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Acute Pancreatitis. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 469-474.
This chapter on acute pancreatitis is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. Of the approximately 210,000 new cases of acute pancreatitis that occur annually in the United States, about 80 percent are the interstitial or edematous variety and the other 20 percent are the necrotizing variety. Necrotizing pancreatitis accounts for most of the morbidity and nearly all the mortality associated with acute pancreatitis. The chapter covers etiology, clinical presentation, diagnostic tests used to confirm the presence of acute pancreatitis, abdominal imaging studies that may be used, treatment of interstitial acute pancreatitis, treatment of acute necrotizing pancreatitis, prognosis, and the long-term sequelae of acute necrotizing pancreatitis. Treatment options discussed include supportive care, the use of antibiotics, detection of pancreatic infection, the role of endoscopic retrograde cholangiopancreatography, nutritional support for acute necrotizing pancreatitis, and surgical therapy for pancreatic necrosis. 2 figures. 4 tables. 30 references.
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Chronic Pancreatitis. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 469-474.
This chapter on chronic pancreatitis is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. Chronic pancreatitis is an often painful inflammation of the pancreas, characterized by progressive fibrosis that leads to irreversible destruction of exocrine and endocrine tissue. The author notes that chronic pancreatitis is classified broadly into chronic calcifying pancreatitis, chronic obstructive pancreatitis, and chronic autoimmune pancreatitis. The chapter focuses on chronic calcifying pancreatitis, which is characterized by recurrent bouts of clinically acute pancreatitis early in the course of the disease, with eventual development of intraductal stones later in the disease course. Eventually, steatorrhea and diabetes mellitus develop in the majority of these patients. Topics covered include diagnostic tests that may be used, including functional testing; clinical features and natural history; complications, including diabetes mellitus, steatorrhea, pseudocysts, biliary obstruction, duodenal obstruction, and splenic vein thrombosis; and patient care management considerations, particularly coping with chronic abdominal pain. 2 tables. 7 references.
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Hemosuccus Pancreaticus: A Rare Complication in Patients with Chronic Pancreatitis. Practical Gastroenterology. 32(3): 42-47. April 2008.
This article presents a case of a patient with hemosuccus pancreaticus, a rare complication in patients with chronic pancreatitis. Hemosuccus pancreaticus is defined as pancreatic hemorrhage that passes via the pancreatic duct into the duodenum through the ampulla of Vater. The case was a 45-year-old male who presented with melena and complaints of intermittent epigastric pain. Upper endoscopy showed active bleeding from the ampulla of Vater. In addition, chronic calcific pancreatitis and a pseudoaneurysm within a pancreatic pseudocyst were seen on computerized tomography (CT) scan. The authors subsequently performed an angiogram that showed a large bilobed pseudoaneurysm that filled from the gastroduodenal artery and the inferior pancreaticoduodenal artery off the superior mesenteric artery. Extensive embolization was performed, with subsequent resolution of contrast opacification of the pseudoaneurysm. The patient had no further episodes of gastrointestinal bleeding and was discharged from the hospital in stable condition. The authors conclude with a brief discussion of treatment strategies. 3 figures. 33 references.
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Pancreas and Biliary Tree: Questions and Answers. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 497-502.
This section of questions and answers is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. This section helps readers review four chapters about the pancreas and biliary tree, covering acute and chronic pancreatitis, pancreatic neoplasms, and gallstones. The section consists of 15 multiple choice questions, followed by annotated answers that explain each of the correct choices.
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Pancreatic Diseases in the Elderly. Practical Gastroenterology. 32(10): 18-32. October 2008.
As the elderly population increases in the United States, it is estimated that 75 percent of health care expenditures will be focused on the elderly by the year 2030. Pancreatobiliary disorders represent some of the most common and feared conditions that affect the elderly. This article reviews pancreatic diseases in this population, with emphasis on disease and management in the older adult population, specifically those older than 60 to 65 years of age. Topics include pancreatic physiology and morphology in aging, acute pancreatitis, drug-induced pancreatitis, chronic pancreatitis, pancreatic malignancy, pancreatic adenocarcinoma, cystic neoplasms of the pancreas, and intraductal papillary mucinous neoplasms (IPMNs). The authors conclude that technological advances in imaging and treatments will allow more aggressive clinical care plans in patients who as recently as 5 years ago would have received only palliative therapy. They note that the progressive aging of patients is receiving high priority in the strategic planning of leading professional organizations, including those in the field of gastroenterology. 82 references.
