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

A new classification of gallstones is reported, which has interesting implications for diagnostic and therapeutic purposes. Gallstones have been divided according to "type" into the following categories: cholesterol (single, multiple), mixed, black pigment, brown pigment, combination and composite. In addition, gallstones primarily formed within the gallbladder have been distinguished from those initially formed in the common duct (before and after surgery) and within the intrahepatic ducts. Stone type and composition have been related to symptoms, on the basis of a new view, according to which gallstones are not a unique entity, but a heterogeneous disease including different entities, each of which has its own pathogenesis, clinical manifestations, biological behaviour and also deserves a different treatment. The proper treatment should be appropriate to the individual and his stones. Therapeutic guide-lines are suggested for each type of stones, in particular for stones complicated by cholangitis, pancreatitis, or for common duct stones concomitantly found with gallbladder stones. For the last group, techniques and therapeutic options preserving the function of the sphincter of Oddi are recommended. Suggestions are also reported concerning the treatment of various types of hepatolithiasis: primary, i.e. associated with cystic intrahepatic bile duct dilatation; post-surgical, i.e. occurring cranially to a biliary enteric anastomosis: secondary, i.e. associated with concomitant gallbladder and common duct stones.
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PMID:[The classification of biliary calculi and the clinico-therapeutic implications]. 1021 40

Gastrointestinal disorders are common in adolescents. Chronic abdominal pain, lactose intolerance, constipation, and irritable bowel syndrome represent the most common gastrointestinal complaints, while inflammatory bowel disease is the major chronic disorder of concern to clinicians. Gallstones and pancreatitis may also be seen in this age group. The authors describe the diagnosis and treatment of these gastrointestinal disorders.
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PMID:Gastrointestinal Disorders in Adolescents. 1035 Jul 72

Gross and histological examination of the autopsy cases in the aged revealed that: 1. Acute interstitial pancreatitis, which was characterized by rupture of the ducts and ductules associated with profuse intraluminal exudation of polymorphonuclear leucocytes and protein plugs formation, was found in nine cases (0.62%) out of 1457 autopsies. There was scarce parenchymal or fat necrosis which might be caused by impaired secretion by atrophic parenchyma. The interstitial type may represent characteristics of acute pancreatitis in the aged. 2. Pancreatic lithiasis was found in six of 85 cases, or 7.1%. 3. Sites of isolated islets of Langerhans were found in an incidence of 26.5% (53/200), which increased with age. 4. Incidence of endocrine tumors was 10% (6/60) in individuals having histological studies of all sections and 1.6% (12/738) in individuals having histological studies of three random sections of the pancreas. The facts that multiple hormone production was found in as much as 70% and glucagon cells in as much as 85% were characteristics. 5. The atypical epithelia were observed with the highest incidence in the common pancreaticobiliary channel of the papilla of Vater, where carcinoma may arise most frequently. 6. The incidence of cystic lesions increased with age. Small cystic lesions appear to have the potential to progress to malignancy. 7. it may be possible to remove the head of the pancreas while preserving of the vascular arcades and their branches to the duodenum, the bile duct and the papilla of Vater. The artery toward the papilla of Vater is very important for the blood supply of both the papilla and second portion of the duodenum, and should be preserved in duodenum-preserving subtotal resection of the head of the pancreas. Gallbladder carcinoma was found in 94 cases, or 2.1% and gallbladder stone was found in 957 cases, or 21.4% among 4482 cases. Incidence of gallbladder carcinoma was six times higher in the cases with cholecystolithiasis than those without stone.
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PMID:[Diseases of the biliary tract and pancreas in the aged--results obtained by investigation of the autopsy cases]. 1119 58

Gallstones are common in the US and western countries. This article describes the pathogenesis of gallstone formation and the clinical manifestations and current approaches to diagnosis and treatment of the most common clinical conditions caused by gallstones: biliary colic, acute cholecystitis, choledocholithiasis, and acute gallstone pancreatitis. The role of widely used imaging techniques (transabdominal ultrasound, CT scan, MR imaging, and MRCP) and diagnostic and therapeutic endoscopy (endoscopic ultrasound, ERCP) is emphasized. This article is intended mainly for general practitioners, primary care physicians, and other specialists providing medical care to patients with gallstones and their complications.
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PMID:Gallstones and biliary disease. 1148 46

Acute pancreatitis is rarely considered in the diagnosis of paediatric abdominal pain and can be misdiagnosed. Gallstones are uncommon in children and are a rare cause of pancreatitis. Trauma, infections and idiopathic causes are the commonest aetiological factors. Three cases of gallstone-induced acute pancreatitis with jaundice in children are reported which resolved with conservative treatment. The gallstones were managed by laparoscopic cholecystectomy with or without endoscopic retrograde cholangiopancreatography (ERCP). The three children had presented previously to a doctor with symptoms of gallstone disease but the diagnosis was missed. It is concluded that acute pancreatitis should be considered in children presenting as an emergency with abdominal pain. Children with recurrent attacks of upper abdominal pain should be investigated for gallstone disease so that the diagnosis is made before the development of potentially serious complications such as acute pancreatitis and jaundice.
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PMID:Acute gallstone pancreatitis in childhood. 1177 36

