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

An experience with 68 patients with hemorrhagic pancreatitis identified at operation or autopsy is reported. Sixteen of the patients were subjected to operation, and 6 survived after celiotomy and peritoneal irrigation. There were no survivors in the unoperated group. Death when the pancreas is hemorrhagic and due to pancreatitis occurs an average of 10 days after the onset of symptoms or within 7 days of hospitalization. In eight patients who presented in coma, the diagnosis was not established before death. Early recognition of patients with hemorrhagic pancreatitis can be facilitated by the routine use of amylase and methemalbumin determinations and peritoneal lavage. Translocation of large volumes of albumin-rich fluid from the intravascular compartment to the retroperitoneum and pleural and abdominal cavities is in part responsible for many of the signs, symptoms, and complications of hemorrhagic pancreatitis. These include hemoconcentration, hypotension, tachycardia, tachypnea, ascites, abdominal distress, respiratory insufficiency, and renal failure. Adequate initial resuscitation and intensive follow-up are probably the most important elements in the management of patients with hemorrhagic pancreatitis. Careful monitoring of fluid and electrolytes and blood gases is required to avoid shock and renal and pulmonary failure. The need for careful monitoring is emphasized by the number of our patients in whom inadequacies of fluid replacement and ventilation were often not appreciated until the patient was in extremis from shock or respiratory or renal failure. Antibiotics are indicated in patients with biliary tract disease and penetrating ulcer in whom the risk of secondary infection is considerable. Associated diseases that initiated pancreatitis and that in themselves may be life-threatening, such as acute cholecystitis or cholangitis, should be promptly treated by operation. Diagnostic and therapeutic lavage are justified in the treatment of hemorrhagic pancreatitis. Resection of the necrotic pancreas should be considered when the patient fails to improve after lavage and nonoperative resuscitation.
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PMID:Hemorrhagic pancreatitis. 45 56

During a 12-month period from September 1976 to September 1977, 114 patients in a community hospital had ultrasonography as part of their diagnostic work-up for suspected gallbladder disease. While 65 per cent had an additional study, such as an oral cholecystogram or intravenous cholangiogram, 35 per cent had ultrasonography as the only study to make the diagnosis. All patients in this group had laparotomy and cholecystectomy to confirm or disprove the diagnosis of calculous gallbladder disease. The overall accuracy rate of ultrasonography for calculous gallbladder disease was 90 per cent, which compares favorably with the standard oral cholecystogram. Ultrasonography has some distinct advantages in certain clinical situations such as acute cholecystitis, jaundice, pancreatitis and pregnancy. A review of our clinical experience in the everyday use of ultrasonography for calculous biliary disease has been discussed, and guidelines for the use of ultrasonography as part of the diagnostic armamentarium for gallbladder disease are presented.
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PMID:The use of ultrasonography in the diagnosis of calculous gallbladder disease. 46 91

In some patients, gallstones are asymptomatic, lying dormant in the gallbladder or wedged in the cystic duct. In others, stones cause specific symptoms of gallbladder disease, such as biliary colic, acute cholecystitis, or cholangitis. Symptoms of flatulent dyspepsia are not markers of gallstone disease, since they occur equally in those with and without gallstones. Complications of gallstone disease include pancreatitis, biliary-enteric fistulas, hydrops, limy bile, porcelain gallsbladder, and carcinoma of the gallbladder. Cholecystectomy is indicated for symptomatic gallstones; for suspected stones in diabetics, who are at high risk should complications of gallstone disease occur; and in a few other limited situations. Prophylactic cholecystectomy for asymptomatic gallstones remains controversial.
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PMID:Manifestations of gallstone disease. 48 73

The use of ultrasound in the non-invasive investigation of the biliary tract and pancreas is discussed. Its accuracy in detecting gallstones in the non-acute condition is as accurate as conventional radiography, which is dependent on the excretion of contrast medium by the liver. Ultrasound is not dependent on liver function and has become the best initial investigation in persistent jaundice, acute cholecystitis, acute pancreatitis, and chronic pancreatic disease. In a retrospective study of 75 patients with acute pancreatitis liver function tests were found to be abnormal in 67% and contrast radiography proved to be of limited value. Ultrasonography performed shortly after admission showed an overall accuracy of 82% correct findings. The identification of gallstones in pancreatitis and cholecystitis permits early surgery, which reduces morbidity, improves prognosis, and is now being accepted as the treatment of choice.
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PMID:The clinical value of ultrasound in biliary tract and pancreatic disease. 49 36

The authors used paranephric, vagosympathetic and vagoganglionic blockade in 253 patients with acute cholecystitis, cholecystopancreatitis and pancreatitis. The universally adopted methods were used for the estimation of the results with the recording of electrogastrogram before the blockade, immediately after novocaine injection and on hour later. The arrest or subsiding of pain syndrome occurred after paranephric blockade in 78.8% of patients, after vagosympathetic blockade in 95.2% and after vagoganglionic blockade in 92.6%. 20 patients were operated upon.
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PMID:[Novocaine blocks in the overall treatment of acute cholecystitis, cholecystopancreatitis and pancreatitis]. 52 80

