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

The authors report 3 cases and report the diagnostic usefulness of two signs of minor cholestasis described by one of them in 1966. A relative increase, in the absence of obvious virus hepatitis or cirrhosis, of the serum bilirubin, cholesterol, lipids and alkaline phosphatase, together with B.S.P. excretion. suggest minor cholestasis. The sign of "metacritical aggravation" when there is some suspicion of minor cholestasis, the supervision of the course of the disease, or a retrospective inquiry, permit, in the presence of minor symptoms, such as, pain, fever, jaundice, or pruritus, one to make the diagnosis of minor cholestasis. The latter is due either to the presence of small gall stones in the common bile duct, or to inflammation of the ampulla of Vater, or sphincter of Oddi, a Vaterian ampulloma, pancreatitis, or following damage to the common bile duct. In practice, liver biopsy confirms the diagnosis, and intravenous cholangiography, by the perfusion method, is usually able to demonstrate obstruction of the common bile duct.
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PMID:[Relative increase and metacritic aggravation in the diagnosis of anicteric cholestasis]. 16 83

The presentation, nonradiologic diagnostic evaluation, and course (including complications and outcome) of gastrointestinal disorders in pregnancy are not substantially different than for the nonpregnant patient. The possible exception is the higher mortality for pancreatitis when it occurs during pregnancy. With the exception of nausea/vomiting and hyperemesis gravidarum, there does not appear to be a gastrointestinal tract disorder that is peculiar to the pregnant state. Hepatic disorders are somewhat different in that the excretory defect-pruritus gravidarum-cholestatic jaundice spectrum and perhaps part of what presents as acute hepatic failure are intimately associated with pregnancy and have an onset and course that are tied to the gestational period. Otherwise, hepatic diseases that occur during pregnancy share the characteristic of gastrointestinal diseases, that their manifestations are not clearly different from the nonpregnant state. As is true for the diagnostic approach to all medical diseases that occur during pregnancy, radiographic procedures are prohibited. Furthermore, therapy must be reconsidered with concern for its effect on the fetus. This leads to elimination of many or all measures used for purely symptomatic or nonspecific benefit. If no harm or potential harm will accrue for the fetus, therapy for hepatic and gastrointestinal disorders preceeds in pregnancy very much as it does in the nongravid individual.
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PMID:Hepatic and gastrointestinal disorders in pregnancy. 31 10

Seven primary carcinomas of the duodenum were observed from 1973 to 1976 at the University Hospital Hamburg; four in females and three in males with an age between 32 and 69 years of age. The interval between the first symptoms (epigastric pain, jaundice, pruritus, diarrhea, and loss of weight) and surgical therapy (duodeno-pancreatectomy) averaged four months. All carcinomas were resected radically from the macroscopic (intraoperative) aspect as well as from the histological findings. Local tumour recurrences which proved fatal occurred in five patients within nine to twenty-one months. One patient died of peritonitis and another of pancreatitis. The diagnostic mode has been changed since the introduction of endoscopy and retrograde cholangio-pancreaticography (ERCP). The consistent inclusion of the duodenum in routine gastroscopy leads to the hope that more carcinomas of the duodenum can be detected early.
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PMID:[Duodenal cancer. A clinical-pathological study]. 65 97

Extrahepatic biliary obstruction due to mechanical obstruction of the common bile duct is a relatively rare complication of pancreatic pseudocyst. When jaundice does occur, clinical or laboratory evidence of associated primary hepatobiliary disease or acute pancreatitis has invariably been present. The patient described had a 3-month history of painless juandice, 40-lb weight loss, pruritus, and hepatomegaly, but no clinical or biochemical evidence of acute or chronic pancreatitis. After initial evaluation, including an abdominal echogram and a transhepatic cholangiogram, carcinoma of the head of the pancreas was diagnosed preoperatively. At laparotomy, a small pancreatic pseudocyst obstructed the terminal portion of the common bile duct. This case illustrates that a pancreatic pseudocyst should be considered in the differential diagnosis of obstructive jaundice, even in the absence of clinical evidence of pancreatitis or pseudocyst formation.
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PMID:Silent pancreatic pseudocyst. An unusual cause of extrahepatic biliary obstruction. 113 Mar 80

The clinical, biochemical and radiological data of 25 patients with carcinoma of the head of the pancreas were compared with the same parameters of 25 patients with chronic pancreatitis producing cholestasis. History of alcohol abuse, pruritus and palpable gallbladder were the only clinical findings useful for the differential diagnosis. Plasma bilirubin levels were significantly higher in patients with malignancy (20.0 +/- 14.3 vs 2.5 +/- 2.4) but the course of the bilirubinemia was similar in the two groups after hospital admission. Preoperative ultrasound and cholangiography were usefull in differentiating both groups of patients. Sensibility of a point score based on significant differences was 100% for pancreatitis and 96% for malignancy.
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PMID:[Differential diagnosis of cholestasis in pancreatic cancer and chronic pancreatitis]. 166 25

