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

Cystic fibrosis (CF), the most common lethal autosomal recessive disease in white populations, is characterized by dysfunctional chloride ion transport across epithelial surfaces. Although recurrent pulmonary infections and pulmonary insufficiency are the principal causes of morbidity and death, gastrointestinal symptoms commonly precede the pulmonary findings and may suggest the diagnosis in infants and young children. The protean gastrointestinal manifestations of CF result primarily from abnormally viscous luminal secretions within hollow viscera and the ducts of solid organs. Bowel obstruction may be present at birth due to meconium ileus or meconium plug syndrome. Complications of meconium ileus include volvulus, small bowel atresia, perforation, and meconium peritonitis with abdominal calcifications. Older children with CF may present with bowel obstruction due to distal intestinal obstruction syndrome or colonic stricture, and tenacious intestinal residue may serve as a lead point for intussusception or cause recurrent rectal prolapse. Radiologic studies often demonstrate thickened intestinal mucosal folds in older children and uncommonly show colonic pneumatosis, peptic esophageal stricture due to gastroesophageal reflux, and duodenal ulcer. Appendicitis due to inspissated secretions is uncommon. Obstruction of ducts and ductules produces exocrine pancreatic insufficiency, pancreatitis, cholestasis, cholelithiasis, and cirrhosis with portal hypertension. On imaging studies, the pancreas is commonly small and largely replaced by fat, sometimes displays calcifications, and is rarely replaced by macrocysts. Radiologic features of hepatobiliary disease include an enlarged radiolucent liver from steatosis, gallstones, a shrunken nodular liver, splenomegaly, and portosystemic collateral vessels. With the improved survival of CF patients, an increased risk for developing gastrointestinal carcinomas has been established, many occurring as early as the 3rd decade.
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PMID:Gastrointestinal manifestations of cystic fibrosis: radiologic-pathologic correlation. 883 77

Choledochal cysts are prone to complications: cholangitis, biliary cirrhosis, portal hypertension, lithiasis, rupture, pancreatitis, and carcinoma. The coincidence of choledochal cysts and neoplasia ranges from 2.5 to 26 per cent. One hundred six cases of choledochal cysts with neoplasms have been collected from the literature. We have tabulated the results of 68 cases found to have a neoplasm at the initial laparotomy and of 38 patients with pristine choledochal cysts treated electively who subsequently developed a neoplasm. Two original cases are presented. The primary site of neoplasia was not confined only to choledochal cysts. There appears to be a propensity for malignancy to develop anywhere in the biliary tract or gallbladder or pancreas in conjunction with the choledochal cyst. Accompanying choledochal cysts is a high incidence of an anomalous relation at the pancreaticobiliary junction with subsequent malignancy formation. A pathogenetic basis is postulated.
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PMID:Choledochal cyst and neoplasm: a comprehensive review of 106 cases and presentation of two original cases. 935 87

Between 1980 and 1996, 16 patients (10 women) with pathologically confirmed insulinomas were operated on; they represents a median of 0.9 per year and 1.1 per cent from the total of pancreatic tumors. Median age was 47.2 (+/- 22.8) years old (range 23-68). Insulinomas occurred with following frequency in: head--2 patients, body and tail--11 patients and diffuse forms (nesidioblastomas)--3 patients. The specific clinical forms only with tumoral syndrome (without hypoglycemic manifestations) and one was an intraoperative discovery. In the case of the four patients two presented with splenic-portal hypertension +/- upper digestive haemorrhages and the other two only tumoral syndrome. The surgical approach was: the midline (ten), uni- or bilateral subcostal (five), and other incisions one. There were performed tumor exeresis through: enucleation (three), segmentary pancreatectomies (two), spleno-left-pancreatectomies (nine) and the extension of an anterior pancreatectomy (one). In one case biopsy alone was done. The tumors were not intraoperatively identified in three cases (blind left spleno-pancreatectomies). The malignancy index was 4/16 (25 per cent). Postoperative mortality rate was 12.5 per cent (two patients: one acute necrotizing pancreatitis and one pulmonary embolism).
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PMID:[Insulinomas--nesidioblastomas. Clinical experience]. 945 52

