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

Gastrointestinal complications, such as ileus, bleeding, stenosis and fistula formation, were retrospectively analysed on 180 patients with acute pancreatitis. Paralytic ileus occurred in only a quarter of patients with acute oedematous pancreatitis and only one had bleeding from a gastric ulcer. Complications occurred in the early but also postacute stage in patients with the haemorrhagic-necrotizing form. Even with early and delayed operation and adequate treatment of most complications, renewed gastrointestinal complications were not uncommon and required re-operations.
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PMID:[Gastrointestinal complications of acute pancreatitis (author's transl)]. 30 3

It is possible to estimate the category and volume of lost liquid in patients who have become acutely depleted of body fluids by measuring the haematocrit and plasma protein concentration in venous blood samples. Three recent examples of different categories of loss are presented: plasma loss in pancreatitis, extracellular fluid (saline) loss in paralytic ileus, and mixed plasma and extracellular fluid loss in peritonitis complicating acute appendicitis. Goood clinical results were achieved by infusion of appropriate volumes of either plasma or saline so as to restore the haematocrit and plasma protein concentration to their presumptive basal values.
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PMID:A simple clinical approach to quantifying losses from the extracellular and plasma compartments. 43 51

Recently, general surgeons have become actively involved in laparoscopic operations. The best method for teaching these techniques to surgical residents is unclear. Since June 1990, at St. Luke's-Roosevelt Hospital Center in New York City, we have instituted a formal course of instruction for surgical residents. This includes a reference syllabus, didactic instruction, use of an inanimate training device and a hands-on practice in swine. Clinically, the residents progress from observer to camera operator and, finally, operator. During the first year of this program, the authors performed 90 laparoscopic cholecystectomies, of which 71 were elective and 19 were for acute cholecystitis. There were seven morbidly obese patients, while 25 had undergone prior abdominal operations. The first 25 operations performed by the authors averaged 93.2 minutes, while the last 40 operations performed primarily by the surgical residents with assistance of the authors averaged 70 minutes. There were nine complications, including postoperative pancreatitis in two patients, Clostridium difficile enterocolitis in two and one each of prolonged paralytic ileus, postoperative transfusion and umbilical incision dehiscence. Two patients had postoperative common duct stones. There were no wound infections, bile duct injuries or deaths. Complications were evenly distributed throughout the series and did not correlate with whether the surgeon was a resident or an attending surgeon. The results of this plan have been quite successful and thus far, 12 residents have completed this program.
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PMID:Surgical laparoscopic experience during the first year on a teaching service. 144 32

The current review has summarized current data relevant to the nutritional support of patients with acute pancreatitis. Selection of the most appropriate form of nutritional support for patients with acute pancreatitis is intimately linked to a thorough understanding of the effects of various forms of enteral and parenteral nutrition on physiologic exocrine secretory mechanisms. Two basic concepts have emerged from the multiple studies that have addressed these issues to date: 1, enteral feeds should have low fat composition and be delivered distal to the ligament of Treitz to minimize exocrine pancreatic secretion and 2, parenteral substrate infusions, alone or in combinations similar to those administered during TPN, do not stimulate exocrine pancreatic secretion. From a practical standpoint, most patients with acute pancreatitis are diagnosed by nonoperative means and will manifest some degree of paralytic ileus during the early phase of the disease. Therefore, jejunal feeds are usually not a therapeutic option early in the course of this disease. On the basis of the clinical studies reviewed herein we propose general guidelines for the nutritional support of patients with acute pancreatitis: 1, most patients with mild uncomplicated pancreatitis (one to two prognostic signs) do not benefit from nutritional support; 2, nutritional support should begin early in the course of patients with moderate to severe disease (as soon as hemodynamic and cardiorespiratory stability permit); 3, initial nutritional support should be through the parenteral route and include fat emulsion in amounts sufficient to prevent essential fatty acid deficiency (no objective data exist to recommend specific amino acid formulations); 4, patients requiring operation for diagnosis or complications of the disease should have a feeding jejunostomy placed at the time of operation for subsequent enteral nutrition using a low fat formula, such as Precision HN (Sandoz, 1.3 percent calories as fat), Criticare HN (Mead Johnson, 3 percent calories as fat) or Vivonex High Nitrogen (Norwich Eaton, 0.87 percent calories as fat), and 5, oral feedings should be low fat in composition and should be reinstituted using traditional clinical criteria, including the symptoms of the patient, physical examination and computed tomographic appearance of the pancreas (clinicians should bear in mind the well documented exocrine stimulatory effects of even low fat oral feeds and the risks of early refeeding). These general guidelines must be individualized to incorporate what is perhaps the most important clinical variable--the premorbid nutritional state of the patient.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Nutritional support for acute pancreatitis. 151 64

