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

The ampulla of Vater is strategically located at the confluence of the terminal end of the bile duct and the pancreatic duct. It is entwined by smooth muscle fibers often referred to as the sphincter of Oddi. As a result, the ampulla demonstrates dynamic motor activity. A variety of structural and functional abnormalities can involve the ampulla and the periampullary region. Disorders involving the ampulla often produce remarkably similar clinical features, such as acute pancreatitis, biliary colic, or jaundice. Therefore, it is important that patients with periampullary disorders are systematically studied using endoscopic retrograde cholangiopancreatography, sphincter of Oddi manometry, and endoscopic ultrasonography. Common disorders involving the periampullary region and state-of-the-art techniques for diagnosis and treatment of these disorders are discussed.
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PMID:Periampullary disorders: review of pathophysiology. 774 19

To understand the surgical approach to acute abdominal pain, the internist must be familiar with common presentations of most abdominal emergencies; these emergencies include acute appendicitis, acute gall bladder disease (biliary colic, acute cholecystitis, and acute pancreatitis), ischemic bowel disease and ischemic colitis, abdominal aortic aneurysm, and intestinal obstruction. Nothing compares to experience; this article reviews the salient points that deserve consideration.
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PMID:An internist's approach to acute abdominal pain. 837 23

We report three cases of pancreatic islet cell tumors causing stricture of the main pancreatic duct. The clinical presentation was consistent with episodes of acute pancreatitis or biliary colic. One patient in whom the diagnosis was delayed died of metastatic disease. Islet cell tumors are an important clinical entity that must be considered in the differential diagnosis of pancreatic duct strictures.
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PMID:Pancreatic duct stricture caused by islet cell tumors. 856 Nov 17

Ascariasis is a helminthic infection of global distribution with more than 1.4 billion persons infected throughout the world. The majority of infections occur in the developing countries of Asia and Latin America. Of 4 million people infected in the United States, a large percentage are immigrants from developing countries. Ascaris-related clinical disease is restricted to subjects with heavy worm load, and an estimated 1.2 to 2 million such cases, with 20,000 deaths, occur in endemic areas per year. More often, recurring moderate infections cause stunting of linear growth, cause reduced cognitive function, and contribute to existing malnutrition in children in endemic areas. Ascaris infection is acquired by the ingestion of the embryonated eggs. The larvae, while passing through the pulmonary migration phase for maturation, cause ascaris pneumonia. Intestinal ascaris is usually detected as an incidental finding. Ascaris-induced intestinal obstruction is a frequent complication in children with heavy worm loads. It can be complicated by intussusception, perforation, and gangrene of the bowel. Acute appendicitis and appendicular perforation can occur as a result of worms entering the appendix. HPA is a frequent cause of biliary and pancreatic disease in endemic areas. It occurs in adult women and can cause biliary colic, acute cholecystitis, acute cholangitis, acute pancreatitis, and hepatic abscess. RPC causing hepatic duct calculi is possibly an aftermath of recurrent biliary invasion in such areas. Ultrasonography can detect worms in the biliary tract and pancreas and is a useful noninvasive technique for diagnosis and follow-up of such patients. ERCP can help diagnose biliary and pancreatic ascariasis, including ascaris in the duodenum. Also, ERCP can be used to extract worms from the biliary and pancreatic ducts when indicated. Pyrantel pomoate, mebendazole, albendazole, and levamisole are effective drugs and can be used for mass therapy to control ascariasis in endemic areas.
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PMID:Ascariasis. 886 40

Biliary sludge was first described with the advent of ultrasonography in the 1970s. It is defined as a mixture of particulate matter and bile that occurs when solutes in bile precipitate. Its composition varies, but cholesterol monohydrate crystals, calcium bilirubinate, and other calcium salts are the most common components. The clinical course of biliary sludge varies, and complete resolution, a waxing and waning course, and progression to gallstones are all possible outcomes. Biliary sludge may cause complications, including biliary colic, acute pancreatitis, and acute cholecystitis. Clinical conditions and events associated with the formation of biliary sludge include rapid weight loss, pregnancy, ceftriaxone therapy, octreotide therapy, and bone marrow or solid organ transplantation. Sludge may be diagnosed on ultrasonography or bile microscopy, and the optimal diagnostic method depends on the clinical setting. This paper proposes a protocol for the microscopic diagnosis of sludge. There are no proven methods for the prevention of sludge formation, even in high-risk patients, and patients should not be routinely monitored for the development of sludge. Asymptomatic patients with sludge can be managed expectantly. If patients with sludge develop symptoms or complications, cholecystectomy should be considered as the definitive therapy. Further studies of the pathogenesis, natural history, and clinical associations of biliary sludge will be essential to our understanding of gallstones and other biliary tract abnormalities.
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PMID:Biliary sludge. 1052 32

