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

Early differentiation of gallstone from nongallstone associated acute pancreatitis by imaging methods is often difficult. Timing of surgery in gallstone pancreatitis is controversial, but early surgery requires early demonstration of gallstones. This study assesses the value of easily available clinical and laboratory data in establishing gallstones as the etiology of pancreatitis. In 405 consecutive episodes of acute pancreatitis, data were collected prospectively on 14 clinical and laboratory variables. Gallstones caused 177 episodes and alcohol 135, 93 were due to other or unknown causes. Age, sex, and within 48 hours of admission, serum alkaline phosphatase, aminotransferases, amylase, and bilirubin were all significantly different (all p less than 0.001, chi square) in gallstone and alcohol groups. Multivariate analysis based on five of these variables enabled correct prediction of the presence or absence of gallstones in 50 of a further 56 episodes. This method may help in planning early interventional treatment of gallstone associated acute pancreatitis.
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PMID:The early identification of patients with gallstone associated pancreatitis using clinical and biochemical factors only. 619 78

The present retrospective study was undertaken to investigate the value of diagnostic procedures--clinical and biochemical parameters, ultra-sonography and ERCP--and the influence of endoscopic papillotomy on the course of biliary pancreatitis in 22 patients. A further 22 patients with alcoholic pancreatitis served as a control group. In the 22 patients with biliary pancreatitis, the case history pointed to biliary disease in 14 cases; in contrast to the patients with alcoholic pancreatitis, in none of these patients did excessive alcohol consumption precede the disease. Seven out of the 22 patients with biliary pancreatitis, but only 2 out of the 22 cases of alcoholic pancreatitis had a previous cholecystectomy. The pain was localized in the right upper abdomen in 60% of the biliary pancreatitis patients, as compared with only 32% of the patients with alcoholic pancreatitis. The laboratory parameters (serum amylases, SGOT, serum bilirubin and leucocytes) did not permit any differentiation between biliary and alcoholic pancreatitis. With respect to the biliary genesis of pancreatitis, the sensitivity of the ultrasound examination was about 68%. The endoscopic detection of a so-called "stone papilla", spontaneous suprapapillary bilio-duodenal fistula, or a blood-tinged papilla, was evidence in favour of a biliary cause of the pancreatitis. In 12 patients, the stones has passed spontaneously; 10 patients were submitted to endoscopic papillotomy for bile duct stones detected by ERCP, and the stones were removed in 9/10 patients. A worsening of the clinical picture by ERCP was not observed in any of the patients. The course of serum amylases, leucocytes and pain in the papillotomied patients corresponded to that in patients with spontaneous stone passage. The results of the present study show that endoscopic papillotomy with stone extraction represents, in most patients with biliary pancreatitis, a possibility for causal therapy, avoiding an emergency surgical intervention. In demonstrated cholecystolithiasis, cholecystectomy can be planned as an elective procedure.
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PMID:[Biliary pancreatitis--diagnostic and therapeutic possibilities with ERCP and endoscopic papillotomy]. 638 6

19 167 autopsy records are analysed to the frequency and to risk-groups for a lethal biliary pancreatitis. In cholecystolithiasis biliary pancreatitis was the far most stone caused lethal complication, in choledocholithiasis the 4. An increased incidence of the lethal biliary pancreatitis was found in younger individuals, in male individuals and in choledocholithiasis.
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PMID:[Incidence of fatal, biliary pancreatitis--an analysis of 19167 autopsy protocols]. 664 92

The diagnosis of acute pancreatitis is based on anamnestic, clinical and chemical data. Ultrasound and computed tomography permit direct visualisation of the pancreas and establish the diagnosis. In cases of haemorrhagic-necrotising pancreatitis they demonstrate the extent of morphological changes and permit exclusion of other causes of an acute abdomen. The imaging methods support indications for operation in cases of subtotal or total parenchymatous necrosis and in pancreatic abscesses. Conservative expectant approaches in patients with severe clinical course and slight morphological changes as well as in agreement of clinical and morphological findings are facilitated. Complete demonstration of parenchymatous and peripancreatic necroses furnishes useful additional information for total extirpation. Gallstone disease can be demonstrated or excluded preoperatively. Since introduction of ultrasound and computed tomography for the diagnosis of acute pancreatitis a marked diminution of early surgical intervention and delayed operation has been achieved.
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PMID:[Surgical treatment in acute pancreatitis. The change as influenced by sonography and computer tomography]. 683 22

