Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endoscopic retrograde pancreaticocholangiography (ERPC) has been performed in 140 patients, mainly Blacks and Indians. The first 100 patients have been analysed. The greatest diagnostic yield in this series is in (suspected) obstructive jaundice, where 26 diagnoses were made in 35 patients. In 40 patients with pancreatitis, the widest ducts were seen in 12 patients with calcific pancreatitis, but the procedure was of less help than expected. This was because no patients with continual pain after cessation of alcohol intake were found with operable strictures of the main pancreatic duct. The pancreatic function test with secretin and cholecystokinin-pancreozymin correctly diagnosed 4 patients with non-calcific pancreatitis in whom the ERPC was normal. There was a useful diagnostic yield in patients with unexplained upper gastrointestinal symptoms (15 diagnoses were made in 23 patients).
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PMID:Technique and results of endoscopic retrograde pancreaticocholangiography. A preliminary report on 140 patients. 16 2

A case is reported of spontaneous perforation of the common bile duct in a 59-year-old woman. Recurrent episodes of epigastric and right hypochondriac pain over one year culminated in the onset of obstructive jaundice. There were not signs of peritonitis, and laparotomy revealed an abscess surrounding a perforation in the common bile duct just distal to the cystic duct. A cholesterol gallstone was present at the site of perforation. A paracolon bacterium, providence alcalifaciens, was isolated from the abscess. The patient made an uncomplicated recovery after cholecystectomy and drainage of the bile duct.
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PMID:Spontaneous perforation of the common bile duct: report of a case. 28 2

The Chiba technique of percutaneous transhepatic cholangiography (PTC) can be easily learned and does not require much technical equipment; it is thus widely used now in the diagnosis of suspected obstructive jaundice. The procedure is generally regarded as safe; thus standby availability of a surgical outfit is not considered to be necessary. However fever, cholangitis, septicemia, biliary peritonitis and bleeding have been reported in patients who underwent PTC. A case report is given of a patient who had biliary peritonitis following PTC, in order to demonstrate the need for careful selection of patients undergoing this procedure. PTC should not be done in patients with coagulopathy, cholangitis and known allergic reactions against the cntrast medium to be injected. If a dilated duct can be visualized bile should be aspirated and only small amounts of contrast medium be injected. If extrahepatic biliary obstruction has been diagnosed or if the patient complains about pain after the procedure surgery should be done within 24 hours.
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PMID:[Biliary peritonitis after percutaneous transhepatic cholangiography with the Chiba technique (author's transl)]. 48 Oct 59

A new endoscopic method for retrograde cholangiography in cases of unsuccessful cannulation of the papilla is described. In 1 patient with obstructive jaundice, severe diabetes and a previous history of biliary pain traditional ERC failed. An endoscopic artificial choledocho-duodenal fistula by means of a diathermic cutter (needle type) was performed at the lower end of the intramural portion of the common bile duct for retrograde cholangiography. X-ray showed an obstruction of the common bile duct due to a carcinoma of the head of the pancreas. Complications did not occur during the procedure and in the post-operative period. It is concluded that the described method may be helpful when traditional selective ERC fails, moreover it may permit an endoscopic choledocho-duodenostomy for choledocholithiasis in cases of unsuccessful endoscopic papillo-sphincterotomy.
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PMID:Endoscopic retrograde cholangiography (ERC) through artificial endoscopic choledocho-duodenal fistula. 69 89

Infestation with Echinococcus granulosus is common in Iraq, where a close relationship exists between dogs, the carnivorous definitive hosts, and sheep, the herbivorous hosts of the parasite. Plants contaminated by eggs of the tapeworm passed in the dog's faeces may be ingested by man, giving rise to hydatid disease. Of 136 cases of hydatid disease affecting various tissues and organs studied and treated during a 3-year period, the liver was involved in 94; intrabiliary rupture occurred in 15. Pain, hectic fever, and obstructive jaundice were invariable in these 15 cases but biliary obstruction became complete in only 7. A palpable mass in the liver was present in 10 cases. Mistaken preoperative diagnoses were made in 4 cases before the true nature of the disease was determined. In the light of our experience four main guidelines to operative management may be formulated: First, the mother cyst, daughter cysts, and debris must be evacuated. Second, the common bile duct must be explored and cleared of daughter cysts, membranous shreds, and hydatid stones and the ampulla of Vater must be dilated; however, sphincterotomy is rarely necessary and should not be performed as a routine. Third, unless there is clear evidence of inflammation or daughter cyst or stone formation in the gallbladder the organ should be preserved, since it may prove useful for future bypass procedures. Finally, the residual cavity of the mother cyst must be drained.
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PMID:Intrabiliary rupture of hydatid cyst of the liver. 84 42