Diets form a part of the treatment concept in numerous gastrointestinal diseases. Their effectiveness, however, varies considerably from one disease to another. Thus, for example, diet is of decisive importance in celiac disease and lactose intolerance. In contrast, dietary measures are ineffective in the treatment of gallstones, and uncertain as a prophylactic measure against biliary colic. While dietetic measures are an important temporary measure in acute pancreatitis, in chronic pancreatitis such an approach is often not complied with, since it includes abstinence from alcohol. In chronic inflammatory bowel disease, diet can ameliorate a number of complications, although it leaves the pathological process itself unaffected. High-fiber diet is, for the most part, ineffective in patients with irritable bowel syndrome. The present article discusses the benefits of dietary measures in a number of gastroenterological disorders.
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PMID:[Nutritional therapy in gastrointestinal diseases. Diets--necessary or superfluous?]. 1126 34

Biliary sludge is a mixture of particulate solids that have precipitated from bile. Such sediment consists of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts. Sludge is usually detected on transabdominal ultrasonography. Microscopy of aspirated bile and endoscopic ultrasonography are far more sensitive. Biliary sludge is associated with pregnancy; with rapid weight loss, particularly in the obese; with critical illness involving low or absent oral intake and the use of total parenteral nutrition (TPN); and following gastric surgery. It is also associated with biliary stones with common bile duct obstruction; with certain drugs, such as ceftriaxone and octreotide; and with bone marrow or solid organ transplantation. The clinical course of biliary sludge varies. It often vanishes, particularly if the causative event disappears; other cases wax and wane, and some go on to gallstones. Complications caused by biliary sludge include biliary colic, acute cholangitis, and acute pancreatitis. Asymptomatic patients with sludge or microlithiasis require no therapy. When patients are symptomatic or if complications arise, cholecystectomy is indicated. For the elderly or those at risk from the surgery, endoscopic sphincterotomy can prevent recurrent episodes of pancreatitis. Medical therapy is limited, although some approaches may show promise in the future.
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PMID:Gallbladder sludge: what is its clinical significance? 1127 86

Ascariasis is a helminthic infection of global distribution with more than 1.4 billion persons infected throughout the world. The majority of infections occur in the developing countries of Asia and Latin America. Of 4 million people infected in the United States, a large percentage are immigrants from developing countries. Ascaris-related clinical disease is restricted to subjects with heavy worm load, and an estimated 1.2 to 2 million such cases, with 20,000 deaths, occur in endemic areas per year. More often, recurring moderate infections cause stunting of linear growth, cause reduced cognitive function, and contribute to existing malnutrition in children in endemic areas. HPA is a frequent cause of biliary and pancreatic disease in endemic areas. It occurs in adult women and can cause biliary colic, acute cholecystitis, acute cholangitis, acute pancreatitis, and hepatic abscess. RPC causing hepatic duct calculi is possibly an aftermath of recurrent biliary invasion in such areas. Ultrasonography can detect worms in the biliary tract and pancreas and is a useful noninvasive technique for diagnosis and follow-up of such patients. ERCP can help diagnose biliary and pancreatic ascariasis, including ascaris in the duodenum. Also, ERCP can be used to extract worms from the biliary and pancreatic ducts when indicated. Pyrantel pamoate, mebendazole, albendazole and levamisole are effective drugs and can be used for mass therapy to control ascariasis in endemic areas.
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PMID:Hepatobiliary and pancreatic ascariasis. 1129 75

The aim of this study was to document the morbidity associated with long waiting times for laparoscopic cholecystectomy and to relate this to the nature of initial presentation either routine out-patient consultation or emergency admission with acute symptoms. This study was performed over a 50-month period in a DGH (serving a population of 320,000) which lacked sufficient operating capacity to allow routine early cholecystectomy after emergency admission. A total of 387 patients underwent cholecystectomy but 22 of these had an early operation after initial emergency admission with signs of peritonitis and were excluded from the study. The median waiting time for cholecystectomy in this study population of 365 patients was 170 days (range, 6-484) days. Of these 365 patients, 246 (67.4%) were listed for surgery after initial out-patient assessment (out-patient cohort) and 119 (32.6%) were diagnosed after an index emergency admission with symptomatic gallstone disease (emergency cohort). Of the 365 patients, 42 (11.5%) had one or more emergency admissions (57 admissions) with gallstone-related complications whilst on the waiting list for surgery. Complications were acute cholecystitis/biliary colic (n = 40), jaundice/cholangitis (n = 8), acute pancreatitis (n = 6) and perforated gallbladder (n = 3). Re-admissions with gallstone-related complications were much more common in patients whose initial presentation had been as an emergency. Thus, 34 of the 119 emergency cohort (28.5%) required re-admission with complications whilst only 8 of 246 (2.8%) elective cohort were re-admitted. Of the 34 re-admissions in the emergency cohort, 22 occurred within 6 weeks of their discharge from hospital. Median total and postoperative stay were significantly shorter (P < 0.001) in the elective cohort (3 and 2 days, respectively) than the emergency cohort (10 and 3 days, respectively). These results document the high incidence of complications experienced by patients waiting for an elective laparoscopic cholecystectomy. Morbidity is highest in patients with an initial emergency admission. These results suggest that cholecystectomy should be offered to all patients presenting as an emergency with symptomatic gallstones on admission.
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PMID:Consequences of prolonged wait before gallbladder surgery. 1258 44

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


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