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

Although cholecystectomy is routinely performed as a part of treatment for gallstone pancreatitis, detailed histopathologic features of the gallbladder have not been described. In this study, the pathologic findings of 53 gallbladders from patients with clinical and laboratory evidence of gallstone pancreatitis are described. The presence of intraepithelial neutrophilic aggregates, a histologic finding associated with common bile duct obstruction, was identified in 32 (60.4%) cholecystectomy specimens and was the most common pathologic findings. Changes of acute cholecystitis and chronic cholecystitis were found in 15 (28.3%) and 6 (11.3%) gallbladders, respectively. Fat necrosis, which is characteristically associated with acute pancreatitis, was the most specific histologic change, but it was seen in the adventitia of only four gallbladders. The similarities of pathologic findings in gallstone pancreatitis and common bile duct obstruction emphasize the role of choledocholithiasis in the pathogenesis of pancreatitis associated with cholelithiasis.
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PMID:Pathology of the gallbladder in gallstone pancreatitis. 772 28

Gallbladder stones remain asymptomatic over a long period. The biliary colic is the typical pain caused by these stones. Dyspeptic symptoms seem to be unrelated to the presence of gallstones. Acute cholecystitis, a serious complication of gallstone disease, spans a wide spectrum of clinical findings. The typical signs are right upper abdominal pain and tenderness, fever, leucocytosis and Murphy's sign. 35% of patients experience gallbladder empyema or perforation. Localized gallbladder perforation, characterized by high fever, severe right upper abdominal pain and tenderness and a palpable mass is often difficult to distinguish from acute cholecystitis. Free perforation into the abdominal cavity causes diffuse peritonitis. Gallbladder perforation into the lumen of an adjacent organ produces fistulas, mostly with minimal symptoms or a pain relief after decompression of the inflamed gallbladder. Air in the bile ducts and on some occasions bile-acid-induced diarrhea may result. Rarely, the perforation of large stones leads to an occlusion of the GI tract and results in a gallstone ileus. Common bile duct stones may be asymptomatic or cause bile duct obstruction with biliary colics and jaundice. Acute bacterial cholangitis characterized by Charcot's triad (pain, jaundice and fever) and the acute biliary pancreatitis with its typical symptoms are the serious complications of common bile duct stones, associated with a high mortality rate. The clinical manifestations of a gallstone disease and its complications reveal important diagnostic features, but the most important diagnostic features, modalities are the imaging procedures. They are decisive for an accurate therapy.
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PMID:[Clinical manifestations of cholelithiasis and its complications]. 776 32

The application of therapeutic ERCP and interventional radiology has significantly altered the treatment of biliary tract emergencies. Although surgery is the principal treatment for acute cholecystitis, nonoperative alternatives exist for high-risk patients. New, prospective, randomized trials have demonstrated that endoscopic management of severe cholangitis is superior to surgery, and that endoscopic sphincterotomy and stone extraction are superior to conservative treatment in severe gallstone pancreatitis. ERCP allows nonoperative management of postoperative bile leaks as well.
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PMID:Biliary tract emergencies. Endoscopic and medical management. 778 32

The article generalizes experience (1986-1991) in the treatment of 246 patients with choledocholithiasis with the performance of endoscopic papillosphincterotomy. Most patients (61%) were over 60 years of age, many had serious concomitant diseases. Among patients with occlusion of the bile ducts, 53.6% had obstructive purulent cholangitis, 53.6% had acute biliary pancreatitis, and 30.9% had acute cholecystitis. Typical as well as atypical cannulation EPST was applied. To exclude an X-ray load on the patient and doctor, the orifices of the terminal part of the common bile duct and of the main pancreatic duct were identified in most patients by an elaborated method of cannulation with aspiration control without preliminary contrast X-ray examination. After EPST the concrements were removed completely in 194 and partly in 52 patients. Complications occurred in 35 patients (bleeding in 5, acute pancreatitis in 8, acute cholangitis in 6, acute cholecystitis in 8, perforation of the duodenum in 1, and wedging of Dormia's basket in 8 patients. Eight patients died after EPST from unresolved purulent cholangitis and multiple cholangitic abscesses of the liver. The long-term results were studied in follow-up periods of 12 months to 7 years. Recurrent cholelithiasis was encountered in 2 patients. On the basis of the accumulated experience we believe EPST to be the method of choice in the management of: residual and recurrent choledocholithiasis, patients with cholecystocholedocholithiasis and operation risk factors, patients with acute biliary pancreatitis and acute obstructive cholangitis.
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PMID:[Endoscopic removal of calculi from the choledochus. Are there debatable questions in this problem?]. 789 39