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Pancreatitis. JAMA: Journal of the American Medical Association. 299(13):1630. April 2008.
This single-page fact sheet helps readers understand pancreatitis, an inflammation of the pancreas, which is an organ located behind the stomach in the upper abdomen. The pancreas produces enzymes and hormones that help digest food and regulate blood sugar. The fact sheet lists the risk factors for pancreatitis, which include alcohol abuse, gallstones, abdominal trauma, major surgery, inherited diseases that affect the pancreas, high blood levels of calcium, and high blood levels of triglycerides. The fact sheet briefly summarizes three types of pancreatitis: acute pancreatitis, gallstone pancreatitis, and chronic pancreatitis. For each, the symptoms, treatment, and prognosis are summarized. Acute pancreatitis is a life-threatening condition that causes severe abdominal pain and that requires immediate health care. Gallstone pancreatitis often causes jaundice and is commonly treated with gallbladder removal, also called cholecystectomy. Chronic pancreatitis is inflammation that occurs over a long period that results in scarring of the pancreas. Heavy alcohol use is a common cause of chronic pancreatitis. Readers are referred to the websites of three resource organizations: the National Institute of Diabetes and Digestive and Kidney Diseases at www.digestive.nikkd.nih.gov, the National Pancreas Foundation at www.pancreasfoundation.org, and the American Gastroenterological Association at www.gastro.org. Readers are also encouraged to go to the JAMA Patient Pages at www.jama.com for more information. 2 figures.
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Pancreatitis. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 8 p.
This fact sheet describes pancreatitis, defined as inflammation of the pancreas. The pancreas is a large gland behind the stomach that secretes digestive juices, or enzymes, into the duodenum through a tube called the pancreatic duct. Pancreatic enzymes join with bile—a liquid produced in the liver and stored in the gallbladder—to digest food. In addition, the pancreas releases the hormones insulin and glucagon into the bloodstream. These hormones help the body regulate the glucose it takes from food for energy. When the pancreas is inflamed, the enzymes inside it attack and damage the tissues that produce them. Pancreatitis can be acute or chronic. Either form is serious and can lead to complications. In severe cases, bleeding, infection, and permanent tissue damage may occur. The fact sheet answers common questions about the anatomy and function of the pancreas and discusses the symptoms of acute and chronic pancreatitis, the diagnostic tests that may be used to confirm the presence of pancreatitis, treatment strategies, complications, and pancreatitis in children. Common causes of pancreatitis include gallstones and heavy alcohol use, but sometimes the cause of pancreatitis cannot be found. Symptoms of acute pancreatitis include abdominal pain, nausea, vomiting, fever, and a rapid pulse. Treatment for acute pancreatitis includes intravenous (IV) fluids, antibiotics, and pain medications. Surgery is sometimes needed to treat complications. Acute pancreatitis can become chronic if pancreatic tissue is permanently destroyed and scarring develops. Symptoms of chronic pancreatitis include abdominal pain, nausea, vomiting, weight loss, diarrhea, and oily stools. Treatment for chronic pancreatitis may involve IV fluids; pain medication; a low-fat, nutritious diet; and enzyme supplements. Surgery may be necessary to remove part of the pancreas. The fact sheet includes a brief description of current research in this area. Readers are referred to three resource organizations: the American Gastroenterological Association at 301–654–2055 or www.gastro.org, the American Dietetic Association at www.eatright.org, and the American Pancreatic Association at 612–626–9797 or www.american-pancreatic-association.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1 figure.
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Acute Pancreatitis: Diagnosis, Prognosis, and Treatment. American Family Physician. 75(10): 1513-1520. May 15, 2007.
This article reviews the current recommendations for the diagnosis, prognosis, and treatment of acute pancreatitis, a reversible inflammatory process of the pancreas. The authors note that mild acute pancreatitis has a low mortality rate, but patients with severe acute pancreatitis are more likely to develop complications and have a much higher death rate. Some patients require only brief hospitalization, while others may be critically ill with multiple organ dysfunction requiring intensive care monitoring. The severity of the disease is classified by Ranson’s criteria, the Imrie scoring system, the Acute Physiology and Chronic Health Evaluation (APACHE II) scale, and the Computed Tomography Severity Index; the Atlanta classification is also widely used to compare these systems and to standardize clinical trials. The authors discuss the use of new developments in imaging modalities, including endoscopic ultrasonography and magnetic resonance cholangiopancreatography, which increase the options available to physicians for determining the cause of pancreatitis and assessing for complications. The most common risk factors for acute pancreatitis are gallbladder disease and chronic alcohol consumption. Aggressive volume repletion, pain control, close monitoring of hemodynamic and volume statuses, attention to nutritional needs, and monitoring for complications are essential in patients with acute pancreatitis. Enteral nutrition is preferred to parenteral nutrition for improving patient outcomes. A patient care algorithm is also included. 1 figure. 5 tables. 39 references.
