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

The value of the amylase--creatinine clearance ratio (ACCR) in the diagnosis of postoperative pancreatitis was prospectively assessed. In 77 patients undergoing operations known to have a significant incidence of postoperative pancreatitis (gastric, biliary or pancreatic) i.e. "high risk" group, the ACCR was abnormally elevated postoperatively in 36 patients (47%). However, overt clinical pancreatitis occurred in only eight patients (10%). In 60 other patients undergoing nonabdominal operations (orthiipedic, head and neck, varicose vein surgery etc.) i.e. "low risk" group, the ACCR was abnormally elevated postoperatively in 23 patients (38%). No patient in this group developed clinical pancreatitis. We conclude, therefore, the ACCR is often abnormally elevated nonspecifically following any type of surgery, and cannot be used as evidence of postoperative pancreatitis. These data do suggest, however, that a normal ACCR, especially on successive daily determinations, might help to exclude the diagnosis of postoperative pancreatitis.
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PMID:Assessment of the amylase--creatinine clearance ratio in postoperative patients. 615 70

Acute pancreatitis is a clinical diagnosis. In most patients with uncomplicated acute pancreatitis, there is no need for radiologic confirmation or work-up. However, in some patients, the diagnosis may be in doubt, or associated abnormalities or complications of acute pancreatitis may be suspected by the patient's protracted course or severity of disease. In these patients, radiology can be extremely helpful. CT is the best single radiologic imaging modality to evaluate these patients. With modern scanners, there are no failures, and CT provides a complete view of the pancreas and peripancreatic tissues, despite overlying bowel gas or other anatomic features that may limit the sonographic evaluation. Sonography may be helpful in evaluating possible biliary complications of acute pancreatitis, in evaluating thin patients with a good sonic window to the pancreas, or in evaluating patients who have a clearly defined complication such as a large pseudocyst. Sonography is also helpful for serial studies following the size of the fluid collection. The complications of pancreatitis include fluid collections and pseudocysts, which may become infected or develop bleeding within them, vascular complications including occlusion of the splenic vein with secondary development of varices, pancreatic ascites, and pancreatic abscess. While these complications can be evaluated by various radiologic methods, they are most effectively evaluated by CT. However, for some cases in which the cause of a cystic mass is in doubt or for cases of suspected pancreatic abscess, radiologic studies may be unable to provide a definitive diagnosis. In these cases, percutaneous needle aspiration will assist in the diagnosis.
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PMID:Acute pancreatitis and its complications. Computed tomography and sonography. 635 18

The computed tomographic (CT) findings in 13 consecutive patients with proven gastric varices were analyzed and correlated with the radiographic, angiographic, and gastroscopic evaluations. In 11 patients, CT clearly identified large (five) or smaller (six) varices located mainly along the posteromedial wall of the gastric fundus and proximal body of the stomach. Well defined rounded or tubular densities that enhanced during intravenous administration of contrast material and could not be distinguished from the gastric wall were identified. Dense, enhancing, round or tubular, intraluminal filling defects were seen in the cases where the stomach was distended with water. In two patients, the CT diagnosis of gastric varices could not be confidently made. All patients had associated intraabdominal collateral circulation, situated medial to the stomach within the lesser omentum, along the distribution of the coronary venous system. In seven patients, the CT examination correctly diagnosed the pathogenesis of gastric varices by identifying hepatic cirrhosis, calcific pancreatitis, and carcinoma of the pancreas.
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PMID:Computed tomographic recognition of gastric varices. 660 94

Eleven of 16 patients with splenic vein thrombosis subsequent to pancreatitis had variceal hemorrhage. variceal development tends to occur in the stomach, although esophageal varices may also occur, and is a result of left-sided or segmental portal hypertension. The antecedent pancreatitis may be quite mild and produce minimal symptoms. Angiography is required to establish the diagnosis as endoscopic detection of gastric varices is difficult and unreliable. Splenectomy is the definitive treatment, although transgastric ligation of varices must be added if active bleeding is taking place.
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PMID:Gastrointestinal hemorrhage from left-sided portal hypertension. An unappreciated complication of pancreatitis. 697 1