Gastrointestinal complications after cardiopulmonary bypass (CPB) procedures are rare, but when they do occur, they carry a significant incidence of morbidity and mortality. Over a 5-year period spanning 1988-1992, 4923 CPB procedures were performed and 64 patients were identified who suffered a GI complication, giving an incidence of 1.3 per cent. The most frequent complications were GI bleeding (40%) and pancreatitis (34%). Other complications included acute cholecystitis (11%), perforated duodenal ulcer (8%), ischemic bowel (5%), and diverticulitis (2%). Complications occurred most frequently in patients undergoing procedures with longer pump and cross-clamp times, such as valvular and combination (CABG/valve) procedures. Redo procedures and the use of an intra-aortic balloon pump increased the risk of developing a GI complication 2.5 and 12 times, respectively. Patients were treated aggressively both medically and surgically, but suffered a higher mortality (16%) as compared to those not suffering a GI complication (3%). We conclude that GI complications after CPB procedures are infrequent but lethal. Clinical features are often subtle, and a high index of suspicion is needed for early diagnosis and aggressive treatment.
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PMID:Gastrointestinal complications associated with cardiopulmonary bypass procedures. 794 44

In the period between September 1988 and September 1992, 133 patients (34 males and 99 females; mean age 49 years [range 24-81]) underwent 299 extracorporeal shockwave lithotripsy sessions with adjuvant oral bile acid therapy. The mean number of extracorporeal shockwave lithotripsy sessions was 2.5 (1-7) and the mean number of shock waves 2,817 (75-4000), while the mean duration per session was 62 minutes (35-210). Ninety-eight patients (73.7%) required intravenous analog-sedation. At last follow-up (mean: 17.7 months [2-46]), 37 patients (27.8%) were free of stones and 30 (22.6%) had undergone cholecystectomy. At 1 year after the first session of extracorporeal shockwave lithotripsy, 51.0% of the patients with a solitary stone and 8.3% of the patients with 2-10 stones were free of concrements (p < 0.0001). Fourteen per cent [6/43] of the patients developed recurrent stones. Major complications comprised pancreatitis (n = 4; 3.0%) and acute cholecystitis (n = 1; 0.8%). Our results reconfirm that extracorporeal shockwave lithotripsy is safe and moderately effective in selected patients. Because of the wide acceptance of the laparoscopic cholecystectomy, extracorporeal shockwave lithotripsy should be restricted to patients at increased surgical risk and patients who refuse surgery. In view of the poor results in multiple stones, extracorporeal shockwave lithotripsy should be performed only on solitary stones.
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PMID:Gallstone lithotripsy: the Rotterdam experience. 795 49

Recent studies have indicated that solitary or multiple gallstones may differ with respect to the conditions favoring their formation, such as nucleation time. We examined the clinical, histological and laboratory characteristics of symptomatic gallstone disease in a series of 125 consecutive patients with either solitary (n = 33) or multiple (n = 92) cholesterol gallstones undergoing cholecystectomy. The nature of biliary pain was found to differ in the two groups. Histological diagnoses of acute cholecystitis and gallbladder cancer was more frequent in the patients with multiple stones, and cholesterolosis in those with solitary stones. Furthermore, the stone cholesterol content was higher in the solitary stone group than in the multiple stone group. Morbid complications such as cholangitis and pancreatitis were rare and occurred only in the multiple stone group. The results support the view that gallbladder disease presents histological evidence of biliary complications more often in patients with multiple cholesterol stones than in those with solitary stones.
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PMID:Characteristics of symptomatic gallbladder disease in patients with either solitary or multiple cholesterol gallstones. 795 50