Two cases of acute pancreatitis in pregnancy are reported together with a short review of the literature relating to this condition. Gallstones, cholecystitis or alcoholism were not at hand in our patients and no other etiologic factor of the pancreatitis than the pregnancy could be found. Both patients developed pancreatic pseudocysts. Our first patient delivered a stillborn baby in the 29th week of pregnancy and our second patient delivered a normal baby in week 38. Even if acute pancreatitis in pregnancy is rare it is important to be aware of the condition especially in the first trimester when it should be considered in differential diagnosis of hyperemesis gravidarum.
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PMID:Acute pancreatitis in pregnancy. Report of two cases. 719 93

Gallstone disease as the etiology of pancreatitis is much more common in private hospital patients than was once described. Common duct stones (choledocholithiasis) have been proven not to coexist in the majority of cases. The objectives of surgery for gallstone pancreatitis therefore should be adequate drainage of the pancreas, evaluation of the common duct, and cholecystectomy. Common duct exploration usually is not warranted or advised.A pseudocyst may occur subsequent to the acute phase of pancreatitis, or subsequent to surgery for pancreatitis if the pancreas is not adequately and widely drained. The collection of fluid adjacent to or within the pancreas must be determined to be either a pancreatic abscess or a pancreatic pseudocyst. The management of the pseudocyst, which is usually diagnosed by the ultrasonographic finding of a thickened wall, is adjacent internal drainage. By contrast, the pancreatic abscess must have wide, radical, external drainage.Mature judgement must be exercised in the approach to, the timing of, and the management of surgery for gallstone pancreatitis or pseudocyst formation.
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PMID:Acute gallstone pancreatitis with pseudocyst as a complication. 727 23

Gallstones and alcohol are the most important causes of acute pancreatitis, accounting for 80% of cases. One hundred and four cases of Acute Gallstone Pancreatitis were retrospectively studied, representing 39.5% of all cases of Acute Pancreatitis that have been treated between 1990-93. Abdominal ultrasound, demonstrating gallstones in 95% of the cases, was a very useful examination in the initial study of these patients. ERCP with sphincterotomy was performed in 25 patients: 6 in a urgent basis and the others as elective procedure. Gallstones have been treated during the initial admission in 80.6% of the cases and the others at a second admission: ERCP with sphincterotomy in 14 patients as the only etiologic treatment, open cholecystectomy in 50 cases and laparoscopic cholecystectomy in 29 cases. The overall mortality rate was 3.8%--four cases.
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PMID:[Acute pancreatitis of biliary etiology. The case histories of the Department of General Surgery of S. Francisco Xavier Hospital (1990-1993)]. 765 99

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

Since the early 1980s extracorporeal shock wave lithotripsy (ESWL) has partially replaced major operative procedures in various fields of surgery. In the interest of the patient, it is important to determine the exact role of ESWL in surgery. Comparing our own prospectively followed patients with other patient series, we have tried to assess this role. We treated 133 patients with cholecystolithiasis, 80 patients with choledocholithiasis, and 17 patients with pancreatic stones using a second-generation lithotriptor, the Siemens Lithostar (Siemens, Erlangen, Germany). The results suggest a limited role of ESWL for cholecystolithiasis, in which it is reserved for patients with high operative risk and patients who reject an operation. For choledocholithiasis ESWL seems to become an integral part of the treatment in the elderly patient in whom endoscopic stone removal proved impossible. Finally, ESWL could become a first option for the treatment of intractable pain in patients with chronic calcifying pancreatitis.
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PMID:Role of extracorporeal shock wave lithotripsy in hepato-biliary-pancreatic surgery. 827 87

Gallstones are the most common causative factor in acute pancreatitis in the Western world. The majority of patients experience a mild course of the disease, with no need for acute invasive intervention. In patients with a severe course, acute endoscopic sphincterotomy seems indicated. Acute surgical intervention is not indicated in acute pancreatitis due to gallstones. In order to aim for early endoscopic decompression early detection og gallstones and determination of the severity og acute pancreatitis is essential. For this purpose, a combination of ultrasonography and biochemical tests seems most valid. Because of the high rate of recurrence, it is important that a cholecystectomy is performed during the same admission, after the acute symptoms have subsided. In patients with gallbladder stones an endoscopic sphincterotomy may be sufficient, but this procedure has never been compared to cholecystectomy in a controlled trial. Repeated ultrasonography is necessary, due to the high rate of false negative results of ultrasonography and biochemical tests in the early phase of acute pancreatitis. With a combination of repeated ultrasonography, endoscopic retrograde cholangiopancreaticography and microscopical examination of the bile a reduction in the incidence of acute "idiopathic" pancreatitis is achieved and appropriate treatment may be initiated. Finally, one should be aware of the presence of biliary sludge. Active intervention in patients with acute pancreatitis and biliary sludge significantly reduces the risk of recurrent pancreatitis.
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PMID:[Acute pancreatitis and gallstones]. 850 74


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