There are few reports on operations in patients with nonalcoholic pancreatitis. Between 1985 and 1995 we operated on 58 such patients, 38 of whom were male and 20 female with a mean age of 35 years (range 5-72 years). The indications for operation were pain (n = 49), biliary obstruction (n = 12), duodenal obstruction (n = 10), portal hypertension (n = 11), cysts (n = 14), and pancreatic ascites (n = 3). Thirty-four patients with a dilated pancreatic duct underwent pancreaticojejunostomy; cysts were drained internally in eight, and biliary and duodenal obstruction was bypassed. Ten patients also underwent surgery for portal hypertension. Four (7%) patients died during the postoperative period. Of the remaining 54 patients, 48 (89%) were followed up for a median period of 63 months (range 6 months to 10 years). Six died: four of pancreatic cancer, one of cerebrovascular accident, and one of malnutrition. Of the 34 surviving patients operated for pain, 30 (88%) felt better, of whom 24 (71%) had complete relief of pain; 14 (41%) recorded a weight gain. Pancreatic decompression results in immediate and lasting pain relief in most patients with nonalcoholic chronic pancreatitis.
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PMID:Surgery for nonalcoholic chronic pancreatitis. 1050 49

Hepatic involvement is frequently in systemic amyloidosis but major clinical symptoms due to portal hypertension or liver failure are rare. To date all treatment modalities proven in these patients have failed. Thus, prognosis is dismal with progressive deterioration in liver function. We describe a patient with massive liver involvement by primary amyloidosis, manifested by severe intrahepatic cholestasis. Up to now 25 similar case have been reported in the English literature. In this subset of patients the most frequently recorded cause of death was renal failure accelerated by hyperbilirrubunemia. In our patient a downhill course was characterized by fatal renal hepatic failure after an hemoperitoneum, probably as a delayed complication of liver biopsy. Although not all authors agree, an added risk of bleeding after liver biopsy have been pointed out in hepatic amyloidosis. This kind of problem recommends the use of tissue other than liver, or a transjugular hepatic biopsy for diagnostic purposes. Also, of interest in the present cause is the autopsy findings of pancreatitis associated to pancreatic amyloidosis, a complication which have been described in previous reports.
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PMID:[Massive hepatic amyloidosis: a case of hepatic failure and haemorrhagic pancreatitis of fatal evolution]. 965 12

Chronic pancreatitis is a inhomogeneous disease of multifactorial genesis and a variable clinical course. Upper abdominal pain is the leading clinical symptom of the majority of the patients. The primary treatment of these patients is conservative, but if the treatment fails in pain relief or organ complications occur surgical treatment is indicated. The most common organ complications due to chronic pancreatitis are stenosis of the common bile duct and the pancreatic duct, duodenal stenosis, stenosis of the portal vein with portal hypertension, pancreatic pseudocysts and the development of pancreatic fistula. Due to the pathophysiological concept of an elevated duct pressure as a source of pain, duct decompression by drainage procedures is the favored surgical procedure by many surgeons. Nevertheless, even in patients with a dilated pancreatic main duct, only half of the patients will benefit from drainage operations. Long-term severe upper abdominal pain and complications of the neighboring organs due to an inflammatory mass in the head of the pancreas should be indicative for resective procedures which should be organ-preserving as much as possible and take into account the endocrine function of the pancreatic gland. Simultaneous multiple organ resections like pylorus-preserving partial duodenopancreatectomy or total pancreatectomy are not necessary for a benign disease and should be only performed in patients with proven malignancy. The aim of the surgical procedure is to reduce pain and frequency of relapsing pancreatitis without impairing the endocrine function of the pancreatic gland.
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PMID:Organ-preserving surgery in chronic pancreatitis: the duodenum-preserving pancreatic head resection. 1082 26

Acute abdominal pain in chronic hemodialysis patients has well-known causes, including acute pancreatitis, mesenteric arterial insufficiency, or complicated duodenal ulcer. Others, such as hemoperitoneum, are far less common. Although hemoperitoneum occurs in patients receiving peritoneal dialysis, dialysis is seldom if ever the direct cause of the bleeding. Hemoperitoneum is often related to menses or ovulation, particularly to ovarian cyst rupture; therefore, it is more common in young women. In most cases, no specific treatment is required. Hemoperitoneum is rarely considered as the cause of acute abdominal pain in chronic hemodialysis patients. In this report of hemoperitoneum confirmed by emergency laparotomy in 3 women, bleeding was not related to gynecologic origin. All of the women were younger than age 50 and undergoing long-term hemodialysis. All patients had a history of acute abdominal pain associated with shock. The cause of bleeding was always an organ lesion: hepatic amyloidosis with suspected portal hypertension or sclerosing peritonitis and acute hemorrhagic pancreatitis. Coagulation abnormalities and the use of anticoagulants during hemodialysis sessions may have been aggravating factors in all three patients. Hemoperitoneum is difficult to diagnose, particularly in the minor forms, and consequently its incidence may be underestimated. Therefore, it should be considered whenever a chronic hemodialysis patient presents with persistent acute abdominal pain.
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PMID:Hemoperitoneum in patients receiving hemodialysis. 1092 32

