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

The physiology and pathophysiology of the sphincter of Oddi are poorly understood. The relationships of functional disorders of the sphincter to biliary and pancreatic disease and of organic lesions of the papilla to pancreatic inflammatory disease are subjudice to say the least. The efficacy of sphincter section in the treatment of chronic pancreatitis is unproved. Section of the sphincter may be necessary to treat biliary tract pathology but its use should not be routine or indiscriminative since, there is morbidity as well as mortality. Finally, the price of sphincterotomy is: 1. hemorrhage; 2. duodenal perforation; 3. pancreatic duct damage--a. acute pancreatitis; b. chronic pancreatitis; 4. sphincter incompetence--a. common duct regurgitation--cholangitis; b. pancreatic duct regurgitation--pancreatitis; 5. sphincter stenosis--obstructive jaundice; 6. stasis cholecystitis; 7. diarrhea; 8. morbidity 10%; 9. mortality 1.9%.
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PMID:The sphincter of Oddi, sphincterotomy and biliopancreatic disease. 39 44

Morphological studies of the pancreas in patients who had died of peritonitis at various periods of its development were carried out. Moreover, an experiment was fulfiled on reproducing peritonitis on 41 dogs. In the pancreas in all sectional observations there was observed a picture of acute inflammatory process of a various degree of intensity (peritonitogenic pancreatitis) depending upon the form of peritonitis. It was established that in pathogenesis of acute peritonitogenic pancreatitis an important role was played by direct transfer of the inflammatory process to the tissue of the gland on the side of the abdominal cavity. At the same time, of great importance were also regurgitation of the intestinal content into the system of the excretory ducts of the gland and hemodynamic disorders. The morphological picture of the reproduced in the experiment on dogs acute peritonitogenic pancreatitis was similar to that in the section observations. Both sectional and experimental data confirm the duct-enzymatic theory, or the theory of "common canal", of the pathogenesis of pancreatitis in general of and peritonitogenic pancreatitis in particular.
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PMID:[Morphology and pathogenesis of peritonitogenic pancreatitis]. 101 95

To investigate the mechanisms initiating pancreatic enzyme activation followed by the development of a choledochal cyst and/or pancreatitis under anomalous choledocho-pancreatic ductal junction (ACPDJ), choledocho-pancreatic end-to-side ductal anastomosis was successfully performed in 40 puppies as an experimental model of ACPDJ. As a result, reflux of pancreatic juice into the common bile duct readily and continuously occurred, and all pancreatic enzymes in bile obtained from the common bile duct were activated. Total bile acids increased about 2 months after surgery, and the ratio of taurodeoxycholic acid to total bile acids increased within the first months after surgery. Various degrees of common bile duct dilatation developed in all puppies within 7 to 10 days after the surgery, and no further dilatation occurred in the subsequent period. Histological change in the pancreatic duct was less prominent than that in the common bile duct, but histologically proved chronic pancreatitis was found in three of 23 sacrificed dogs, in which there was strong evidence of free and massive regurgitation of the bile-pancreatic juice mixture between the bile and the pancreatic duct systems. These findings in this experimental study constitute the first step to prove that ACPDJ, which is often found in patients with choledochal cyst, is an important etiologic factor not only for choledochal cyst but also for pancreatitis, and bile acids play an important role in the mechanism of pancreatic enzyme activation under the condition of ACPDJ.
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PMID:Experimental study of the pathogenesis of choledochal cyst and pancreatitis, with special reference to the role of bile acids and pancreatic enzymes in the anomalous choledocho-pancreatico ductal junction. 656 75

Opie suggested in 1901 that a common channel between the pancreatic duct and the common bile duct is created when a gall stone becomes impacted at the duodenal papilla. He proposed that bile would regurgitate into the pancreas and trigger pancreatitis. The case is reported of a 22 year old woman with an impacted stone at the duodenal papilla creating a common channel. The patient suffered from acute pancreatitis. Three days before the onset of pancreatitis, however, a T drain had been inserted into the common bile duct from which bile had been flowing freely and continuously. Moreover, amylase activity in fluid from the T drain was 49,000 U/l at the onset of pancreatitis pointing to reflux of pancreatic juice into the biliary tract. The amylase activity in bile decreased rapidly after endoscopic papillotomy and retrieval of the stone. The events participating in the development of acute gall stone induced pancreatitis in this patient with a common channel situation permitted reflux of pancreatic juice into the biliary tract rather than bile into the pancreas. Impairment of pancreatic outflow by a gall stone was probably the primary triggering event, rather than the regurgitation of bile into the pancreas. Preventive or therapeutic treatment in gall stone pancreatitis should be aimed at the urgent restoration of pancreatic flow rather than at the prevention of a hypothetical bile reflux.
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PMID:Pancreatic outflow obstruction as the critical event for human gall stone induced pancreatitis. 795 14