Infestation of the bile ducts by the adult Ascaris lumbricoides roundworm is a common condition in many parts of the world. The most frequent clinical presentation is as upper abdominal colicky pain with a normal or only slightly raised serum bilirubin. In most cases these worms can be visualized by intravenous cholangiography because of the absence of obstructive jaundice and can therefore be specifically treated by nonsurgical methods. The radiographic appearance is diagnostic. This is the first report of such a case presenting in North America or the United Kingdom, where the importance of biliary ascariasis in endemic areas is not fully appreciated.
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PMID:Biliary ascariasis presenting in the United States. 92 Jul 17

In a series of 136 cases of hydatid disease affecting various tissues and organs admitted to one surgical unit in the Medical City Hospital, Baghdad, and personally studied and treated by the author, the liver was involved in 94 cases (69-1 per cent) and intrabiliary rupture occurred in 15. Pain in the right upper abdominal quadrant associated with tenderness and rigidity, radiating to the back and right, shoulder, was the presenting feature in almost all the patients. Hectic fever was present in 14. Obstructive jaundice developed in all the patients at some stage of the illness, but was complete with clay-coloured stools in only half. Chills and rigors were present in 67 per cent, eosinophilia in 40 per cent, a positive Casoni's test in 87 per cent, itching with urticaria and weal formation in 20 per cent and a palpable mass in the liver in 67 per cent of cases. Operative treatment is mandatory in order to clean the mother cyst of hydatid membranes, debris and daughter cysts, to explore and clear the common bile duct and to ensure free biliary passage to the duodenum. Sphincterotomy is neither necessary nor advisable, and when the gallbladder is not invaded by the cyst it should be preserved.
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PMID:Intrabiliary rupture of hydatid cyst of the liver. 119 49

Jaundice occurring in patients with pancreatitis is usually due to hepatocellular injury or to associated biliary tract disease. Common duct obstruction is occasionally caused by pancreatic fibrosis, edema or pseudocyst in patients who have neither hepatocellular injury nor biliary tract disease. We have studied 7 patients with obstructive jaundice due to pancreatitis who demonstrated no other known cause for jaundice. The difficulty in making the differential diagnosis between benign and malignant disease in these patients, particularly when no pain is associated with obstructive jaundice, is discussed. In view of the fact that the terminal common duct traverses the pancreas, it is uncertain why obstructive jaundice associated with chronic pancreatitis does not occur more often unless the condition is sometimes transient and overlooked. Operative intervention is required in those patients in whom jaundice is persistent. Operation is intended to decompress the biliary tract and the pancreas. The approach used will be dictated by the operative findings in each patient.
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PMID:Obstructive jaundice in patients with pancreatitis without associated biliary tract disease. 121 86

The value of endoscopic retrograde cholangiopancreaticography (ERCP) for establishing the indication for surgery and for planning surgical procedures is discussed. The two most widely practiced methods of direct cholangiography - percutaneous transhepatic and endoscopic retrograde cholangiography (PTC and ERC) - are compared: although the filling rate with ERC is slightly lower than with PTC, the endoscopic method has some important advantages as it allows endoscopic observation and biopsy of the duodenum. Furthermore, opacification of the pancreatic duct system often provides important additional information. ERCP is essentially important in post-cholecystectomy syndrome, as puncture of undilated bile ducts is difficult and persistent symptoms after cholecystectomy are not infrequently related to pancreatic disease. The importance of rapid surgical intervention after retrograde filling of the biliary tree in obstructive jaundice is stressed. In pancreatic diseases the indication for surgery is based mainly on clinical and laboratory findings. Differentiation of malignant and inflammatory changes in the pancreaticogram is still a problem. However, the contribution of ERCP to pancreatic surgery is very important, as it exactly localized lesions of the pancreas and therefore allows detailed planning of a surgical procedure. Stenosing or obstructing lesions often are an indication for surgery, even if their malignant nature is not certain, as severe pain in chronic pancreatitis may be relieved by surgery. The potential for therapeutic application of endoscopy in biliary and pancreatic diseases is briefly discussed.
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PMID:[The value of endoscopic retrograde cholangiopancreaticography for the surgery of bile duct and pancreatic diseases]. 121 73

An 82-year-old patient with obstructive jaundice secondary to simple renal cyst also suffered pain and vomiting from partial duodenal obstruction. The symptoms were relieved by aspiration of 1,750 ml of fluid. This reaccumulated over a five-year period when aspiration again relieved his symptoms, which then only consisted of epigastric fullness. Review of the literature shows jaundice to be an extremely rare symptom of renal cyst.
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PMID:Obstructive jaundice and renal masses. 126 10


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