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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For medical treatment of acute pancreatitis, only very few effective measures can be recommended. To put the gland to rest, the patient has to be maintained in a fasting state. Additionally, Cimetidine should be administered intravenously. A properly functioning nasogastric tube is an efficacious method of inducing the pancreas to rest. To maintain an adequate blood volume and in protecting the microcirculation of pancreas, the use of intravenous fluids that include colloids, is important. Sufficient replacement of electrolytes evidently seems to be indicated. Drug therapy consists of the administration of analgetics and of an adjuvant use of calcitonine or somatostatine, for reducing the pancreatic flow. Aprotinine given early and in sufficient amounts is to be recommended. Antibiotic prophylaxis should be utilized only when pancreatitis associated with biliary tract disease or postoperative pancreatitis seems to be apparent. Whenever systemic hypotension and shock occurs, plasma or dextran, together with sufficient but controlled amounts of intravenous fluids, must be administered. In acute renal failure dopamine has been used with success. Peritoneal dialysis or hemodialysis as an ultimate measure, has to be considered. In the case of respiratory distress syndrome, oxygen by nasal catheter must be applied.
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PMID:[Medical treatment of acute pancreatitis (author's transl)]. 615 71

Pancreas divisum was demonstrated in 22 of 500 consecutive ERCP (4.4%). Among patients with otherwise normal ERCP, pancreas divisum was found in 12.8%. In contrast, only 1.8% of patients with other pathology in the ERCP exhibited pancreas divisum (p less than 0.001). In relation to the clinical indication, pancreas divisum was found in 13.3% of patients with suspected or proven pancreatitis, in 1.9% of patients with suspicion of biliary tract disease (p less than 0.001), in 1.9% of patients with suspicion of pancreatic cancer (p less than 0,05) and in 4.4% of patients with epigastric pain of undetermined origin (p greater than 0.05). In 14 patients pancreas divisum was the only pathological finding in a thorough clinical and gastrointestinal workup; 6 of the 14 patients had had typical episodes of pancreatitis, in 6 other patients there was clinical and biochemical evidence of pancreatic disease (mainly pain and hyperenzymemia), and the last 2 cases had chronic epigastric pain without biochemical abnormalities. In 2 patients of this series the pancreas divisum was misinterpreted morphologically (sonography, autopsy) as tumor of the head of the pancreas. Based upon our experience and the literature, the following practical conclusions can be drawn: 1. Pancreas divisum may cause typical episodes of acute (relapsing) pancreatitis. 2. In patients with chronic epigastric pain associated with hyperenzymemia but without typical acute pancreatitis, pancreas divisum may be the cause. 3. Morphologically pancreas divisum may mimic a pancreatic tumor (sonography, computer-tomography, autopsy).
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PMID:[Clinical significance of pancreas divisum]. 618 82

Biliary tract disease is a major cause of acute pancreatitis. However, with traditionally employed Telepaque, radiographic visualization of the gallbladder during acute pancreatitis remains unreliable, even in patients with apparently normal gallbladders. Therefore, oral cholecystography has customarily been deferred for such patients for several weeks. Recently, successful oral cholecystography has been described during the acute episode of pancreatitis, using Bilopaque, a more water-soluble cholecystopaque. The relative intestinal absorption of Telepaque and Bilopaque and the ability of these agents to produce diagnostic oral cholecystograms of fasting patients with acute alcoholic pancreatitis were compared. Forty-five hospitalized patients were studied within 96 hours of admission. Mean peak plasma contrast concentrations for Bilopaque exceeded those for Telepaque. Thirty-one percent of the Bilopaque group achieved diagnostic single-dose oral cholecystograms, compared with to 11% of the Telepaque group (P less than 0.05).
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PMID:Oral cholecystography in the early phase of acute alcoholic pancreatitis. A prospective, randomized comparison of Telepaque and Bilopaque. 675 57