In patients with pancreatitis and blood loss, bleeding from visceral artery aneurysms should be suspected, especially in cases complicated by pseudocyst or abscess formation. We report of a patient with a transverse pancreatic artery aneurysm which was successfully embolized. In addition, decompression of the gastric varices associated with isolated splenic vein occlusion was performed successfully by Gelfoam embolization of 80% of the spleen.
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PMID:Embolization of bleeding transverse pancreatic artery aneurysms. 708 60

Splenic vein thrombosis is a complication of pancreatic carcinoma or pancreatitis. It may lead to gastric varices which are difficult to treat and splenectomy may be required to stop variceal bleeding. A case of bleeding gastric varices secondary to splenic vein thrombosis and successfully treated by splenic artery embolization is reported. Embolization was performed by transcatheter deposition of four Gianturco coils into the splenic artery. This resulted in reduced blood flow through the spleen with partial splenic infarction and cessation of variceal bleeding. There has been no recurrence of bleeding in the 6 months since the procedure. Literature review confirms that experience of using this treatment is very limited and it should therefore be restricted to patients at high risk from surgery.
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PMID:Case report: bleeding gastric varices secondary to splenic vein thrombosis successfully treated by splenic artery embolization. 755 96

Endosonography was performed in 76 patients who had endoscopically detected gastroesophageal varices or questionable submucosal lesions, or who were being evaluated for pancreatic carcinoma or pancreatitis. The result were compared with surgery or autopsy results. The patients were divided retrospectively into four groups. Group 1 consisted of 6 patients who underwent surgery or autopsy. Five esophageal varices and 1 fundic varix were diagnosed with endosonography and confirmed histologically. Group 2 consisted of 29 patients undergoing sclerotherapy. Intramural thickening of the esophagus and extramural collaterals were found in 20 of 22 patients, respectively. Endoscopy revealed fibrosis in 10 patients. Group 3 consisted of 16 patients evaluated for pancreatic disease. Fifteen fundic varices, 6 cardiac varices, and 5 extramural collateral veins were found by EUS. Group 4 consisted of 16 patients with questionable submucosal lesions and 9 patients with lesions recognized endoscopically as varices. EUS found varices in all 25 patients. In conclusion, EUS is an important procedure in the diagnosis and follow-up of gastroesophageal varices, and in the identification of questionable abnormalities found endoscopically. The effect of sclerotherapy can be demonstrated as mural thickening with disappearance of submucosal varices.
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PMID:Endosonography of gastroesophageal varices: evaluation and follow-up of 76 cases. 759 50

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

Colonic varices are a rare finding, with variable clinical features. The authors describe the first case of colonic varices secondary to acute recurrent pancreatitis, and associated with colon cancer. There are about 70 reports of colonic varices; none of them is related to acute recurrent pancreatitis, whereas 52 are related to portal hypertension, and 9 are on a familial basis. Association with colon cancer is reported in one case, and seems to be occasional.
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PMID:[Colonic varices secondary to recurrent acute pancreatitis]. 816 18

In a five year review of 648 patients with chronic pancreatitis, 446 (68.8%) were documented with regional complications consisting of biliary, duodenal or colonic obstruction, pseudocysts, haemorrhage, pancreatic ascites and gastric varices. Although the majority could be treated conservatively, surgical intervention was needed in 129 patients (28.9%). The commonest operations were choledocho-duodenostomy for distal bile duct obstruction, gastro-enterostomy for duodenal obstruction, local resection for colon obstruction, cyst-gastrostomy for pseudocysts, duct-enteric anastomosis for pancreatic ascites and splenectomy for gastric varices. Operative mortality was 8.5% and morbidity 27.9%. During 1-5 year follow-up, re-admission for pancreatitis was needed in 24%. No secondary biliary cirrhosis was encountered in long standing bile duct obstruction, but fibrosis was present in 73% of liver biopsies. Cholangitis occurred in 14%. Angiographic embolisation was useful in the control of massive bleeding from peri-pancreatic visceral arteries. Although relief of pain in chronic pancreatitis has generally been disappointing, regional complications, occurring in the majority of patients, can be corrected satisfactorily by surgical intervention.
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PMID:Surgical intervention for regional complications of chronic pancreatitis. 817 59


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