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

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

Fifty patients with choledochal calculus were treated by endoscopic sphincterotomy (EST) and forty-nine of them were cured. Stones were excreted in forty-six patients spontaneously and in two patients by basket. Stones disappeared in one patient after extracorporeal shock wave therapy. The complications included gastrointestinal hemorrhage (2%), pancreatitis (2%) and cholangitis (4.1%). Twelve of them were followed by barium meal after EST. The barium was found in biliary tract in one patient and pneumatosis in another one without any clinical symptoms. The authors suggest that EST could be an important nonoperative therapy in the treatment of choledochal calculus.
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PMID:[Endoscopic sphincterotomy in the treatment of choledochol calculus]. 139 68

We determined the prevalance and significance of hyperamylasemia in 180 patients with idiopathic inflammatory bowel disease (IBD) (83 with ulcerative colitis, and 97 with Crohn's disease). Serum total amylase and pancreatic and salivary isoamylase activity were measured in all patients. In all patients with hyperamylasemia, we measured isoamylase activity by cellulose acetate electrophoresis and lipase activity, assayed for the presence of macroamylase, and carried out pancreatic ultrasound examination and barium studies of the upper gastrointestinal tract. Eight of 97 patients with Crohn's disease (8%) had hyperamylasemia; 4 of them had an elevated pancreatic isoamylase and 2 a raised lipase activity. All patients with hyperamylasemia had normal ultrasonographic scans of the pancreas and no evidence of duodenal involvement on barium meal. None had macroamylasemia. We found no relationship of hyperamylasemia to disease site, activity, and duration or therapy and no patient developed clinical evidence of pancreatitis. We conclude that a small but important number of patients with Crohn's disease have hyperamylasemia not associated with overt pancreatitis. In the absence of appropriate indications, it requires no investigation.
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PMID:Hyperamylasemia in inflammatory bowel disease. 246 72

Supine and upright films of the abdomen are usually the first imaging procedures in the evaluation of patients with suspected acute pancreatitis and may document calcific pancreatitis, inflammatory masses, abscesses, or obstruction. Appropriate barium or water-soluble contrast examination of the upper GI tract may provide an accurate indication of upper GI tract obstruction as well as document gastric varices that may occur as a complication of pancreatitis. Appropriate contrast examinations of the colon are important in documenting the extent of inflammatory changes of the colon, which may include perforation and necrosis. Accurate and expeditious documentation of these colonic complications is important in planning appropriate surgical therapy.
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PMID:Gastrointestinal complications of pancreatitis. 264 78

Choledochocele or type III choledochal cyst is a rare abnormality of obscure etiology that consists of cystic or diverticular dilatation of the terminal intramural portion of the common bile duct protruding into the duodenum. It should be considered in the differential diagnosis of otherwise unexplained biliary colic or recurrent pancreatitis--particularly after cholecystectomy. An intraluminal duodenal filling defect on barium study that opacifies during cholangiography or endoscopic retrograde cholangiopancreatography is diagnostic. We present one case of choledochocele in which the first use of the biliary scintigraphic (HIDA) scan for diagnosis is demonstrated. An additional 47 cases found in the literature are reviewed and a new anatomic classification of choledochoceles is proposed as a guide for treatment. Treatment options are partial excision of the cyst, sphincterotomy, or both.
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PMID:Choledochocele: case report, literature review, and a proposed classification. 264 45

The author presents the different imaging modalities that are now available for the diagnosis and treatment of chronic pancreatitis. These methods are indispensable although they do not preclude clinical examination and laboratory studies. The classical examinations such as plain abdominal film, upper GI studies and barium enema, cholangiography and arteriography are still of interest, especially in the diagnosis of complications and preoperative cartography. ERCP is still the only means of visualizing the many ducts, and often serves to differentiate pancreatitis from certain neoplastic lesions. CT is now the most effective method, even though a negative scan does not exclude the diagnosis of pancreatitis. Sonography maintains its usefulness in initial screening as well as in follow-up evaluation. Magnetic resonance imaging does not offer an advantage over CT, but future prospects are encouraging. Percutaneous diagnostic or therapeutic procedures under radiological guidance now belong to the current medical arsenal. Under fluoroscopic, sonographic or CT control, percutaneous drainage is often offered as an alternative or a complement to surgery.
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PMID:[Imaging in chronic pancreatitis]. 266 23