1. Alcohol was the most common cause of pancreatitis, irrespective of sex or age. The acute hemorrhagic necrotizing form could arise after the consumption of no more than 100-450 g of alcohol a day for 7-10 days. Chronic pancreatitis was almost invariably caused by alcohol. 2. While alcohol predominantly (93%) among the under-60s, biliary tract disease and cancer were a major cause (53%) of pancreatitis in the over-60s. 3. Pancreatitis usually followed one of three courses: acute hemorrhagic, acute oedematous (acute pancreatitis) or chronic. 4. Patients who have been treated for alcoholic pancreatitis have a high death rate. The mean age at death was 46 years. 5. Most cases of acute hemorrhagic, necrotizing pancreatitis (92%) occurred as the patient's first attack of pancreatitis. 6. The diagnosis acute hemorrhagic, necrotizing pancreatitis can at present be established only at operation or autopsy. 7. Extensive resection of the pancreas should be avoided in acute hemorrhagic necrotizing pancreatitis because the function of the pancreas was often acceptably restituted once the disorder had subsided. 8. Disturbed sugar regulation was the most common complication in patients who had had pancreatitis. Diabetes mellitus often occurred (29%) and might do so months or years after an attack. 9. Patients with alcoholic pancreatitis were greatly disadvantaged socially (little education, poor jobs and housing) and in the event of a recurrence elicited by alcohol it is suggested that they should be cared for at a department for alcoholics. 10. It is suggested that in chronic pancreatitis the diagnosis should specify any exocrine and endocrine disturbances as well as any morphological changes that have been documented by i.e. ERCP or ultrasound. Studies of pancreatic function and morphology for the classification of pancreatitis should be made no earlier than 6 weeks after clinical signs of pancreatitis have subsided, with abstention from alcohol in the intervals. A classification of this type would contribute to a better follow-up and treatment of patients with chronic pancreatitis and improve the possibility of comparing patient materials.
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PMID:Diagnostic criteria, classification and clinical course in pancreatitis. 676 27

In a prospective study of 80 patients with duodenal diverticula and calculous biliary tract disease, bacteriocholia with typical intestinal bacteria was found in 51 of 71 patients, whereas, in cholelithiasis without duodenal diverticula, this complication was present in 278 of 809 patients. With an increasing distance between duodenal diverticula and the papilla of Vater, the rate of bacteriocholia decreases. Advancing age of the patients results in the augmentation of bacteriocholia. Bacteriocholia on the basis of duodenal diverticula seems to present an additional pathogenic factor for inflammatory biliary tract disease and pancreatitis. Consequently, the pathologic value of juxtapapillary duodenal diverticula is much more prominent than has so far been reported.
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PMID:The pathologic implication of duodenal diverticula. 679 81

A total of 40 patients with pancreatitis had associated extrahepatic biliary obstruction. Eighteen had biliary-induced pancreatitis. Comprehensive correction of the biliary tract disease, including cholecystectomy, common duct exploration and, when indicated, transduodenal sphincteroplasty, resulted in a high recovery rate (83%) with no recurrence of pancreatitis. Twenty-two patients had chronic pancreatitis with involvement of the terminal biliary tract by a long tapering stenosis. Nineteen of these patients had chronic fibrocalcific pancreatitis secondary to chronic alcohol abuse. In five patients, the stenosis produced a high grade obstruction which required biliary bypass with choledochoduodenostomy (four) or cholecystoduodenostomy (one). The remaining 14 patients maintained patency of the biliary tract following correction of the underlying pancreatic pathology. The latter consisted of drainage (nine) or resection (five) of 14 associated pseudocysts (present in 64% of the 22 patients), combined with side-to-side pancreaticojejunostomy to decompress an obstruction of the major pancreatic duct. In assessing the degree of terminal bile duct stenosis, calibration of the duct with Bakes dilators or rubber catheters was a useful aid. Two of the 22 patients ultimately proved to have carcinomas, producing obstruction of the pancreatic duct in the head of the gland. Both were treated initially with choledochoduodenostomy. This possibility must be considered in the management of these patients.
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PMID:Extrahepatic biliary obstruction associated with pancreatitis. 685 77

