Time of appearance of symptoms of this residual pathology was reviewed. All methods or procedures employed to treat this pathology were studied, and it was found that endoscopic cholangiography (ERCP) was the most frequently used procedure. Also, results of other alternative procedures, such as open surgery or ERCP combined with laparoscopic cholecystectomy, were considered. Finally, this study was complemented with a thorough bibliographic review of more than 100 publications on the subject that were published in high-impact surgical reviews, emphasizing the course of treatment followed during the last 7 years.
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PMID:Management of common bile duct stones: the state of the art in 2000. 1458 72

Cholecystectomy is after appendectomy the second most frequent surgical procedure made in pregnant women. The operation is indicated in all cases of symptomatic gallbladder stones which do not respond to medical treatment and all complicated forms such as acute cholecystitis or acute pancreatitis. Laparoscopic cholecystectomy, considered in the beginning as a high risk procedure both for mother and child, is nowadays safer and useful comparing to open surgery. Our limited experience can confirm this. There were operated two pregnant (2nd and 6th month of pregnancy) with acute cholecystitis. There were no intraoperative incidents or accidents, no postoperative complications and no problems in pregnancy evolution after operation. This presentation emphasis the particular technical problems due to pregnancy during laparoscopic cholecystectomy, aspects concerning anesthesia and preoperative monitoring of mother and child.
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PMID:[Laparoscopic cholecystectomy during pregnancy]. 1499 74

The incidence of surgical infections after laparoscopic cholecystectomy is reported to be <2%, because of the minimal trauma due to this approach. We report the results of a prospective study of antibiotic prophylaxis in laparoscopic cholecystectomy, comparing ceftriaxone vs ceftazidime. From Jan 1 to Dec 31 2002 a consecutive series of 242 cholecystectomies were performed, consisting in 18 open cholecystectomies and 224 laparoscopic cholecystectomies, 7 of which (3.1%) were converted to open cholecystectomies for technical and/or anatomical reasons. One hundred and eleven patients received 1 g i.v. ceftazidime 1 h before surgery, and 105 patients 1 g i.v. ceftriaxone on an alternate basis. Thirty-nine patients (17.4%) with acute cholecystitis received at least one booster dose at the end of the operation; 30 out of 39 were given further therapy for 2-3 days, i.e. 1 g i.v. bid. Twenty-two patients treated elsewhere with ceftriaxone or ceftazidime before surgery were transferred to another prophylactic regimen. The final diagnosis in the laparoscopic cholecystectomy group was 219 bile stones, 3 adenomas, and 2 occult carcinomas. We had 4 complications (1.8% of 217 laparoscopic cholecystectomies), 2 of which were minor (infection of the umbilical access by S. aureus) and 2 major (1 biliary fistula [accessory duct] and 1 acute pancreatitis), both treated conservatively. Positive bile cultures (27 cases) were unrelated to the clinical course. The incidence of infections after laparoscopic cholecystectomy in our prospective series was <2%. Ceftriaxone is confirmed as the gold standard in biliary tract surgery, but ceftazidime was equivalent (no statistical difference between the two antibiotics, P=0.59 NS). Ultra-short prophylaxis is enough in most cases, except in cholecystitis. We found no correlation between positive bile cultures and surgical infections after laparoscopic cholecystectomy. The umbilicus was the preferred site of infection in obese patients after the laparoscopic procedure. Major complications are usually related to technical pitfalls.
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PMID:Surgical infections after laparoscopic cholecystectomy: ceftriaxone vs ceftazidime antibiotic prophylaxis. A prospective study. 1528 37

Sickle cell disease is characterized by chronic hemolytic anemia and vaso-occlusive painful crises. The vascular occlusion in sickle cell disease is a complex process and accounts for the majority of the clinical manifestation of the disease. Abdominal pain is an important component of vaso-occlusive painful crises. It often represents a substantial diagnostic challenge in this population of patients. These episodes are often attributed to micro-vessel occlusion and infarcts of mesentery and abdominal viscera. Abdominal pain due to sickle cell vaso-occlusive crisis is often indistinguishable from an acute intra-abdominal disease process such as acute cholecystitis, acute pancreatitis, hepatic infarction, ischemic colitis and acute appendicitis. In the majority of cases, however, no specific cause is identified and spontaneous resolution occurs. This chapter will focus on etiologies, pathophysiology and management of abdominal pain in patients with sickle cell disease.
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PMID:Unusual causes of abdominal pain: sickle cell anemia. 1583 95

We report a case of acute cholecystitis accompanied by acute pancreatitis and caused by Dolosigranulum pigrum in a 76-year-old male with gallstones. D. pigrum was isolated from a blood culture and confirmed by biochemistry tests and 16S rRNA sequencing. The isolate was susceptible to the beta-lactams ampicillin, penicillin, cephalothin, ceftriaxone, ceftazidime, chloramphenicol, and vancomycin but was intermediate to erythromycin and clindamycin. The patient recovered without sequelae after treatment with appropriate antibiotics for two weeks.
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PMID:Acute cholecystitis accompanied by acute pancreatitis potentially caused by Dolosigranulum pigrum. 1675 45

Several risk factors for cholesterol gallstone formation in the general population have been identified. There is a strongly increased risk of gallstone disease during prolonged fasting, rapid weight loss, total parenteral nutrition, and somatostatin(-analogue) treatment. The annual risk of biliary colic and gallstone complications in asymptomatic gallstone carriers has been investigated sparsely. In asymptomatic and symptomatic gallstone carriers, treatment with the hydrophilic bile salt ursodeoxycholic acid (UDCA) has been claimed to reduce the risk of biliary colic and gallstone complications such as acute cholecystitis and acute pancreatitis. Also, prophylactic cholecystectomy could be beneficial in certain subgroups of asymptomatic gallstone carriers. However, randomized, double-blind, placebo-controlled trials are lacking. In this review, strategies for the prevention of gallstone formation in the general population and in high-risk conditions are dealt with. Also, strategies for the prevention of biliary colic and gallstone complications in asymptomatic and symptomatic gallstone carriers are discussed.
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PMID:Gallstone disease: Primary and secondary prevention. 1712 88


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