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

The group of conditions variously termed biliary dyskinesia, acalculous cholecystitis, biliary pain without stones, or functional disorders of the biliary tract, is poorly defined clinically, and no consistent pathological abnormalities have been previously described in patients with this diagnosis. In this paper we report histological abnormalities encountered in operative live biopsies in such patients. The criteria for the diagnosis of a functional biliary tract disorders were: pain typical of biliary pain, negative results of investigations for organic biliary tract or other gastrointestinal disease, and reproduction of the patient's symptoms by cholecystokinin, or morphine, or both. Twenty of 45 patients with a presumptive diagnosis satisfied these criteria, and had a wedge liver biopsy at the time of operation. The 20 liver biopsy specimens were compared in a blind fashion with similar ones taken from patients having diagnostic laparotomies; patients with stones confined to the gallbladder; patients with gallstone pancreatitis; and patients with proven common bile duct stones. The biopsy findings were found to be similar to those in the latter two groups. Thus the abnormalities were similar to those found in partial or intermittent biliary obstruction, and it is suggested that they may be due to intermittent increases in biliary pressure.
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PMID:Operative liver biopsy abnormalities in patients with functional disorders of the biliary tract. 28 96

On the Surgery Department of Military Hospital in Zagreb 164 cases of acute pancreatitis, among them 88 male and 76 female, were treated during the period of 1963 to 1974. Diagnosis was based on anamnesis, clinical symptoms, laboratory tests as well as X-ray pictures of the lungs and abdomen. In most cases (72,5 percent) etiology of the disease has shown changes of biliary tract; obesity and alchoholism were also present in high percentage. Operative treatment was applied in 72 cases and 92 cases have undergone conservative treatment. Indications for surgical intervention were lithiasis, cholecystitis, inefficiency of conservative therapy during the first 12 hours and such cases in which diagnosis could not have been given with sufficient certainty. Along with usual surgical treatment in 23 cases in which biliary obstruction and serose pancreatitis were present choledochoduodenostomy was applied with satisfactory results. 28 patients died out of 164; mortality percentage 17,1.
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PMID:[Acute pancreatitis in our case reports]. 30 Sep 74

Elevated circulating CEA levels occur in patients with benign gastrointestinal and hepatic disorders. These are usually less than 10 ng/ml. Of clinical importance is the influence of liver disease on the interpretation of CEA. At least 50% of patients with severe benign hepatic disease have elevated CEA levels, most often active alcoholic cirrhosis, and also chronic active and viral hepatitis, and cryptogenic and biliary cirrhosis. Patients with benign extrahepatic biliary obstruction may have increased plasma CEA, the highest in patients with co-existent cholangitis and especially liver abscess. The liver appears to be essential for the metabolism and/or excretion of CEA. Hence, liver work-up is needed to assess any patient with an elevated CEA. A damaged liver may further augment elevated CEA levels due to cancer. The increased circulating CEA observed in some patients with active ulcerative colitis tends to correlate with severity and extent of disease and usually returns to normal with remission. CEA levels also may be mildly elevated in patients with pancreatitis and in adults with colonic polyps. Smoking may contribute to the increased CEA levels seen in patients with alcoholic liver disease and pancreatitis. Therefore, in interpreting mildy elevated circulating CEA levels in patients with GI tract diseases, one must consider benign as well as malignant etiologies.
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PMID:Carcinoembryonic antigen (CEA) levels in benign gastrointestinal disease states. 36 Dec

The clinical, biochemical and radiological findings in 16 patients with carcinoma of the head of the pancreas were compared with that of 13 with cholestatic jaundice due to chronic pancreatitis. Patients presenting with malignancy had more severe hyperbilirubinemia (18.5 +/- 2.1 vs 5.6 +/- 1.6 p to ten days of hospital admission was the single most accurate test distinguishing carcinoma from pancreatitis. The mean bilirubin rose in carcinoma but fell in pancreatitis (mean net change 15.1 +/- 2.9 vs 3.9 +/- 0.6, p less than 0.001). Calcification in the pancreatic region was identified on a flat plate of the abdomen in 8/13 with pancreatitis but 0/16 with malignancy. Preoperative percutaneous transhepatic cholangiography was helpful in defining the site of biliary obstruction but the radiologist was unable to clearly predict the definitive diagnosis in five of the 29 patients. A point score based upon the major significant differences noted, predicted the presence or absence of malignancy in all patients (16/16 vs 0/13, p less than 0.01).
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PMID:Mass in the head of the pancreas in cholestatic jaundice: carcinoma or pancreatitis? 50 68

This is a report of our experience with 13 patients who had a distal common duct stricture associated with chronic relapsing pancreatitis. All patients, when first seen, had an elevated alkaline phosphatase level; eight of 13 patients also had an elevated serum bilirubin level. Five of the jaundiced patients had a febrile course; a preoperative diagnosis of acute cholangitis was made in four of these. Eight of the 13 patients have had a choledochoduodenostomy for relief of biliary obstruction; seven of these patients are living and well; one died of continued alcoholism and pancreatitis. One patient had a loop cholecystojejunostomy; decompression was inadequate and death due to septicemia secondary to ascending cholangitis ensued. Four patients have not yet had an operation. Two are symptomatic, but elective operation has been refused. Two have been lost to follow-up. We recommend investigation of the biliary tract in patients known to have chronic relapsing pancreatitis who also have persisting abdominal symptoms and an elevated alkaline phosphatase. If a stricture of the distal common bile duct is identified in the absence of acute pancreatitis, choledochoduodenostomy should be performed.
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PMID:Chronic pancreatitis: a cause of biliary stricture. 88 95