Significant differences exist in the prevalence of most gastroenterological emergencies in tropical compared with temperate countries. Both ethnic and environmental (often clearly defined geographically) factors are relevant. The major oesophageal lesions which can present acutely in tropical countries are varices and carcinoma; bleeding and obstruction are important sequelae. Peptic ulcer disease (and its complications), often associated (not necessarily causally) with Helicobacter pylori infection, has marked geographical variations in incidence. Emergencies involving the small intestine are dominated by severe dehydration, and its sequelae, resulting from secretory diarrhoea, most notably cholera. However, enteritis necroticans ('pig bel' disease), paralytic ileus (sometimes caused by antiperistaltic agents) and obstruction (secondary to luminal helminths, volvulus and intussusception) are other important problems, especially in infants and children. Enteric fever is occasionally complicated by perforation and haemorrhage; the former (which is notoriously difficult to manage) is accompanied by significant mortality. Ileocaecal tuberculosis is a major cause of right iliac fossa pathology--sometimes associated with malabsorption; amoeboma is an important clinical differential diagnosis. The colon can be involved in invasive Entamoeba histolytica infection (which, like complicated enteric fever, is difficult to manage if the fulminant form, with perforation, ensues), shigellosis, volvulus and intussusception. Acute colonic dilatation occasionally follows Salmonella sp., Shigella sp., Campylobacter jejuni, Yersinia enterocolitica and rarely E. histolytica infections. Acute hepatocellular failure is a major cause of morbidity and mortality in the tropics and subtropics. It usually results from viral hepatitis (HBV, sometimes complicated by HDV, and HCV), but there is a long list of differential diagnoses. Hepatotoxicity resulting from herbs, chemotherapeutic agents or alcohol also occurs not infrequently. Chronic liver disease and its sequelae (often long-term results of viral hepatitis) are commonplace. Haematemesis and hepatocellular failure are usually very difficult to manage due to a lack of sophisticated support techniques in developing countries. Invasive hepatic amoebiasis usually responds well to medical management; however, spontaneous perforation can occur and the consequences of this are serious. Pyogenic liver abscess, although far less common than amoebic 'abscess', carries a bad prognosis whatever the method(s) of management. Hydatidosis and schistosomiasis also involve the liver, and helminthiases are important in the context of biliary tract disease. Gall stones are unusual in most tropical settings. Acute pancreatitis is overall unusual, but chronic calcific pancreatitis can present as an acute abdominal emergency.
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PMID:Gastroenterological emergencies in the tropics. 176 26

Lesions of the colon are generally considered to be sequelae of pancreatitis. They include: localized paralytic ileus (colon cutoff sign), necrosis, fistulae, stenosis and varices. On the basis of an extensive review of the literature (332 cases), it is suggested that the real incidence of these lesions is significant. The anatomic relationship of the large bowel to the pancreas is an important factor in the genesis and localization of the lesions. Enzymatic-inflammatory and ischemic processes are involved in the most highly supported theories. Each complication shows different diagnostic and clinical patterns. In this paper, six cases of such lesions are presented, including 2 cases of necrosis, 2 of stenosis, 1 of fistula and 1 case of localized paralytic ileus.
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PMID:Colonic involvement in pancreatitis. Six cases more. 186 86