Over the period of two weeks a 19-year-old man developed gradually increasing painless jaundice with dark urine and light-coloured soft stools (6-7 times daily), as well as loss of appetite, nausea and nagging itch. Biochemical tests indicated marked cholestasis (alkaline phosphatase 800 U/l, gamma-GT 206 U/l). Abdominal ultrasound examination revealed high-grade stenosis of the distal choledochal duct caused by an enlargement of the head of the pancreas and computed tomography confirmed a tumour in this location. Endoscopic retrograde cholangiopancreatography demonstrated filiform stenosis of the major pancreatic duct and prepapillary stenosis of the choledochal duct. Several needle biopsies failed to establish a definitive diagnosis. A Whipple operation was performed: the stomach was preserved but about 40% of pancreatic tissue resected. Histologically there was chronic suppurative pancreatitis of the head of the pancreas. The patient was symptom-free 6 months after the operation. The case illustrates that it is not always possible in a painless pancreatic tumour to distinguish between pancreatitis and malignant tumour.
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PMID:[Chronic purulent, draining, indolent pancreatic head pancreatitis with extrahepatic cholestasis]. 193 34

We reported two cases of acute recurrent pancreatitis lasting for 8 and 10 years, respectively, and characterized by acute abdominal pain associated with an increased serum level of pancreatic enzymes and in one case transient enlargement of the pancreas on sonography and CT scan. Exocrine and endocrine pancreatic function remained normal. Pain attacks were associated with headache or typical migraine, myalgia, pruritus, and diarrhea. In one case only, the IgE serum level was increased. In both cases, the symptoms were reproduced in the 2 h following the consumption of some particular food and cured for years by the suppression of this food and the use of cromoglycate, but recurred 1 month to 3 years after this treatment was stopped, to be again healed by the same treatment. We suggest that these cases are due to food allergy and that food allergy could be a rare cause of acute recurrent pancreatitis. Responsible foods were beef (twice), milk, potato, fish, and eggs, which is in agreement with the frequency of food allergens in southwestern Europe.
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PMID:Is food allergy a cause of acute pancreatitis? 210 39

Cholestatic syndromes present symptomatically with pruritus and biochemically either with elevated levels of serum bile acid as an early manifestation of hepatocellular disease or with elevated levels of serum alkaline phosphatase if the disease originates in the biliary tree. Slow progression to cirrhosis occurs, with recurrent cholangitis and/or pancreatitis as the major problems if the obstruction is in the larger duct system. Maintenance of nutrition and relief of pruritus are important supportive measures. Colchicine and ursodeoxycholic acid administered orally have been proposed as useful therapies for delaying the progression to cirrhosis. Liver transplantation has proven successful in those patients in whom spontaneous remission does not occur.
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PMID:Cholestatic liver disease and its management. 265 62

Although choledochal cyst is generally considered a disorder of childhood, in approximately 20% of patients a cyst is first recognized in adult life. We reviewed nine adults who underwent operation for choledochal cyst from 1974-1985 at Yale New Haven Hospital. Presenting symptoms included: crampy right upper quadrant pain, jaundice, pruritus, cholangitis, pancreatitis, hepatomegaly, and elevated liver function tests. Seven patients had undergone previous biliary surgery. The eight patients with type I cysts underwent complete excision of the cysts with Roux-Y choledochojejunostomy. One patient with a type IVa cyst underwent Roux-Y cystjejunostomy. All patients had complete resolution of biliary symptoms. There were no deaths, serious complications, or development of biliary malignancy in the 6 months to 13 years of follow-up. Optimum treatment of choledochal cyst is complete excision with reconstruction by Roux-Y choledochojejunostomy.
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PMID:Choledochal cysts in the adult. 298 Jul 68

The papilla of Vater, diminutive as it may be, forms the nidus for a variety of clinical disorders. Owing to its crucial location at the confluence of the bile and pancreatic ducts, many of these clinical disorders lead to an impedance to the flow of secretions from the liver and pancreas. Thus, most symptomatic papillary disorders present with a rather predictable and monotonous conglomeration of symptoms. The common clinical presentations of papillary disorders include abdominal pain, jaundice, fever, pruritus and pancreatitis. Rarely, gastrointestinal bleeding leading to anaemia and weight loss may also be observed. The advent of ERCP rekindled interest in diseases of the papilla. The major duodenal papilla is more accessible now than ever before. The endoscopist can visualize the papilla within minutes and take an appropriate tissue sample using different biopsy techniques. Definitive diagnosis is thus possible in most patients with papillary tumours. Along with ERCP, the miniaturization of a perfusion system with minimal compliance enabled us to accurately evaluate sphincter of Oddi (SO) dynamics. This in turn gave us a wealth of information on the physiology of the sphincter of Oddi. In addition, ERCP manometry led to a resurgence of interest in SO dysfunction, especially papillary stenosis. Several characteristic manometric abnormalities have been identified recently. Finally, the introduction of endoscopic sphincterotomy (ES), nearly a decade ago, opened a new chapter in the therapeutic approach towards papillary disorders. While the technique was initially applied in the management of common bile duct stones in postcholecystectomy patients who were high operative risks, the indications for ES steadily increased during the past decade. Experience over the years led us to be convinced that ES is equally effective in the management of a variety of papillary disorders, including choledochoduodenal fistula, choledochocele, papillary tumours and SO dysfunction. Most recently, other ancillary procedures such as endoprosthesis insertion have emerged as yet another useful therapeutic modality. Such internal biliary stents have been shown to be suitable in establishing biliary drainage in ampullary neoplasms when the operative approach is considered risky.
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PMID:Diagnosis and treatment of diseases of the papilla. 373 20


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