Long strictures of the intrapancreatic portion of the common bile duct were found in 6 patients with chronic pancreatitis. These strictures were responsible for painless obstructive jaundice, recurrent cholangitis, secondary biliary cirrhosis, and chronic abdominal pain difficult to distinguish from that caused by pancreatitis. Endoscopic retrograde cholangiopancreatography and intraoperative cholangiography were invaluable in making the diagnosis and in planning surgical correction. Decompression of the biliary tree by anastomosis of the gallbladder or common duct to the small intestine completely relieved symptoms and allowed liver function to improve significantly. Common duct stricture as a complication of chronic pancreatitis should be considered in the differential diagnosis of extrahepatic biliary obstruction and whenever surgical treatment of chronic pancreatitis is contemplated.
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PMID:Persistent obstructive jaundice, cholangitis, and biliary cirrhosis due to common bile duct stenosis in chronic pancreatitis. 94 56

A retrospective analysis of complications arising from 300 consecutive attempts at endoscopic retrograde cholangiopancreatography (ERCP) in 278 patients was undetaken to determine the rate and severity of complications. An over-all complication rate of 5% (15 cases) was documented. Complications were categorized in terms of those arising from endoscopy itself or from the administration of pharmacological agents (7 cases), and those observed after the injection of radioopaque contrast into the biliary tree or pancreas (8 cases). Complications which might be considered coincidental to a patient's underlying illness were not excluded. Complications were significantly more frequent after injection of diseased duct systems. Brief, self-limited pancreatitis after retrograde pancreatography occurred in 5 of 90 patients with pancreatic disease. No cases of pancreatitis were observed after retrograde pancreatography in 102 patients without pancreatic disease X2 = 5.82, P less than 0.025). Sepsis occurred after retrograde cholangiography in 3 of 56 patients with extrahepatic biliary obstruction. In the absence of extrahepatic obstruction, cholangiography was performed without complication in 85 cases (X2 = 3.62, P less than 0.1), although 25 of these had intense cholestasis due to hepatic parenchymal disease. This analysis provides the basis for modifications of ERCP technique and management that may reduce the future incidence of complications. This study suggests that the incidence and severity of complications that arise from ERCP compare favorably with procedures of equivalent diagnostic yield.
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PMID:Complications of endoscopic retrograde cholangiopancreatography. Analysis of 300 consecutive cases. 109 96

A 75-year-old woman was subjected to biliary surgery 38 years after partial gastrectomy for ulcer. There was a history of gallstones of 10 years duration, pentagastrin-resistant achylia, cholecystolithiasis and choledocholithiasis complicated by stenosis of papilla of vater, cholecystitis and pancreatitis. Peroperative cholangiography and biliary tract surgery were performed. On the third postoperative day heavy jaundice and hemolysis developed, leading to death of the patient. Culture of bile taken at operation revealed strains of Clostridium perfringens and Escherichia coli. Autopsy showed a picture of gas gangraena of the liver and Clostridium septicemia. The role of achylia, blind loop, and biliary obstruction in bile surgery is stressed.
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PMID:Clostridium septicemia following biliary surgery in a gastrectomized patient. 112 39

Gray scale scanners allow the demonstration of much more anatomical detail than was possible with the older type scanners. The initial step in the ultrasonic examination of the pancreas is display of the anatomical detail of the portal vasculature which provides a guidepost to the pancreas. Pancreatitis is characterized by a diffusely enlarged echo-free pancreas. Pancreatic pseudocyst is almost always an echo-free unilocular fluid collection. The size of a pancreatic pseudocyst can be measured so that progress can be assessed. Pseudocysts located in the region of the tail of the pancreas may be best demonstrated by scanning from the back over the left kidney. Pancreatic pseudocysts may be partly solid. Pancreatic carcinoma appears as a localized relatively echo-free, poorly defined solid mass which attenuates the ultrasound beam. Pancreatic carcinoma smaller than 2 cm in diameter are particularly difficult to diagnose by ultrasonic examination. Pancreatic carcinoma may be difficult to distinguish from chronic pancreatitis. Dilated bile ducts can be demonstrated and point to extrahepatic biliary obstruction. Serial ultrasonic scans have been suggested as a means of monitoring the response of pancreatic tumors to therapy. The relative diagnostic value of endoscopic retrograde cannulation of the pancreatic ducts and ultrasound has not as yet been established. Ultrasonic examination is easier to perform and less expensive than any other pancreatic imaging procedure other than the upper gastrointestinal barium examination.
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PMID:Ultrasonic examination of the pancreas. 120 74

Pancreatic duct obstruction, even in the absence of biliary obstruction and/or bile reflux into the pancreatic duct, can trigger acute hemorrhagic necrotizing pancreatitis. The earliest changes are seen within acinar cells. Early derangements in acinar cell biology include inhibition of digestive enzyme secretion and the co-localization of lysosomal hydrolases with digestive enzyme zymogens. Under appropriate conditions, this co-localization could lead to digestive enzyme activation within acinar cells.
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PMID:Pathobiology of experimental acute pancreatitis. 134 59


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