The authors illustrate the diagnostic possibilities of echography in the evaluation of the nontraumatic abdominal emergencies. They first refer about the methods of investigation and the scanning techniques. Then they illustrate the value of echography in the evaluation of the acute cholecystitis and pancreatitis pointing out the sensitivity of this procedure to the detection of the spread of the infections to the peritoneum and to the retroperitoneal spaces. The authors also present the echographic findings in the acute pathology of the retroperitoneum and of the female pelvic organs. Finally they emphasize the diagnostic value of ultrasounds in the search of the abdominal causes of the acute anemia and of the fever of unknown origin and as a preliminary investigation in case of actue renal failure.
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PMID:[Echographic evaluation of nontraumatic abdominal emergencies (author's transl)]. 55 87

The diagnostic yields of intravenous cholangiography (IVC) and 99mTc-diethyl-IDA cholescintigraphy (CS) were compared in 50 patients; 19 had acute cholecystitis, 5 pancreatitis, 4 obstructive disease of the common bile duct, 5 chronic gallbladder disease, 6 parenchymal liver disease and 11 had other intra-abdominal diseases. The comparison of IVC and CS covered three aspects: the definition of the biliary tract structures, their morphologic changes and an assessment of bile flow through the cystic duct and the common bile duct. The definition of the main intrahepatic bile ducts was better with IVC; that of the common bile duct and the gallbladder was better with CS. Morphologic details such as calculi or local changes in duct calibre were detected only in IVC. Measurements of common bile duct calibre obtained from operative cholangiograms correlated better with those from the IVCs than with those from the CSs. CS was more sensitive in the diagnosis of cystic duct obstruction. Bile flow in the common bile duct was estimated in the cases where the gallbladder did not fill. Delayed emptying of the common bile duct was revealed in IVC in 1 and in CS in 3 out of 6 cases with disturbed bile flow. The morphologic findings in IVC gave indication of the obstructive condition in the 1 case with retarded flow and in 2 additional cases. CS provided functional information for which the concentration of the tracer was sufficient except in one case. IVC provided morphologic and functional information, but the excretion of the contrast medium was insufficient for a morphologic assessment of the common bile duct in 16 cases and for a functional assessment in 11 cases.
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PMID:Intravenous cholangiography and cholescintigraphy in the diagnosis of hepatobiliary disease. 73 87

The authors consider the urgent surgery for acute cholecystitis complicated with pancreatitis and with marked bile and pancreatic hypertension to be indicated. In their opinion, the best method of eliminating the cause of duct hypertension in the bile and pancreatic duct system is the transduodenal dissection of the papilla followed with papillocholedochoplasty combined in some patients with plasty of the Wirsung's duct. A separate drainage of the common bile duct and main pancreatic duct according to the Doubilet's method was used. Cholecystectomy was carried out upon all the patients. On patient died of progressive pancreonecrosis.
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PMID:[Transduodenal transpapillar operations in acute cholecystitis complicated by pancreatitis]. 74 66

A retrospective analysis has been made of 89 patients, who were treated for acute pancreatitis and later underwent cholecystectomy. The object was to elucidate whether cholecystectomy can be performed soon after recovery from the pancreatitis ('early operation') or must be postponed a few months ('elective operation'). While waiting for operation a quarter of the patients in the elective group had a recurrent attack of pancreatitis or acute cholecystitis. A further quarter of the patients had slight symptoms. The postoperative complications were few, their frequency being comparable in both groups. No damage resulted to the common bile duct, there was no postoperative bleeding and only one case of postoperative pancreatitis in the group of patients operated early. It is concluded that 'early operation' is to be preferred provided a firm diagnosis of gallstone disease has been made. However, the oral cholecystogram is unreliable during the first three weeks after the attack of pancreatitis. If an oral cholecystogram is performed during these weeks and shows nonvisualization of the gallbladder but no stones, a repeated examination must be performed.
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PMID:The timing of cholecystectomy in patients with gallstone pancreatitis. A retrospective analysis of 89 patients. 74 68

The high incidence of calculous biliary tract disease accounts for surgical operation upon the biliary tract disease accounts for surgical operation upon the biliary tract being the most frequently performed within the abdomen. Untreated surgically critical sequelae tend to occur with advancing age and duration of the disease. The more common of these are: acute cholecystitis, choledocholithiasis, acute obstructive suppurative cholangitis, biliary enteric fistulas, liver abscess, related pancreatitis, and biliary cirrhosis. The greater the pathological changes in the biliary tract and the more debilitated the individual, the greater is the risk of surgery. However, the risk is even greater without operation.
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PMID:Critical sequelae in biliary tract disease. 78 79


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