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AGA Institute Medical Position Statement on Acute Pancreatitis. Gastroenterology. 132(5): 2019-2021. May 2007.
Acute pancreatitis is a disease of increasing annual incidence and one that produces significant morbidity and mortality and consumes enormous health care resources. This document presents the official recommendations of the American Gastroenterological Association (AGA) Institute on management of acute pancreatitis. The authors note that the management of acute pancreatitis has evolved over several decades, and many treatments that were considered essential in the past have been abandoned based on more recent findings from clinical trials. These guidelines were developed to guide clinicians in the management of patients with both mild and severe acute pancreatitis. Recommendations are provided in the areas of diagnosis, assessment of severity, determination of etiology, and patient care management, including general supportive care, nutritional support, and management of gallstone pancreatitis and necrosis. A final section of four brief recommendations covers the management of fluid collections and pseudocysts, the role of surgery in acute pancreatitis, the prevention of recurrences, and the prevention of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis. 1 reference.
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AGA Institute Technical Review on Acute Pancreatitis. Gastroenterology. 132(5): 2022-2044. May 2007.
Acute pancreatitis is a disease of increasing annual incidence and one that produces significant morbidity and mortality and consumes enormous health care resources. This clinical practice position paper, from the American Gastroenterological Association (AGA) educates and guides physicians in patient care decisions for patients with acute pancreatitis. The authors caution that there is a lack of adequate controlled trials in this area, so the guidelines must include a measure of less solid but evidence-based recommendations, including expert opinion. In addition, acute pancreatitis is so varied that it cannot be effectively managed by closely adhering to a specific set of recommendations. The guidelines cover diagnosis and the role of certain diagnostic tests, the assessment of severity, determination of etiology, and patient care management, including general supportive care, nutritional support, prophylactic antibiotics, and management of complications, including pancreatic necrosis, pancreatic infections, and pseudocysts. Additional sections discuss the role of surgery in acute pancreatitis, the prevention of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis, and the prevention of other forms of pancreatitis. 10 tables. 191 references.
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Case Of Gallbladder Cancer With Extensive Lymphadenopathy Mimicking Klatskin Tumor. Practical Gastroenterology. 31(6): 83-85. June 2007.
This article presents a case report of a 58-year-old woman who presented with 3-week obstructive jaundice. She was found to have metastatic (stage IV) gallbladder adenocarcinoma, with a common bile duct (CBD) stricture mimicking Klatskin tumor. The authors present the differential diagnosis, along with the radiological images that make it a memorable case. Her symptoms include the triad of cholestasis, vague abdominal pain, and weight loss. The differential diagnosis included malignant CBD stricture, CBD stones, benign CBD strictures, primary sclerosing cholangitis, or compression of the CBD by either chronic pancreatitis or pancreatic cancer. They note that gallbladder cancer is an uncommon but highly fatal malignancy. The majority of cases are found incidentally in patients undergoing surgery for cholelithiasis; gallstones are present in 70 to 90 percent of patients with gallbladder cancer. 3 figures. 18 references.
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Diagnostic and Therapeutic Applications of EUS in Pancreatic Disease. Gastroenterology and Hepatology. 3(10): 768-771. October 2007.
This article answers common clinical questions about the diagnostic and therapeutic applications of endoscopic ultrasound (EUS) in pancreatic disease. Topics include the use of EUS compared with cross-sectional imaging techniques such as computerized tomography (CT) or magnetic resonance imaging (MRI), the role of EUS in the detection and management of peripancreatic fluid collections in acute and chronic pancreatitis, the use of EUS for detecting and managing pancreatic cysts, performing cystgastrostomy with EUS, other therapeutic EUS procedures used in patients with pancreatic disease, the interface between EUS and endoscopic retrograde cholangiopancreatography (ERCP), technological advances in EUS techniques, and future applications for EUS. The diagnostic functions for EUS in malignant pancreatic disease include detection and staging in pancreatic adenocarcinoma, ampullary adenomas, and ampullary adenocarcinomas, as well as localization of neuroendocrine tumors of the pancreas. EUS can be used to detect choledocholithiasis and direct the need for ERCP. For therapeutic purposes, EUS is increasingly used for celiac plexus block, transmural pseudocysts drainage, and gallstone extraction. 24 references.
