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

The most important issues in pancreatic imaging are the detection and staging of pancreatic cancer, differentiation between cancer and focal pancreatitis, the characterization of cystic lesions and the search for neuroendocrine tumours. Magnetic resonance (MR) units (1.5 T) with strong gradients and a phased-array torso coil should be used, making breath-hold imaging possible in order to avoid motion artifacts. Standard imaging sequences are T1-weighted (T1w) gradient recalled-echo (GRE) with and without fat saturation. For T2-weighted (T2w) imaging, axial single-shot turbo spin-echo (TSE) and coronal/oblique MR cholangio-pancreatography (MRCP) pulse sequences are preferable. As contrast agents either gadolinium agents or mangafodipir trisodium are used. Dynamic gadolinium-enhanced T1w fatsat 3D GRE images are helpful to delineate vessel infiltration by adenocarcinoma and to assess the aetiology of cystic masses. Mangafodipir-enhanced MRI has been found to be superior to helical computed tomography (CT) in the detection of small cancers and in the delineation of liver metastases. In cases of an equivocal pancreatic mass the presence of the "duct penetrating sign" at MRCP (i.e., the duct traversing the mass) is suggestive of an inflammatory pseudotumour. Hypoattenuation due to focal fatty infiltration may mimic a tumour at CT, but in-phase and opposedphased T1w imaging readily depicts the fat. Multi-detector CT has gained increasing popularity for pancreatic imaging because of the 3D visualization of the peripancreatic vessels. However, MR imaging is excellent in the delineation of small pancreatic tumours. Due to its superior soft tissue contrast, MR imaging is also the method of choice in the differential diagnosis between tumours and tumour-simulating conditions in patients with equivocal CT and to assess cystic lesions.
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PMID:MRI of the pancreas: tumours and tumour-simulating processes. 1720 76

Surgery of primary hyperparathyroidism. Primary hyperparathyroidism is usually caused by a single parathyroid adenoma, rarely by multiple adenomas or hyperplasia and in 1-2% of cases by carcinoma. The definitive cure of the disease can be achieved only by surgical means. Unfortunately, only 10% of expected cases based on the number of population are diagnosed in Hungary. The main reason is that the disease has no specific symptoms and it causes only a few cases present with clinical entities such as nephrolithiasis, osteoporosis-osteopenia, pancreatitis, hypertension, peptic ulcer disease, depression, etc. The clue to the diagnosis of primary hyperparathyroidism is usually the laboratory result of hypercalcemia and in order to this aim the measurement of serum Ca would be an obligatory part of routine laboratory investigation in Hungary. The diagnosis of primary hyperparathyroidism rests on the laboratory confirmation of increased serum calcium and inappropriately elevated intact parathyroid hormone concentrations. If surgical intervention is planned, cervical ultrasonography and parathyroid-scintigraphy are indicated for the exact localization of hyperfunctioning parathyroid gland(s). CT and/or MRI are usually not necessary, except in cases of previous neck operation. The operation must be performed by surgeon skilled in parathyroid surgery. The surgical success can be assessed intraoperatively by the use of a gamma probe or by intraoperative measurement of parathyroid hormone concentrations in the serum or in the removed tissue(s). Support of these procedures is recommended. Although many recent publications deal with the minimal invasive methods of parathyroidectomy, the cost-effectiveness of these newer techniques are controversial.
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PMID:[Surgery of primary hyperparathyroidism]. 1722 13