A spectrum of radiologic findings in cytomegalovirus (CMV) infection of the alimentary canal seen in 14 patients and correlated with pathologic examinations is described. Twelve patients had acquired immunodeficiency syndrome and two had no identified immunosuppression. Autopsies were performed on 12. Diffuse CMV colitis was present in eight patients, enteritis in seven, esophagitis in four, gastritis in two, cholangitis in one, and acute pancreatitis in one. Of 11 patients with enteritis and/or colitis seven had significant lower gastrointestinal bleeding and five died as a result of it. Radiologic findings in the gastrointestinal tract included superficial or deep mucosal ulcerations, perforation or fistula formation, luminal narrowing, rigidity and thickening of the intestinal wall, and inflammatory infiltration of the mesentery. These were seen on barium examinations and computed tomographic (CT) scans. Findings of pancreatitis were seen on CT scans in one patient. In another, a cholangiogram showed abnormal bile ducts caused by CMV cholangitis. The radiologist should be aware of the diverse manifestations of the disease and its likely occurrence in immunosuppressed individuals.
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PMID:Cytomegalovirus infection of the alimentary canal: radiologic findings with pathologic correlation. 303 23

A 21-year-old woman with duodenal Crohn's disease developed pancreatitis many years after radiographic evidence of duodenopancreatic reflux. We review the 17 previously reported cases of non-drug-induced recurrent pancreatitis associated with Crohn's disease and discuss possible pathogenetic mechanisms. Pancreatitis should be considered in any Crohn's disease patient with filling of the pancreatic duct on barium study of the upper gastrointestinal tract.
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PMID:Pancreatitis and duodenopancreatic reflux in Crohn's disease. Case report and review of the literature. 305 77

Cystic neoplasms of the pancreas (CNP) are rare lesions that can be difficult to diagnose preoperatively. Twenty patients with cystic neoplasms of the pancreas including five microcystic adenomas, six benign mucinous cystic neoplasms, three malignant mucinous cystic neoplasms, two solid and papillary epithelial neoplasms, and four cystic neuroendocrine tumors were treated at a single institution between 1962 and 1987. The average duration of symptoms prior to diagnosis was 10 months. Five patients were asymptomatic. Forty percent of patients presented with an abdominal mass. Plain abdominal x-rays and UGI barium contrast studies were never diagnostic. Ultrasonography, computerized tomography (CT) and visceral angiography aided in the correct diagnosis in 28%, 36%, and 75% of patients studied, respectively. Overall a correct diagnosis was made preoperatively in only 35% of patients. Twelve of 13 patients were correctly diagnosed at laparotomy with intraoperative biopsy. Without biopsy the mass was misdiagnosed at laparotomy in five of six cases. CNP must be suspected in any patients who present with an upper abdominal mass with or without abdominal pain and no history of pancreatitis. CT may be diagnostic in up to one third of cases and should be obtained routinely to demonstrate the proximity of the lesion to other structures. Visceral angiography should also be obtained prior to operation. A generous incisional biopsy should be obtained of all pancreatic cysts that are not to be resected.
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PMID:Diagnostic dilemmas in patients with cystic neoplasms of the pancreas. 306 18

A 43-year-old man underwent orthotopic heart transplantation for end-stage ischemic cardiomyopathy. Immunosuppressive therapy consisted of cyclosporine and corticosteroids. The diagnosis of acute pancreatitis was made on the ninth postoperative day and was based on clinical symptoms and an upper gastrointestinal barium study. Both serum and urine amylase values were normal. Abdominal ultrasound examination was nondiagnostic. Two weeks postoperatively, the patient's clinical condition deteriorated sharply. Chest and abdominal roentgenograms revealed free intraperitoneal air, as well as air in the lesser sac. Diagnosis of a ruptured pancreatic abscess was made, and he underwent immediate exploratory laparotomy. Four liters of purulent fluid were present in the peritoneal cavity. A ruptured pancreatic abscess was found, and it had dissected above the superior mesenteric vessels and down the right gutter over the inferior vena cava. After extensive retroperitoneal debridement and copious irrigation, multiple surgical drains were placed. The patient is now well and is performing normal daily activities 16 months after the transplantation procedure. The incidence and proposed causes of pancreatitis occurring after heart transplant are reviewed, and we discuss our management of this complication.
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PMID:Survival following rupture of a pancreatic abscess in a heart transplant recipient. 311 39


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