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

Total parenteral nutrition (TPN) is a relatively new innovation in patient care which allows us to replace and maintain essential nutrients in patients in whom oral or tube feedings are contraindicated or inadequate. Insertion of a catheter into a large central vein permits one to concentrate hypertonic dextrose calories in normal daily fluid requirements. In addition, TPN solutions contain synthetic amino acids or protein hydrolysates, macroelements, electrolytes, and vitamins. Indications for TPN include intestinal fistulas, severe short bowel syndrome, unresolving pancreatitis, advanced inflammatory bowel disease, delayed postoperative gastrointestinal function, developmental anomalies of the intestinal tract, protracted diarrhea of infancy, and hypermetabolic states. Complications encountered in patients receiving TPN are catheter-related mechanical problems, infections, and metabolic abnormalities. In select patients, who otherwise would require repeated hospitalizations for malnutrition, encouraging results have been achieved by the use of TPN in the home.
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PMID:Total parenteral nutrition. 81 25

An increased incidence of gallbladder disease is seen in patients receiving long-term parenteral nutrition (PN). Stasis is thought to play a key role in the development of gallbladder sludge and gallstone formation. The highest incidence of gallbladder disease, by previous reports, is seen in patients with terminal ileal disease or resection. Since PN-dependent patients with severe short bowel syndrome secondary to mesenteric vascular accident have both gallbladder stasis and massive small bowel resection, a retrospective study was undertaken to evaluate the incidence of symptomatic gallbladder disease in this group. Of 11 patients followed over 9 years, five met the inclusion criteria of less than 60 cm of bowel remaining, receiving PN for longer than 6 months and the initial presence of a gallbladder. All five patients developed symptomatic gallbladder disease manifested by cholecystitis or pancreatitis. Factors contributing to gallbladder stasis included poor oral intake and use of anticholinergic and analgesic drugs. Gastric hypersecretion indirectly contributed to decreased oral intake as a means to minimize stool output. As these patients often require several laparotomies during the initial hospitalization, consideration should be given to performing prophylactic cholecystectomy, especially when the potential mortality and morbidity of emergent cholecystectomy done for symptomatic gallbladder disease is taken into account.
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PMID:Gallstone disease in patients with severe short bowel syndrome dependent on parenteral nutrition. 251 85

Somatostatin is a naturally occurring peptide with a wide spectrum of biologic actions, most of which are inhibitory in nature. It has wide distribution, and within the gastrointestinal tract is is found in the pancreas, the stomach, intestinal mucosa, and myenteric neurons. It appears to function as a classic circulating hormone, as well as both a paracrine or locally acting agent and a neurocrine agent. Because of its inhibitory actions on gut endocrine, secretory, and motor functions, it has potential applicability in the treatment of a variety of disorders of interest to the surgeon. Indeed, it has been used successfully in the management of upper gastrointestinal hemorrhage, secretory diarrhea, short bowel syndrome, pancreatitis, gastrointestinal fistulas, and peptide-secreting tumors of the gut (apudomas). This review discusses physiology, pathophysiology, and therapeutic applications of somatostatin that may be important in surgical practice.
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PMID:The use of somatostatin and its analogs in the treatment of surgical disorders. 287 18

During the past decade, 246 infants and children treated at the Columbus Children's Hospital have required more than 4 weeks of parenteral nutrition (PN). Of the 178 survivors, 70 returned for evaluation. Sixty-eight either had adequate visualization of the gallbladder by ultrasound or had previous gallbladder surgery (39%). Of 68 children who did not survive, complete postmortem examinations or ultrasound studies were available for 16 (24%). A diagnosis of cholelithiasis was established in 11 of the 84 studied patients (13%). Six of these children (55%) have required cholecystectomy for relief of chronic abdominal pain, pancreatitis, or empyema of the gallbladder. One additional infant underwent cholecystostomy. Two of the four remaining patients are asymptomatic, one has episodes of abdominal colic, and one child expired of chronic hepatic insufficiency as a result of PN-associated cholestasis. Risk factors that predisposed these children to cholelithiasis included short bowel syndrome, lack of an ileocecal valve, and an increased number of abdominal operative procedures (P less than .05). Patients with biliary calculi also had a longer duration of parenteral feeding, and a higher incidence of both PN-associated cholestasis and necrotizing enterocolitis. The intergroup differences for these characteristics, however, did not achieve statistical significance. On the basis of this information, routine ultrasound examinations of the gallbladder are recommended for children maintained on PN for longer than 30 days. All patients presenting with abdominal pain who previously received PN should also be evaluated. Early elective cholecystectomy is suggested for children who develop PN-associated cholelithiasis.
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PMID:Parenteral nutrition with associated cholelithiasis: another iatrogenic disease of infants and children. 311 62

Preliminary experience with elemental diet therapy in 30 patients is presented. Positive nitrogen balance and nutritional recovery can be achieved in patients with fistulas, inflammatory bowel disease and pancreatitis, and after extensive resection of the small bowel (short gut syndrome). The mode of administration and rare complications are described.
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PMID:Clinical uses of an elemental diet: preliminary studies. 504 34

