Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ceftriaxone, a third-generation cephalosporin, has been associated with the development of sludge or stones in the gallbladders of some patients treated with this medication. Such precipitates, which are usually reversible upon discontinuation of the drug, sometimes cause symptoms, have simulated acute cholecystitis, and have even led to cholecystectomy in some cases. We report the first known instance of biliary obstruction and secondary pancreatitis in association with reversible ceftriaxone-induced pseudolithiasis.
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PMID:Reversible symptomatic biliary obstruction associated with ceftriaxone pseudolithiasis. 188 6

Foreign bodies of the biliary tree represent infrequent causes of obstructive jaundice. We report a patient who developed biliary obstruction from metal shrapnel, 44 yr after a war injury. From our review of the literature, the syndrome of shrapnel-induced obstructive jaundice may occur many years after the initial injury. In the majority of patients, the missile lodges in the liver parenchyma, and migrates to the common bile duct. Complications from this injury include cholangitis, pancreatitis, and liver abscesses. As demonstrated by this case, computed tomography scan and endoscopic retrograde cholangio-pancreatogram may reliably detect this infrequent occurrence. With the development of therapeutic biliary procedures, many foreign bodies can be removed endoscopically. Thus, one should consider shrapnel-induced biliary obstruction in those patients with obstructive jaundice and prior combat injury.
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PMID:Biliary obstruction secondary to shrapnel. 192 51

Using a minimally compliant infusion system and a triple-lumen pressure recording catheter, we obtained endoscopic manometric measurements from both the common bile duct and pancreatic duct segments of the sphincter of Oddi (SO) in 58 patients. Fifteen patients (ages 27-69) had the diagnosis of functional abdominal pain, 19 patients (ages 30-76) had partial biliary obstruction, and 24 patients (ages 15-80) had idiopathic acute recurrent pancreatitis. Resting ductal pressure was similar in the common bile duct and pancreatic duct in all patient groups. In the group with functional pain, basal SO pressure was similar, whether obtained from the common bile duct or pancreatic duct sphincteric segment. Eight of 19 patients with partial biliary obstruction had elevated basal SO pressure. Five of these eight patients had elevated basal SO pressure confined exclusively to the common bile duct segment of the sphincter, while three patients had elevated basal SO in both segments. Conversely seven of 24 patients with acute recurrent pancreatitis had an elevated basal SO pressure, with five patients having pressure elevation only in the pancreatic duct segment while two patients had abnormal basal SO pressure in both segments. We conclude that selective cannulation of the common bile duct and/or the pancreatic duct during manometric study of the SO is necessary in order to diagnose segmental SO dysfunction responsible for partial biliary obstruction or episodes of acute recurrent pancreatitis.
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PMID:Pressure measurements from biliary and pancreatic segments of sphincter of Oddi. Comparison between patients with functional abdominal pain, biliary, or pancreatic disease. 158 5

Annular pancreas is a rare congenital abnormality that is increasingly diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) in the adult. In this population, it can present with duodenal or gastric ulceration, duodenal obstruction, pancreatitis, and, rarely, with associated congenital abnormalities. Although it has been suggested that biliary obstruction may result from associated pancreatitis, such cases have not been reported; primary extrahepatic biliary obstruction from a constricting annulus also has not been reported. We report such a case, and describe resolution of symptoms and a return to normal biochemical tests in a patient. The literature and embryology of annular pancreas are reviewed. We suggest that this entity be added to the differential diagnosis of extrahepatic biliary obstruction.
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PMID:Annular pancreas as a cause of extrahepatic biliary obstruction. 199 39

The increasing detection of asymptomatic gallstones leads to difficult decisions for the surgeon and patient about whether the stones should be managed expectantly or surgically. This review examines the evidence currently available upon which such decisions must be based. Gallstones may present as biliary pain, acute cholecystitis, biliary obstruction or pancreatitis, but it is not clear who will develop symptoms and what are the commonest initial symptoms. Studies of the natural history of silent gallstones suggest that a large majority of patients with such stones will remain asymptomatic. However, diabetics are at increased risk, as are patients whose stones are detected initially at laparotomy. Incidental cholecystectomy is usually safe, and preoperative detection by ultrasonic screening is an advantage in planning the operation. Prophylactic cholecystectomy is not indicated to prevent gallbladder carcinoma (except in cases of porcelain gallbladder) and there is conflicting evidence about whether cholecystectomy predisposes to colorectal carcinoma.
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PMID:Asymptomatic gallstones. 218 58

Intramural duodenal hematoma (IDH) is a rare finding in the adult, especially when related to iatrogenic complications of ulcer treatment. It can lead to biliary obstruction and pancreatitis, which proved fatal in our case. Contrast-enhanced computed tomography (CT) is invaluable in detecting the abnormality and can definitely be diagnostic.
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PMID:Fatal pancreatitis secondary to iatrogenic intramural duodenal hematoma: a case report and review of the literature. 193 83