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Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis. Gastroenterology and Hepatology. 3(4): 279-281. April 2007.
This article answers common questions physicians may have regarding endoscopic ultrasound-guided celiac plexus neurolysis, or block, a technique used for patients with chronic abdominal pain where the source for the pain has been located but where standard treatments have not fully controlled the pain. These patients most commonly have chronic pancreatitis (CP), which is the primary diagnosis in which celiac plexus neurolysis has been used. The other indication for this technique is intra-abdominal malignancy, such as advanced pancreatic cancer or metastatic cancer. The author describes how the celiac plexus block is administered, including the special endoscopy tools needed. The average length of relief with this procedure is approximately 3 months, and about 50 to 60 percent of patients undergoing celiac plexus block will achieve some degree of relief. Few complications to this technique have been reported, although some patients have noted transient hypotension and diarrhea. The author concludes by comparing this procedure using the endoscopic ultrasound guide to the earlier computerized tomography (CT)-based method of performing the procedure. 5 references.
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Nutrition in Gastrointestinal Illness. Gastroenterology Clinics of North America. 36(1):1-218. March 2007.
This issue of Gastroenterology Clinics of North America focuses on nutrition in gastrointestinal illness. The issue includes 11 articles: nutritional assessment; the complications of parenteral nutrition; prebiotics, probiotics, and dietary fiber in gastrointestinal disease; nutrition support in acute pancreatitis; food allergies and eosinophilic gastrointestinal illness; nutritional deficiencies in celiac disease; growth factors in people with short-bowel syndrome; home parenteral and enteral nutrition; intestinal transplantation; metabolic bone disease in gastrointestinal illness; and obesity management. The editor of the issue stresses that it is vital for gastroenterologists to understand the role of the gastrointestinal tract in nutrient assimilation and to understand when and how to intervene when nutrient assimilation is compromised in order to prevent the development of systemic nutrient disorders. Each article concludes with a list of references for additional information. A detailed subject index is included with the issue.
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Nutrition Support in Acute Pancreatitis. Gastroenterology Clinics of North America. 36(1): 65-74. 2007.
This article, from a special issue of Gastroenterology Clinics of North America that covers nutrition in gastrointestinal illness, discusses the role of nutrition support in patients with acute pancreatitis. The author stresses that a narrow window of opportunity exists during which there is potential for enteral nutrition (EN) to decrease disease severity and reduce overall complications. Most patients with severe pancreatitis tolerate enteral feeds. Any signs of symptom exacerbation or increasing inflammation in response to EN may be ameliorated by subtle adjustments in the feeding strategy. The author discusses the factors responsible for a systemic inflammatory response syndrome in severe acute pancreatitis, the influence of disease severity on gut integrity and likelihood for EN to change outcome, and appropriate use of EN. The author concludes that provision of EN represents primary therapy in the management of patients with acute pancreatitis and is emerging as the gold standard of therapy in nutrition support for this disease process. 47 references.
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Pancreas Divisum: A Retrospective Review to Evaluate the Risk of Biliary Tract Neoplasms. Practical Gastroenterology. 31(12): 24-34. December 2007.
This review article assesses the association of pancreas divisum (PD) with biliary tract neoplasms. PD is the most common congenital anomaly and is recognized as a potential risk factor for recurrent acute pancreatitis and possibly for chronic pancreatitis. The authors conducted a retrospective review of prospectively collected computer data for all patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) at the Indiana University Hospital (IUH). A total of 10,339 ERCPs were performed on 7,809 patients between 1994 and 2001. Of those patients, 5,570 also underwent pancreatograms; these patients were the focus of this study. Of this sample, 875 (15.7 percent) had PD. Out of all the ERCPs in both patients with or without divisum, a total of 73 cholangiocarcinomas, 46 ampullary carcinomas (ACA), and 42 ampullary adenomas were found. These figures did not differ significantly when compared with the number of biliary tract malignancies seen in patients without PD. The authors conclude there was no statistically significant association found between biliary tract malignancies and PD. 5 tables. 42 references.