Between 1980 and 1993, 18 patients underwent formal laparotomy after laparostomy and healing of the peritoneal cavity by granulation. The majority (12 patients) were men and the median age was 47 (range 22-67) years. Intraabdominal infection following surgery for Crohn's disease (four patients) and necrotizing pancreatitis (six) was the most common primary condition requiring laparostomy. A total of 23 reconstructive operations were carried out on the 18 patients a median of 6 (range 1-18) months after laparostomy. The indication for surgery was for closure and/or resection of an enteric fistula in 13 patients. The site of the fistula included three gastric, two duodenal, 11 small bowel and seven colonic. A further four patients required operation for closure or refashioning of a stoma. Five patients subsequently required a second laparotomy: two for elective restoration of bowel continuity, two for recurrent fistula and one for an acute abdomen. After reconstructive surgery following laparostomy 16 patients were discharged home alive and well, one requiring home parenteral nutrition for short bowel syndrome. In contrast, the two oldest patients in the series died from multiple organ failure immediately after initial reconstructive surgery. Both had pre-existing medical problems and in neither was there evidence of further intra-abdominal infection after reconstruction.
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PMID:Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection. 782 Apr 76

Possible new indications for the use of octreotide are discussed. In October 1988, octreotide received FDA-approved labeling for use in the management of carcinoid syndrome and vipomas. Since that time, research results and clinical experience have accumulated that suggest a potentially much broader therapeutic role for octreotide. Reports continue to be published on the use of octreotide for treating pituitary tumors, gastroenteropancreatic tumors, diabetes mellitus, AIDS-associated diarrhea, autonomic neuropathy, pancreatitis, pancreatic pseudocysts and ascites, complications of pancreatic surgery and transplantation, ileostomy-associated diarrhea, enterocutaneous fistulas, pancreatic fistulas, dumping syndrome, short bowel syndrome, and gastrointestinal bleeding. Other emerging indications for the use of octreotide include psoriasis, hypercalcemia, cancer-related pain, polycystic ovary syndrome, and certain cancers. In children, octreotide has been studied for use in treating hyperinsulinemic hypoglycemia of infancy. Along with the common adverse effects of octreotide, such as pain at the injection site and nausea, less frequent effects, such as cholelithiasis, gallbladder hypercontractility, and gastritis have now been described. Much of what has been learned is based on small uncontrolled studies and case reports, since the rarity of many of the conditions for which octreotide has shown promise has tended to preclude larger studies. As clinical experience with octreotide accumulates and better-designed trials are completed where possible, a broader therapeutic role for octreotide is likely to be recognized.
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PMID:Emerging indications for octreotide therapy, Part 1. 804 37

The aim of this study was to evaluate pancreatic function in total parenteral nutrition (TPN)-dependent children with permanent intestinal failure by measuring immunoreactive trypsinogen (IRT) levels. Between 1992 and 1996, 105 pediatric patients with permanent intestinal failure were referred to the Children's Hospital of Pittsburgh for small intestinal transplant evaluation. Serum samples were available from 55 of them. Ten suffered from intestinal pseudo-obstruction or microvillus inclusion disease, while 45 had short bowel syndrome (SBS). IRT levels were significantly higher (p < 0.001) in SBS patients (89.4 +/- 9.2 ng mL) compared to controls (43.4 +/- 5.6 ng/ nL) without liver, gastrointestinal, or kidney disease. IRT levels did not correlate with liver injury, length of bowel, or the cause of SBS. Five of 20 patients who underwent intestinal transplantation developed pancreatitis during a median post-operative follow up 15.4 months later. IRT levels failed to predict who would develop pancreatitis post-transplant. The data suggest that elevated plasma IRT levels are common among children with intestinal failure, but fail to identify patients at risk for pancreatitis post-transplant.
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PMID:Immunoreactive trypsinogen levels in pediatric patients with intestinal failure awaiting intestinal transplantation. 1051 20

Data regarding the use of both parenteral and enteral specialized nutritional support (SNS) are available for a variety of common clinical scenarios. Herein, the data are reviewed for SNS in the context of critical illness, perioperative care, wasting syndromes (including HIV disease and cancer), and gastrointestinal disease (including short bowel syndrome, inflammatory bowel disease, and pancreatitis).
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PMID:Evidence base for specialized nutrition support. 1106 Sep 99

Aneurysms of the superior mesenteric artery (SMA) are an uncommon but lethal entity, which must be treated expeditiously to avoid mortality and high incidence of ischemic small bowel complications. In the past 7 years the authors have treated 4 patients with a variety of types of aneurysms involving the SMA and its branches at a university-based teaching hospital. The first was a mycotic SMA aneurysm as a result of septic mitral valve, the second a jejunal aneurysm in a patient with pancreatitis, the third a spontaneous dissection distal to a small SMA aneurysm with thrombus partially occluding the distal vessel, and the fourth an SMA aneurysm associated with the diagnosis of mesenteric insufficiency. All patients presented with abdominal pain. The diagnosis was made initially in 1 patient on plain abdominal films with a calcified aneurysm, on duplex scan in the second, and on computed tomography (CT) scans in the remaining 2. Treatment consisted of bowel resection and ligation of mycotic aneurysm in the first patient, of catheter embolization of jejunal aneurysm in the patient with pancreatitis, and of vein graft bypass in the patient with a large SMA aneurysm. The patient with SMA aneurysm and distal dissection with partially occluding thrombus received anticoagulation and is being followed up with serial CT scans. There were no deaths. One patient required bowel resection, which did not result in short gut syndrome. Improved abdominal duplex scanning and CT technology facilitates the diagnosis of mesenteric aneurysm. The broad spectrum of etiologies mandates that treatment be tailored to the individual patient, and it varies from endovascular techniques to traditional bypass surgery. Prompt diagnosis and treatment results in the lowest mortality rate and minimizes the prevalence of intestinal infarction.
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PMID:Diagnosis and management of aneurysms involving the superior mesenteric artery and its branches--a report of four cases. 1257 40


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