Endoscopic retrograde cholangiopancreatography (ERCP) is highly sensitive for detecting chronic pancreatitis, even when mild, but it is invasive. Magnetic resonance cholangiopancreatography (MRCP), a noninvasive modality, well demonstrates dilatation, stricture, and irregularity of the main pancreatic duct as well as filling defects due to pancreatic stones and protein plugs in chronic pancreatitis. MRCP well visualizes the pancreatic ducts distal to the sites of complete obstruction and noncommunicating pseudocysts, in contrast to ERCP. MRCP is sensitive for detecting moderate to severe pancreatitis but not for mild pancreatitis. However, secretin-stimulated MRCP and technological innovations in magnetic resonance may improve diagnostic accuracy. A recently developed technique, secretin-stimulated diffusion-weighted magnetic resonance imaging (DW-MRI), noninvasively and accurately evaluates pancreatic exocrine function. In conclusion, MRCP can most likely replace ERCP for evaluation of moderate to severe chronic pancreatitis. Secretin-stimulated DW-MRI may help to detect mild or early pancreatitis.
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PMID:Magnetic resonance imaging for diagnosing chronic pancreatitis. 1723 38

Severity stratification is a critical issue in acute pancreatitis that strongly influences diagnostic and therapeutic decision making. According to the widely used Atlanta classification, "severe" disease comprises various local and systemic complications that are associated with an increased risk of mortality. However, results from recent clinical studies indicate that these complications vary in their effect on outcome, and many are not necessarily life threatening on their own. Therefore, "severe," as defined by Atlanta, must be distinguished from "prognostic," aiming at nonsurvival. In the first week after disease onset, pancreatitis-related organ failure is the preferred variable for predicting severity and prognosis because it outweighs morphologic complications. Contrast-enhanced CT and MRI allow for accurate stratification of local severity beyond the first week after symptom onset. Among the biochemical markers, C-reactive protein is still the parameter of choice to assess attack severity, although prognostic estimation is not possible. Other markers, including pancreatic protease activation peptides, interleukins-6 and -8, and polymorphonuclear elastase are useful early indicators of severity. Procalcitonin is one of the most promising single markers for assessment of major complications and prognosis throughout the disease course.
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PMID:Predicting severity of acute pancreatitis. 1741 55

Parasitic infestations of the biliary tract are a common cause of biliary obstruction in tropical countries and can lead to such serious complications as cholangitis and cholangiocarcinoma. Endoscopic therapy has helped in the management of biliary complications caused by these parasites. Ascaris lumbricoides organisms, which normally reside in the jejunum, are actively motile and can invade the papilla, thus migrating into the bile duct and causing biliary obstruction. Endoscopic retrograde cholangiopancreatography is a useful diagnostic tool with potential for therapeutic management of biliary ascariasis. Infestation with Clonorchis sinensis organisms can cause such complications as intrahepatic stones, recurrent pyogenic cholangitis, cirrhosis, cholelithiasis, pancreatitis, and cholangiocarcinoma. Opisthorchis viverrini, Opisthorchis felineus, and Dicrocoelium dendriticum are closely related to C. sinensis and can also cause serious biliary complications. Fascioliasis, caused by Fasciola hepatica and F. gigantica, is a zoonotic helminthiasis that can present as acute hepatic or chronic biliary tract infection. CT, MRI, and ultrasound guidance are useful imaging tools for identifying these parasites and their complications.
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PMID:Parasitic infestations of the biliary tract. 1741 62

The pancreas develops from ventral and dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum. MR cholangiopancreatography (MRCP) is the technique of choice for detecting it non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of this disease. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis.
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PMID:[Pancreas. Congenital changes, acute and chronic pancreatitis]. 1746 82

A 75-year-old man had been admitted to another hospital because of left abdominal pain, and was given a diagnosis of left hydronephrosis and acute pancreatitis. After a JJ stent insertion and medication, he was transferred to our hospital for further examinations. US and EUS revealed a chronic pancreatitis-like pattern and multicystic lesion in the pancreas head and body. At that time enhanced CT findings showed an extrapancreatic low density area to be inflammatory change, extending from the pancreas body to the left crus of the diaphragm and posteriorly the spreading from the left crus of the diaphragm via the left urinary duct into the left iliopsoas muscle, in which MRI revealed partial high intensity. ERCP and MRCP showed focal irregular narrowing of the pancreatic duct of unknown cause, and we decided that an internal pancreatic fistula due to pancreatitis had induced left ureteral obstruction, caused by a protein plug or alcohol. Follow-up 6 months later showed that extrapancreatic spreading of the low density area had markedly regressed without any change in the ureteral obstruction.
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PMID:[A case of intraductal papillary mucinous neoplasm with internal pancreatic fistula causing left ureteral obstruction]. 1767 27