Splenectomy for massive splenomegaly and hypersplenism carries a significant morbidity and mortality. We have used partial splenic embolization (PSE) as an effective alternative to splenectomy. Ten PSE procedures were performed on nine patients without mortality and with minimal morbidity. The age of the patients ranged from 8 months to 32 years (mean 14 years). The causes of splenomegaly and hypersplenism included cystic fibrosis with cirrhosis (2), tyrosinemia and cirrhosis (1); thalassemia (1), hemophilia with Human Immune Deficiency Virus infection (2), chronic hepatitis with portal hypertension (1), malignant histiocytosis (1), and Wiskott-Aldrich Syndrome (1). All procedures were performed under local anesthesia with sedation. A percutaneous femoral artery approach to the splenic artery was used to deliver Ivalon sponge particles (280-800 microns) into the spleen. Splenic infarction was assessed by postembolization angiograms. All of the patients except one demonstrated improvement of hematologic parameters. In one patient, however, cytopenia improved only after a second embolization. In the total series, there was an early mean rise of 8,600/mm3 in the leukocyte count (range 2,900-14,900) and 212,000/mm3 in the platelet count (range 30,000-718,000). Follow-up ranged from 4 months to 7 years. Improvement of the blood picture has been persistent in seven of the eight patients who showed initial improvement. Transient procedural complications included fever (5), pleural effusion (2), pneumonia (1), and splenic abscess (1). One patient had paralytic ileus lasting for 10 days and one patient developed a streptococcal peritonitis 3 weeks after embolization. No patient developed pancreatitis or vascular compromise of other abdominal viscera.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Partial splenic embolization. An effective alternative to splenectomy for hypersplenism. 226 5

Chronic intestinal pseudo-obstruction is a rare disorder characterized by ineffective intestinal propulsion in the absence of mechanical factors. It depends on isolated or associated disturbances of intrinsic and extrinsic innervation of the smooth muscle, neurotransmitters and hormones. In children the most common causes are postoperative paralytic ileus, pneumonia or pancreatitis, occurring usually in the first year of life. There is also hereditary transmission, comprising the familial visceral myopathy (hollow visceral myopathy) and the familial visceral neuropathy. The pseudo-obstruction may be associated with congenital anomalies (digestive or not) in 10 to 30% of the cases, mainly malrotation, pyloric stenosis and bladder atony. Diagnostic difficulties may lead to exploratory laparotomy. A precise diagnosis requires judicious interpretation of radiologic, manometric, radioisotopic and hystologic findings. Medical treatment includes drugs acting on gastrointestinal motility as well as hydroelectric and nutritional support, besides treatment or prevention of infections. It is possible that in the future these patients may be treated by surgical implantation of electrodes promoting gastrointestinal myoelectrical stimulation.
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PMID:Diagnosis and management of chronic intestinal pseudo-obstruction syndromes in infancy and childhood. 307 60

Lesions of the colon are generally considered to be uncommon sequelae of pancreatitis. They include: localized paralytic ileus (colon cut-off sign), necrosis, fistulae, stenosis and varices. On the basis of an extensive review of the literature (432 cases), it is suggested indeed that the real incidence is significant. The anatomic relationship of the large bowel to the pancreas is an important factor in the genesis and localization of the lesions. Enzymatic-inflammatory and ischemic processes are involved in the most highly supported theories. Colon cut-off sign is almost always spontaneously reversible and may represent an "alarm" for more serious complications. Massive necrosis develops during the early stage of severe pancreatitis and its mortality rate has been reported to be high. Fistulae are late complications of the disease, associated with a protracted course and probably a consequence of pancreatic suppuration or pseudocysts. Stenoses are the most interesting colonic complications following pancreatitis and caused by either acute obstruction of the colon due to an inflammatory mass or progressive obstruction due to pericolic fibrosis. In this case, the clinical picture may mimic carcinoma.
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PMID:Colonic lesions in pancreatitis. 766 99

A rare case of painless pancreatitis caused by Leptospira is reported. The patient presented clinically with features of paralytic ileus and renal failure. Hyperamylasemia was persistent inspite of recovery of renal function. The patient recovered on treatment with penicillin and serum amylase returned to normal in three months.
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PMID:Painless pancreatitis: a rare manifestation of leptospirosis. 1256 22


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