Transient electrocardiographic changes in patients with acute cholecystitis, pancreatitis, and pneumonia have been reported in the past. These changes usually are in the form of T-wave inversion, ST-segment depression, and rarely ST-segment elevation in the absence of coronary artery disease. To the authors' knowledge, this is the first report documenting both left ventricular segmental wall motion abnormality and electrocardiographic changes of myocardial injury in the presence of acute pancreatitis.
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PMID:Electrocardiographic and segmental wall motion abnormalities in pancreatitis mimicking myocardial infarction. 772 Feb 88

The treatment of biliary lithiasis has changed during the past 20 years. Cholecystectomy remains the gold standard for cholelithiasis, but many options are available for calculi of the common bile duct. Among them are surgical open or laparoscopic choledochotomy, biliary-enteric anastomosis, transduodenal sphincterotomy (TDS), endoscopic sphincterotomy. With the aim to describe the current place of TDS, we reviewed the patients operated on in our department between 1976 and 1992. We found 78 patients with a mean age of 58 years (26-89 years). 34 (43%) of them had acute cholecystitis, with 26 being operated on urgently. 47 (60%) were jaundiced, 15 (19%) had pancreatitis and 12 (15%) had cholangitis before operation. Indications for TDS have been impacted stone or absence of progression of the contrast medium on intraoperative cholangiography in 71 patients (91%). 3 patients died (1 pulmonary embolism, 1 sepsis of pulmonary origin, 1 MOF syndrome complicating preoperative necrotizing pancreatitis). 30 patients (38%) had complications, of which 20 were directly related to TDS. Hemorrhage occurred in 4 cases, and resolved spontaneously without transfusion. Hyperamylasemia occurred in 17 instances, but clinical pancreatitis developed in only 1 case, with complete resolution. 1 duodenal fistula healed after conservative therapy. No death is attributable directly to TDS. Today, the importance of endoscopic sphincterotomy is increasing. This retrospective study shows that TDS, if performed with caution, does not increase the operative risks even in emergent operations. During surgical exploration of the common bile duct, TDS is indicated to remove an impacted stone, or as a bilio-enteric anastomosis if multiple stones are present with a thin common duct.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Current status of surgical transduodenal papillotomy]. 803 53

We reviewed 600 patients who underwent laparoscopic cholecystectomy (LC) in a teaching community hospital from May 1990 to August 1992. The safety, efficacy, morbidity, and mortality of LC, as performed by one surgeon or under his direct supervision, were studied. Five hundred forty-eight patients (91.3%) were treated electively; 52 (8.7%) were admitted for acute cholecystitis (41) or gallstone pancreatitis (11). Mean operating time was 54 min, with a range of 20 to 145 min. Twenty-four (4%) patients required conversion to traditional (open) cholecystectomy. Operative cholangiograms were completed in 106 patients. These revealed choledocholithiasis in 7. Five hundred thirty-seven patients (89.5%) were discharged within 24 h and 564 (94%) within 48 h. The overall morbidity of 9.2% compared favorably with both open and laparoscopic series previously reported. Three patients (0.5%) had small lacerations of the anterior wall of the common duct. Two were recognized and repaired immediately. The third patient came for treatment on the fifth postoperative day and was stented by a T-tube. There was 1 death in this group--a myocardial infarction on postoperative day 4.
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PMID:Laparoscopic cholecystectomy in a community hospital: experience with 600 laparoscopic cholecystectomies. 804 16


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