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Parenteral Nutrition in Pancreatitis Is Passe: But Are We Ready for Gastric Feeding? A Critical Evaluation of the Literature: Part I. Practical Gastroenterology. 31(9): pp 92-104, 110-112. September 2007.
This article reviews the parenteral and enteral nutrition support that can be used for the 20 to 30 percent of patients with pancreatitis who progress to more severe illness. Topics include the nutritional impact of pancreatitis, malnutrition in patients with pancreatitis, laboratory studies that can diagnose and monitor nutritional difficulties, the use of total parenteral nutrition (TPN) in these patients, jejunal-based enteral nutrition, gastric feeding and the research that supports it, the indications for parenteral nutrition, the use of lipid emulsions, and peripheral parenteral nutrition. A lengthy table comparing the research studies on various feeding methods in patients with pancreatitis is included. The authors note that well-nourished patients with mild pancreatitis rarely require nutrition support. Routine use of parenteral nutrition is unnecessary and may even cause more problems than it solves. The authors conclude that, in patients with severe pancreatitis and those with existing malnutrition that require nutritional support, the weight of current evidence supports jejunal enteral nutrition as the preferred route of nutrition support. 1 table. 44 references.
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Acute Pancreatitis. IN: Lichtenstein, G.; Ginsberg, G.; Ahmad, N., eds. The Clinician’s Guide to Pancreaticobiliary Disorders. Thorofare, NJ: Slack Incorporated. 2006. pp 147-178.
This chapter about acute pancreatitis is from a comprehensive text that covers the epidemiology, pathophysiology, diagnosis, and management of disorders of the pancreatic and biliary systems. The authors of this chapter note that despite improvements in antibiotics, nutrition, imaging, and intensive care, the mortality associated with this disorder is still high. This chapter offers an overview of the evaluation, management, and treatment of this common, prevalent, and morbid disorder. Specific topics include the recommended diagnostic approach, medications associated with a risk of acute pancreatitis, conditions associated with an elevated amylase or lipase, the etiology of pancreatitis, acquired causes of hypertriglyceridemia, the causes of acute pancreatitis, radiological evaluation in acute pancreatitis, predicting severity of disease, the role of endoscopic retrograde cholangiopancreatography (ERCP), the use of antibiotics, the role of nutrition in acute pancreatitis, and complications. The chapter concludes with a summary of the recommended patient care management for this condition. 7 tables. 88 references.
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Acute Pancreatitis. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 362-370.
This chapter on acute pancreatitis is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. Specific topics covered in this chapter include the mortality of acute pancreatitis; the role of gallstones and alcohol in cases of acute pancreatitis; diagnostic tests used to confirm acute pancreatitis, including serum amylase or lipase, or radiographic (X ray) evidence; determination of severity by Ranson's score, APACHE-II criteria, or CT scan; and the use of prophylactic antibiotics in patients with acute necrotizing pancreatitis. The chapter concludes with a lengthy list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 3 figures. 2 tables. 35 references.
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Acute Pancreatitis. BMJ. 332 (7549): 1072-1076. May 6, 2006.
This article reviews the epidemiology, symptoms, etiology, and patient care of acute pancreatitis, a potentially lethal disease that is increasing in incidence. The authors stress that optimal management requires a greater willingness to consider the diagnosis of acute pancreatitis, stratification of severity, and adequate fluid resuscitation. The authors also examine current controversies in acute pancreatitis: how to deliver nutritional support, the role of antibiotic prophylaxis, when to do a computerized tomography (CT) scan, and the role of early endoscopic retrograde cholangiopancreatography (ERCP). Early enteral nutrition is an important mode of acute treatment. The preliminary studies of antibiotic prophylaxis in acute pancreatitis did not show a benefit for development of infected pancreatic necrosis. Patients with acute severe biliary pancreatitis should have early ERCP and endoscopic sphincterotomy within 72 hours of symptom onset. Patients with gallstone pancreatitis should have cholecystectomy, ideally during the same admission. The diagnosis of infected necrosis is an indication for radiological or surgical intervention. 6 figures. 23 references.
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Acute Pancreatitis: The Role of Imaging and Interventional Radiology. Care of the Critically Ill. 22(1): 12-18. February 2006.