The aetiology of portal vein thrombosis (PVT) is heterogeneous. Important primary risk factors for PVT are cirrhosis, hepatobiliary malignancies and pancreatitis. Newly discovered thrombotic risk factors, such as latent myeloproliferative disorders and prothrombotic genetic defects, have also been identified as major risk factors for PVT. At least one-third of PVT patients demonstrate a combination of thrombotic risk factors. PVT, which does not have a detrimental effect on liver function, usually becomes manifest as a variceal haemorrhage in the oesophagus months to years after the development of thrombosis. Owing to intact coagulation variceal bleeding has a better prognosis among patients with PVT than cirrhotics. Endoscopic sclerotherapy or band ligation is the primary therapeutic option for variceal bleeding in patients with PVT. It is questionable whether anticoagulant therapy should be started, since it has not proven beneficial for most PVT patients. Therapy with anticoagulants is only recommended for those with acute PVT (especially in association with mesenteric vein thrombosis), those who recently underwent a portosystemic shunt procedure, and those with other thrombotic manifestations, particularly in case of proven hypercoagulability. Mortality of patients with PVT may be associated with concomitant medical conditions which lead to the PVT or with manifestations of portal hypertension, such as variceal haemorrhage. Multivariate analysis of a large Dutch PVT population has shown that age, malignancy, ascites and the presence of mesenteric vein thrombosis are independently related to survival. Death due to a variceal haemorrhage is rare. Poor outcome of PVT thus appears to be associated primarily with concomitant diseases which lead to PVT, and not the complications of portal hypertension. It is therefore uncertain whether surgical portosystemic shunting affects survival favourably.
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PMID:Changing perspectives in portal vein thrombosis. 1123 96

Bleeding from varices outside the gastroesophageal region is a rare, but regularly reported complication of portal hypertension. The treatment differs from the management of esophageal and gastric varices. We present here a report on the diagnosis and treatment of bleeding jejunal and gallbladder varices in a man with portal hypertension caused by chronic calcifying pancreatitis. The patient was suffering from recurrent, frequent, and massive gastrointestinal bleeding from varices at the anastomotic area of a cholecystojejunostomy. For diagnostic purposes, we carried out percutaneous Duplex ultrasonography and push enteroscopy with the Doppler technique. The treatment of varices in this area is traditionally surgical. This is the first report of enteroscopic sclerotherapy being successfully carried out using cyanoacrylate to treat hemorrhage from jejunal and gallbladder varices. No clinical signs of gastrointestinal bleeding were observed during a follow-up period of seven months.
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PMID:Enteroscopic cyanoacrylate sclerotherapy of jejunal and gallbladder varices in a patient with portal hypertension. 1139 68

Cystic disease of the intrahepatic and extrahepatic bile ducts results in rare malformations with a variable presentation. The majority of patients present during childhood with symptoms of abdominal pain, cholangitis, and an abdominal mass. A palpable mass is unusual in adults, and adult patients tend to present with recurrent cholangitis, pancreatitis, or rarely portal hypertension. The cause of this disorder also is debated, with both congenital and acquired origins postulated. The gold standard for the treatment of choledochal cysts is complete excision with the establishment of biliary flow into the gastrointestinal tract. The well described malignant potential of the cyst and the high rate of recurrent cholangitis with internal drainage procedures mandate cyst excision when possible. In the event of extensive scarring or malignant changes of the cyst, the posterior wall of the cyst may be left in situ to avoid endangering the portal vessels, which are found posteriorly. Alternatively, various endoscopic or percutaneous interventions may provide symptomatic relief. However, every effort should be directed towards complete resection of the cyst and the re-establishment of biliary-enteric continuity.
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PMID:Choledochal Cystic Diseases. 1146 69


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