Since Helicobacter pylori (Hp) was first isolated in 1983, much work has been carried out on the pathogenic effects of this organism. Hp infection is common in humans and currently is the most important etiologic agent in the development of chronic active gastritis, gastric and duodenal ulcers, carcinoma and Malt-lymphoma of the stomach. Moreover Hp infection has also been associated with various extradigestive diseases. At present, a role of Hp infection in dyspepsia is discussed. Dyspepsia is defined by persistence of pain, burning or discomfort localised to the upper abdomen; some authors include in dyspepsia symptoms such as belching, bloating, alitosis, nausea, postprandial repletion, vomiting and regurgitation. In absence of any underlying pathologies, such as peptic ulcer, gastroesophageal reflux, pancreatitis, biliary tract disease or others, dyspepsia is defined as functional or idiopathic dyspepsia. Functional dyspepsia may be distinct in ulcer, reflux or dysmotility-like dyspepsia and unspecified dyspepsia. Hp infection is common in dyspeptic patients and a role of this bacterium has been postulated mostly in ulcer-like dyspepsia. Mechanisms by when Hp induces dyspeptic symptoms are uncertain; bacterial cytotoxins, phlogosis mediators, activity of chronic gastritis Helicobacter-related and host immune response probably play an important role in pathogenesis of functional dyspepsia. However, dyspepsia is not present only in infected patients; therefore other pathogenic factors may be implicated in expression of dyspeptic symptoms in uninfected subjects, such as gastric dysmotility, modifications of gastric output or altered visceral sensibility, psychological factors, gastroesophageal reflux and irritable bowel.
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PMID:[Dyspepsia and Helicobacter pylori]. 1036 46

Cholelithiasis and gastroesophageal reflux are both very common diseases that may occur simultaneously. Management of asymptomatic gallstones is still controversial. Because severe complications due to gallstones may occur incidental cholecystectomy during nonrelated abdominal surgery may be offered to patients with coexisting gallbladder disease. The aim of this study was to assess the clinical outcome of patients after laparoscopic fundoplication and incidental cholecystectomy for cholelithiasis compared with the outcome of patients after fundoplication alone. We conducted a retrospective chart review and prospective analysis using a questionnaire of the clinical outcome of patients who underwent laparoscopic fundoplication and incidental cholecystectomy from June 1991 to January 2000 in comparison with sex- and age-matched patients who had antireflux surgery alone. Sixty-seven (6.3%) of 1065 patients had a laparoscopic cholecystectomy at the time of laparoscopic antireflux surgery; 101 (75%) of 134 answered the questionnaire. The mean follow-up time was 4.6 years. Laparoscopic cholecystectomy did not influence surgical morbidity or mortality. Postoperative symptom score (1-10) did not show a statistically significant difference regarding bloating, diarrhea, abdominal pain, nausea, vomiting, biliary problems, jaundice, pancreatitis, dysphagia for liquids and solid, heartburn, regurgitation, and chest pain when the two groups were compared. We conclude that incidental cholecystectomy during laparoscopic antireflux surgery is safe and does not appear to influence the clinical outcome of the antireflux procedure.
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PMID:Incidental cholecystectomy during laparoscopic antireflux surgery. 1213 45

We report a 40-year-old man with rheumatic heart disease who presented with abdominal pain for three weeks and hematemesis for 24 hours. CT scan showed a large splenic artery aneurysm without evidence of pancreatitis. Mycotic aneurysm due to infective endocarditis was considered and confirmed by echocardiogram, which showed aortic and mitral valve regurgitation and vegetations. He was managed successfully with coil embolization of the aneurysm and antibiotics.
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PMID:Giant splenic artery mycotic aneurysm presenting with massive hematemesis. 1296 41

In patients with superinvasion opisthorchiasis of prolonged invasion, 84% develop duodenal hypertension, 94% of the patients are found to have gastric hypertension; duodenogastric reflux with formation of chronic gastritis and reorganization is revealed in 75%. Reflux of gastric contents into the esophagus gives rise to chronic eosophagitis, regurgitation of intestinal contents into the pancreatic duct is a cause of chronic indurative pancreatitis of the head of the gland. In cases of duodenal hypertension, the rates of pancreatic O. felineus invasion are as high as 93.7%.
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PMID:[Duodenogastroesophageal reflux disease as a complication of superinvasion opisthorchiasis]. 1548 77

The use of small bowel access for small intestinal delivery of enteral nutrition is becoming more common. Patients at risk for gastric regurgitation and aspiration, gastric intolerance, and pancreatitis are some of the classic patient groups for which small bowel feedings may be necessary. The endoscopist should have command of all forms of endoscopic small bowel enteral access, including nasojejunal tube placement, percutaneous gastro/jejunostomy, and direct percutaneous jejunostomy. Knowledge of not only the procedure techniques, but also the potential complications, is imperative to achieving good clinical outcomes.
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PMID:Small bowel endoscopic enteral access. 1796 73

The article presents a clinical observation of a female patient suffering from Wegener's granulomatosis with a rare variant of cardiac involvement--a combination of an aortal valvular disease (aortal regurgitation) and total atrioventricular blockade--who later underwent pacemaker implantation. The direct cause of the lethal outcome in this patient was destructive pancreatitis. Data from Russian and foreign literature on cardiac pathology in patients with Wegener's granulomatosis are analyzed.
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PMID:[Aortal regurgitation and atrioventricular block III in Wegener's granulomatosis]. 1831 72


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