Histories of alcohol and tobacco consumption and other potential risk factors were obtained from 98 patients with pancreatitis and 451 comparison patients at 11 large hospitals in Eastern Massachusetts and Rhode Island between 1975 and 1979. The great majority of the patients with pancreatitis had chronic or recurrent disease. From the comparison patients were excluded patients with other diseases of the pancreas and biliary tract and those admitted for disorders known to be associated with smoking or alcohol use. A statistically significant association of pancreatitis with alcohol use was present in males, but not in females. Cigarette use was very strongly associated with pancreatitis in males and less so in females. The associations with alcohol and cigarette use were independent, each retaining significance after adjustment for the other. There was no significant association of risk with coffee consumption in either sex. A history of biliary tract disease was given by 45 per cent of the male and 60 per cent of the female cases. The associations with alcohol use and cigarette smoking did not appear to be restricted either to the patients with or those without a history of biliary tract disease. Chronic or recurrent pancreatitis appears to have different dominant etiologies in males and females.
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PMID:Consumption of alcohol and tobacco and other risk factors for pancreatitis. 712 9

A retrospective study of 314 patients hospitalized for pancreatitis in the period 1972-1973, showed that 74 (24%) had died in the course of five years. The aim of the study was to elucidate the etiology and the course of the pancreatitis and the immediate cause of death in the 61 cases where an autopsy was performed. There were three types of histopathological findings at autopsy concerning the pancreas: acute hemorrhagic pancreatitis, chronic pancreatitis and one group with no or minimal changes in the pancreas. The last group had had typical clinical symptoms of pancreatitis with abdominal pain and elevated urine and/or serum amylase, in many patients a very marked rise. Alcoholism was the dominant predisposing factor, regardless of the type of histopathological findings, but when the first attack of pancreatitis appeared at advanced age, biliary tract disease and cancer were the dominant causes. Liver damage was a common finding in alcoholic pancreatitis.
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PMID:Clinical course and autopsy findings in acute and chronic pancreatitis. 713 29

Acute haemorrhagic and/or necrotizing pancreatitis is a most serious condition. A retrospective account is presented of the clinical course, treatment and results in 61 patients with the diagnosis confirmed at laparotomy and/or autopsy. Forty-eight patients (79%) died while in hospital. Of the 13 surviving patients, 10 were followed up for periods ranging from 1.5 to 9 years. They were reinvestigated with respect to morphologic and exocrine and endocrine functional changes in the pancreas. The aetiology of the acute condition was biliary tract disease in 33% of the total series and alcoholism in 59%. Neither cause of the disease nor type of treatment (surgery with or without peritoneal lavage) had statistically significant effect on survival. At the follow-up examination the endocrine and exocrine pancreatic functions were satisfactory in many patients. In almost half of the surviving patients, endoscopic retrograde pancreatography showed openly minor changes.
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PMID:Prognosis in acute haemorrhagic, necrotizing pancreatitis. 718 Mar 38

The records of twenty-one patients treated for pancreatic abscesses were reviewed. Pancreatitis developed following alcohol ingestion, operative procedures, biliary tract disease, ulcers, and undetermined causes. The clinical findings included abdominal pain in 19 patients (90%); fever in 18 (86%); tenderness in 18 (86%); and leukocytosis in 18 (86%). Ultrasonographic examination aided the diagnosis in seven of 11 patients. Computerized tomography was useful in diagnosing eight of ten cases. There were twenty-nine hospital admissions, with a mean length of hospitalization of 76 days per patient. The operative findings varied with extent and duration of underlying pancreatitis. The surgical approach depended on clinical presentation and prior localization of the abscess. Eleven additional operations were performed. Complications included respiratory failure (three patients); fistula formation (five patients); hemorrhage (two patients); renal failure (one patient); and splenic vein thrombosis (one patient). Thirteen patients were treated with hyperalimentation and nine patients had gastrostomy and jejunostomy placed for decompression and feeding. Of 15 patients in whom microbial studies were reviewed, nine patients had polymicrobial infections. Three patients had Candida albicans. There was one death.
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PMID:Management of pancreatic abscesses. 729 26


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