This article reviews the role of imaging and interventional radiology in the care of patients with acute pancreatitis. Acute pancreatitis has mild or severe forms; severe acute pancreatitis is associated with pancreatic necrosis (death of the organ) and may result in multiorgan failure or local complications. The authors discuss the incidence and mortality of acute pancreatitis, its etiology, diagnosis, the clinical assessment of severity, early complications, acute fluid collections, pancreatic necrosis, intermediate complications, infected pancreatic necrosis, pancreatic abscesses, pseudocysts, hemorrhage and vascular complications, the imaging of patients with acute pancreatitis, imaging used to identify the etiology of acute pancreatitis, idiopathic pancreatitis, the role of (magnetic resonance imaging) MRI scanning, indicates for computed tomography (CT), managing the complications, and the drainage of pseudocysts. The authors note that contrast-enhanced CT scanning is the mainstay of imaging but ultrasound also has an important role to play. Interventional radiology is now an integral part of the multidisciplinary approach to managing the complications of acute pancreatitis. 5 figures. 1 table. 31 references.
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Autoimmune Pancreatitis. New England Journal of Medicine. 355(26): 2670-2676. December 21, 2006.
This article brings readers up-to-date on the epidemiology, etiology, pathogenesis, clinical features, diagnostic imaging, diagnostic criteria, and therapeutic management of autoimmune pancreatitis. Autoimmune pancreatitis is a form of chronic pancreatitis characterized by an autoimmune inflammatory process in which lymphocyte infiltration with associated fibrosis of the pancreas causes organ dysfunction. Patients with autoimmune pancreatitis present with a wide variety of symptoms, including jaundice and abdominal pain. Most symptoms associated with autoimmune pancreatitis are responsive to corticosteroid therapy. Diagnostic tests used to confirm the diagnosis may include abdominal computerized tomography (CT) scanning, endoscopic ultrasonography, and magnetic resonance imaging (MRI). The accurate diagnosis is vital, as the symptoms of autoimmune pancreatitis can mimic pancreatic cancer and its lesions respond readily to corticosteroids. The authors note that more widespread use of pancreatic biopsy would aid in the diagnosis of autoimmune pancreatitis and support the use of treatment with corticosteroids. The article includes a patient care algorithm.
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Chronic Pancreatitis. Indian Journal of Pediatrics. 73(10): 907-912. October 2006.
This article reviews the etiology and patient care of chronic pancreatitis, a condition characterized by pancreatic inflammation and fibrosis that eventually lead to destruction of the pancreatic parenchyma and loss of exocrine and endocrine function. The author explains the pathogenesis of chronic pancreatitis (CP) with the use of a model of interactions between environmental triggers of pancreatic inflammation and disease susceptibility or modifying genes. The author cautions that early in the disease, when fibrosis is mild and pancreatic damage is still limited, it can be difficult to distinguish CP from recurrent acute pancreatitis (RAP). RAP and CP may represent opposite ends of a spectrum of disease with a common etiology; CP is a later disease stage or disease in individuals who are predisposed to generate a chronic fibrogenic inflammatory response. Pain is a dominant symptom, resulting in part from neuroimmune interactions within the pancreas. Current treatments are largely supportive and reactive. The author concludes that the challenge for health care providers is to achieve diagnosis at an early stage of the disease and to develop treatments that can alter its natural history. 3 figures. 1 table. 19 references.
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Chronic Pancreatitis. IN: Lichtenstein, G.; Ginsberg, G.; Ahmad, N., eds. The Clinician’s Guide to Pancreaticobiliary Disorders. Thorofare, NJ: Slack Incorporated. 2006. pp 179-216.
This chapter about chronic pancreatitis is from a comprehensive text that covers the epidemiology, pathophysiology, diagnosis, and management of disorders of the pancreatic and biliary systems. The authors of this chapter explain how chronic pancreatitis is characterized by the gradual fibrotic destruction of pancreatic tissue. This destruction results in symptoms of abdominal pain and maldigestion, frequently complicated by malnutrition, psychosocial decline, work-loss, narcotic addiction, and large health care expenditures. The chapter covers epidemiology, classification, pathology and pathophysiology, etiology, clinical presentation, diagnostic approaches, complications, patient management, and prognosis. Etiology of chronic pancreatitis can include alcohol abuse, tropic pancreatitis, obstructive chronic pancreatitis, autoimmune pancreatitis, genetic causes, and idiopathic chronic pancreatitis. Clinical presentation can include abdominal pain, steatorrhea and maldigestion, diabetes mellitus, and weight loss. Complications that may be encountered include pseudocysts, gastric outlet and biliary obstruction, pancreatic adenocarcinoma, pancreatic fistula and ascites, and splenic vein thrombosis and splenic artery pseudoaneurysm. The chapter is illustrated with black-and-white photographs. 17 figures. 4 tables. 191 references.