Pancreatitis was induced in the opossum by occluding the common bile duct above or below the entrance of the pancreatic duct. The common channel theory was tested by evaluating the effect of preligation of the pancreatic duct to prevent the reflux of bile after ligation of the distal common duct. The severity of the disease was determined by histologic grading of the degree of pancreatic tissue necrosis. Serum amylase, lipase, and calcium were determined. Concomitant obstruction of the biliary and pancreatic ducts produced severe necrotizing pancreatitis whether or not bile reflux was present. Pancreatic ductal obstruction alone was associated with acinar atrophy and mild interstitial pancreatitis. Biliary obstruction alone above the entrance of the pancreatic duct resulted in marked hyperemia of the gland but without histologic evidence of pancreatic inflammation. A positive bacterial culture of the pancreas was obtained in only four of 36 opossums in a distribution to suggest random contamination. There was an inverse correlation between calcium levels and the degree of tissue necrosis. This study demonstrates that biliary obstruction rather than bile reflux into the pancreas is a requisite for the pathogenesis of severe biliary pancreatitis in this model.
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PMID:The role of biliary obstruction in the pathogenesis of acute pancreatitis in the opossum. 242 9

Some patients with extrahepatic biliary occlusion present high levels of serum aminotransferases indicating parenchymatous liver disease. The levels, usually in the range of 400-500 U/l, may sometimes exceed 1,000 U/l. Most of these patients have stones in the bile ducts, but the causes may occasionally be pancreatic tumours and pancreatitis. Typically the maximum enzyme levels are reached within 1-2 days, followed by a rapid fall--whether the gallstones have passed or not. The alkaline phophatase levels are initially normal or slightly elevated, usually increasing slowly to about twice the upper reference level. The pathogenesis of this rapid elevation of the aminotransferases has yet not been fully elucidated. However, the main mechanisms are probably increased permeability of the hepatocyte membrane caused by elevated pressure in the bile ducts, combined with a direct toxic effect of retinated bile acids. Increased enzyme synthesis may also be a contributory factor. Further knowledge of this not unusual enzyme pattern in acute (and sometimes also chronic) biliary obstruction will help to establish a correct diagnosis at an early stage of the disease, and thus avoid a need for invasive, potentially dangerous investigations.
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PMID:[Biliary duct obstruction presenting with laboratory levels indicating liver cell damage]. 247 42

In patients with chronic pancreatitis, the sclerosing process of the pancreas may constrict not only the pancreatic duct for also the bile duct and duodenum. This study analyzes the prevalence of these obstructive lesions in 58 consecutive patients with chronic pancreatitis requiring surgery for either pain (57 patients) or for painless jaundice (1 patient). There was significant biliary obstruction in 21, 4 of whom also had symptomatic duodenal obstruction. All 21 patients with biliary and duodenal obstruction were among the 38 with a dilated pancreatic duct suitable for pancreaticojejunostomy (modified Puestow procedure). None of the 20 patients with small duct pancreatitis had biliary or duodenal obstruction. Pseudocysts were distributed evenly between the two groups (9 of 38 patients with a dilated duct versus 4 of 20 patients with small duct pancreatitis). Pancreaticojejunostomy combined with choledochoenterostomy and gastrojejunostomy in appropriately selected patients provided good to excellent long-term (mean 3.6 years) relief of pain in 30 of 36 patients (83 percent). There was no correlation between successful relief of pain and development of pancreatic exocrine or endocrine insufficiency or calcification. Stenosis of the bile duct developed some years subsequent to pancreaticojejunostomy in four patients and required a second operation for choledochoenterostomy in three. Three other patients required secondary pancreatic resections due to failure of the pancreaticojejunostomy to relieve pain. It is often possible to effect excellent relief of symptoms with maximal conservation of remaining pancreatic functions despite sclerotic obstruction of multiple organ systems.
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PMID:Conservation of pancreatic tissue by combined gastric, biliary, and pancreatic duct drainage for pain from chronic pancreatitis. 258 Apr 54

Surgery for obstructive jaundice is being challenged by endoscopic and percutaneous techniques. To compare their safety and efficacy, the courses of 157 patients treated for biliary obstruction were examined. Outcome was judged by mortality, complications, and need for further intervention. Forty-eight patients underwent endoscopic papillotomy (43 [90%] had stone disease) with two deaths and 11 cases of (23% incidence) of cholangitis. Pancreatitis developed in 9 (19%). Twenty-seven patients (56%) required further endoscopic, percutaneous, or surgical intervention. Sixty-five patients underwent transhepatic drainage (58 [89%] had malignant neoplasms) with a 28% (n = 18) mortality rate. Cholangitis developed in 26 (40%), and 50 (77%) required further transhepatic or surgical intervention. Forty-four patients underwent surgery (22 [50%] had stone disease and 12 [27%] had malignant neoplasms) with a 4.5% (n = 2) mortality rate. Cholangitis developed in 3 (7%), pancreatitis developed in 2 (4.5%), and bleeding developed in 1 (2%). Eight (18%) required further intervention. While endoscopic papillotomy provides efficacious treatment for stone disease, surgery provides a more expeditious, less morbid relief for malignant obstruction.
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PMID:Management of biliary obstruction. A comparison of percutaneous, endoscopic, and operative techniques. 265 78


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