An 18-year-old woman developed pancreatitis and a thrombotic microangiopathy but no electrolyte abnormalities. She required intubation hours after admission and was not able to communicate for 8 days. Upon recovering consciousness, she reported severely impaired vision in both eyes, but ophthalmologic evaluation and neuroimaging were not obtained until several days later. Ophthalmologic examination documented retinal infarcts and profound binocular vision loss with hourglass bilateral homonymous hemianopic visual field loss. MRI showed signal abnormalities restricted to the area of the lateral geniculate bodies (LGBs) with characteristics most suggestive of hemorrhagic infarction. Very few cases of isolated bilateral LBG lesions have been reported. Damage has been attributed to myelinolysis from osmotic demyelination or to infarction from microvascular occlusion. This case conforms more to microvascular infarction. The vulnerability of the LGB to selective microvascular infarction may be based on a combination of its unique architecture and high metabolic demand.
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PMID:Bilateral isolated lateral geniculate body lesions in a patient with pancreatitis and microangiopathy. 1789 15

The diagnosis and treatment of patients with pancreatic strictures presents a multitude of clinical challenges. The etiology of pancreatic strictures is varied, including benign strictures subsequent to acute pancreatitis, trauma, postsurgical, post-endoscopic retrograde cholangiopancreatography (ERCP), and malignancy. Patients with strictures usually present with symptoms of recurrent pancreatitis, abdominal pain, weight loss, and/or steatorrhea. The absence of a prior history of pancreatitis or surgery increases the likelihood of malignancy. High-quality imaging studies of the pancreas, CT, MRI/magnetic resonance cholangiopancreatography, or endoscopic ultrasound (EUS) scanning are utilized for better definition. Imaging detects an associated mass and/or demonstrates the ductal anatomy. Invasive procedures such as ERCP are performed to better define the causal relationships of the patient's symptoms or to obtain tissue diagnosis. Treatment goals include ameliorating symptoms, dilating the stricture, and ruling out cancer. The risk of malignancy underlies much of the intervention, which includes serology, cytologic analysis, and serial imaging. EUS has become the procedure of choice to rule out a mass, to evaluate the parenchyma for evidence of chronic pancreatitis, and to obtain fine-needle biopsies for tissue confirmation. In symptomatic patients or patients with indeterminate strictures, ERCP is used for direct pancreatography, tissue acquisition, and endoscopic treatment. Endotherapy includes sphincterotomy, dilation, and stenting to provide drainage. We view ERCP as the optimal first-line treatment modality. ERCP offers the potential of curative treatment and is less invasive than surgery, especially as some patients' symptoms are not severe enough to justify surgery. If patients do not experience relief of symptoms after several sessions of endoscopic therapy, surgery is the logical next step for definitive, long-term treatment.
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PMID:Treatment of pancreatic strictures. 1789 73

The close proximity of the endoscopic ultrasound probe to the pancreas results in superior spatial resolution compared to CT scan and MRI. In addition, endoscopic ultrasound (EUS) is a minimally invasive procedure that does not share the relatively high complication rate of ERCP. Due to these advantages, EUS has evolved into an important technique to assess pancreatobiliary disease. This review will discuss the role of EUS in patients with pancreatitis. The indications can be divided into acute pancreatitis and chronic pancreatitis. In acute pancreatitis, EUS is used to determine the etiology; in suspected chronic pancreatitis it is helpful to establish the diagnosis. Lastly, this review will discuss biliary pancreatitis with suspicion for persistent choledocholithiasis.
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PMID:Utility of endoscopic ultrasound in pancreatitis: a review. 1808 Dec 19


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