Laparoscopic cholecystectomy is nowadays the method of choice in treatment of symptomatic cholecystolithiasis, despite the fact that some operations cannot be completed laparoscopically and are converted. In a group of 431 patients operated during the last two years the authors evaluate the causes and predispositions of conversion which was performed in 7.4%. A significantly higher risk was found in subjects above 65 years of age, in those with ultrasonographic signs of thickening of the gallbladder wall and patients with acute cholecystitis. The risk of conversion is not significantly influenced by the patient's sex, obesity, the condition after endoscopic retrograde cholangiopancreaticography, pancreatitis and a previous abdominal operation.
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PMID:[Conversion of laparoscopic cholecystectomy]. 1204 26

Acute pancreatitis is an inflammation of the pancreas that can, in a minority of patients, lead to local complications, multiorgan failure, and death. Gallstones are the most common cause of acute pancreatitis in Western countries. The majority of patients with acute gallstone pancreatitis have mild disease and recover within 3 to 5 days with bed rest and intravenous fluid replacement. In up to 20% of patients, severe pancreatitis develops and can involve pancreatic tissue necrosis and multiorgan failure. Recent advances in the care of patients with gallstone-induced pancreatitis include better severity stratification on hospital admission, more aggressive fluid resuscitation in the early disease course, early use of antibiotics in patients with pancreatic necrosis, a shift from parenteral to enteral feeding regimens, a better defined and less aggressive approach to pancreatic surgery, and the possibility to remove impacted gallstones endoscopically. Urgent endoscopic retrograde cholangiopancreatography and sphincterotomy are recommended in patients with signs of cholangitis or jaundice, ultrasound evidence of dilated common bile duct, or evidence of severe disease.
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PMID:Gallstone pancreatitis: when is endoscopic retrograde cholangiopancreatography truly necessary? 1263 52

Gallstone diseases (asymptomatic, symptomatic and complicated) are frequently seen in the elderly; the prevalence increases proportionally with age. At higher ages (> 60 years) the presentation of symptomatic or complicated gallstone disease is frequently atypical. Complicated gallstone disease (especially cholecystitis and cholangitis) in the elderly is associated with high morbidity and mortality rates. The introduction of laparoscopic cholecystectomy has decreased the morbidity and mortality rates of symptomatic and complicated gallstone disease in the elderly; for elective procedures in particular, the risks hardly differ from those for younger patients. Percutaneous cholecystostomy is an effective and safe alternative for (laparoscopic) cholecystectomy in high-risk patients with an acute cholecystitis. Endoscopic retrograde cholangiopancreaticography (ERCP) with sphincterotomy is also the treatment of choice for common bile duct stones in the elderly. After removal of common bile duct stones (whether or not accompanied by cholangitis or pancreatitis) a laparoscopic cholecystectomy should be performed, unless contraindications are present.
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PMID:[The treatment of gallstone disease in the elderly]. 1263 44

Gallstone-induced acute pancreatitis is a prevalent condition that is associated with an unacceptably high mortality rate. Early endoscopic intervention, including endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy within 24 to 72 h of hospital admission, can be used to remove stones in the common bile duct (CBD) and establish biliary drainage. Anecdotal evidence of its effectiveness led to formal testing in randomized clinical trials. Although the design and results of the four published studies have varied, the overall conclusion is that early endoscopic therapy reduces morbidity and mortality in patients with acute biliary pancreatitis. Benefits are especially apparent in patients who satisfy generally accepted criteria for severe pancreatitis. The author's practice is to undertake endoscopic retrograde cholangiopancreatography in patients with severe or worsening pancreatitis, or in patients with jaundice, cholangitis or dilation of the CBD. Endoscopic sphincterotomy is performed in patients with CBD stones or in patients with biliary pancreatitis and cholelithiasis who are not candidates for cholecystectomy. The roles of newer diagnostic modalities, including magnetic resonance cholangiopancreatography and endoscopic ultrasonography, are not yet clear.
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PMID:Biliary pancreatitis. 1267 72

Gallstone disease is one of the most common disorders of the gastrointestinal tract, and more cholecystectomies are performed each year in the United States than any other elective abdominal operation. As such, clinicians need a fundamental knowledge of gallstone disease and the common complications that are associated with this disease. Overall, the prevalence of gallstones in the United States is approximately 10% to 15%, of which, approximately 80% are without symptoms. Symptoms will occur in approximately 20% of those with gallstones, and this subgroup is at the highest risk for developing serious complications from their gallstone disease. These complications can range from simple recurrent biliary colic to severe, life-threatening ascending cholangitis and/or pancreatitis. This review will outline the basis for gallstone formation, the underlying mechanisms that result in gallstone-induced symptoms and a rational approach to individuals who present with symptoms consistent with gallstone disease. Current diagnostic and treatment modalities will be discussed, with a particular emphasis on acute cholecystitis and acute biliary pancreatitis.
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PMID:Gallstone disease and its complications. 1471 67


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