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Clinical Implications of Oxidative Stress and Antioxidant Therapy in Gastrointestinal Disease. IN: Buchman, A., ed. Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 329-342.
This chapter about oxidative stress and antioxidant therapy is from a comprehensive textbook that compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders that affect the gastrointestinal (GI) tract. The authors consider the clinical implications of oxidative stress and antioxidant therapy in GI disease, including liver disease, inflammatory bowel disease (IBD), and pancreatic disease. The chapter gives an overview of oxidative stress, including the causes of oxidative stress in vivo, and the mechanisms of defense against oxidative stress. The authors discuss oxidative stress in specific conditions, including alcoholic liver disease, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis, hepatitis C, toxin or metabolic induced liver disease, IBD, and acute and chronic pancreatitis. The next section reviews altered antioxidant defenses, abnormal detoxification pathways, immune regulation, and the possible roles of antioxidant therapy in IBD. The authors conclude that oxidative stress is increasingly recognized as an etiologic factor in many forms of GI diseases. Antioxidant therapy is an attractive and inexpensive intervention in many GI diseases. However, the authors caution that dosing, appropriate combinations of agents, and targeting of agents still need to be addressed in individual organ systems. 6 figures. 136 references.
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Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. 674 p.
This comprehensive textbook compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders of the stomach, intestines, liver, pancreas, and colon, as well as other diseases that affect the gastrointestinal (GI) tract. The 53 chapters are organized into seven sections: nutritional assessment, general nutrition, nutrition in GI disease, nutrition in the critical care environment, management of intestinal failure, nutritional support, and obesity. Specific topics include body composition analysis, micronutrient deficiencies, the clinical consequences of undernutrition, the malabsorption syndrome, general nutrition, Dietary Reference Intakes (DRIs), the dietary treatment of GI diseases, macronutrient digestion and metabolism, food allergies, dietary supplements, prebiotics and probiotics, dietary fiber, food and water safety, metabolic bone disease in GI illness, nutrition in the elderly, nutrition and alcoholism, nutrition and diabetes mellitus, nutrition and colorectal cancer, nutritional support in inflammatory bowel disease, celiac disease, nutrition and liver disease, nutrition in chronic pancreatitis, nutritional support in acute pancreatitis, nutrition and GI motility in health and disease, inborn errors of metabolism for the gastroenterologist, nutrition and cystic fibrosis, nutrition and GI oncology, the metabolic response to critical illness, the clinical implications of oxidative stress and antioxidant therapy in GI disease, perioperative nutritional support, dietary management in short bowel syndrome, nontransplant surgery for short bowel syndrome, intestinal transplantation, the use of growth factors in short bowel syndrome, indications and contraindications to enteral and parenteral nutrition (PN), vascular access for the patient receiving PN, PN formulas, pediatric PN, complications of long-term PN, complications of enteral nutrition (EN), home PN in infants, children, and adults, administration routes for EN, formulas and supplements for adult EN, pediatric enteral formulas, home EN, refeeding syndrome, the medical, legal, and ethical aspects of nutritional support, the medical management of obesity, control of food intake, the surgical management of obesity, the GI complications of bariatric surgery, the genetic and nutritional aspects of hyperlipidemia, the management of childhood obesity, and the nutritional support of obese and bariatric patients. Each chapter includes black-and-white figures and tables and concludes with a list of references. A detailed subject index concludes the volume.
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Clinician’s Guide to Pancreaticobiliary Disorders. Thorofare, NJ: Slack Incorporated. 2006. 384 p.
This comprehensive text covers the epidemiology, pathophysiology, diagnosis, and management of disorders of the pancreatic and biliary systems. Designed as a practical guide for clinicians, the book offers 17 chapters: development and function of the pancreas, bile duct, and gallbladder; gallstones and gallbladder disorders; choledocholithiasis; bile duct injuries; ampullary disorders; cholangiocarcinoma; infections of the biliary system; acute pancreatitis; chronic pancreatitis; pancreatic ductal complications; solid pancreatic tumor; pancreatic cystic lesions; surgical approaches to pancreatic cancer; biliary tract surgery; imaging of the pancreatobiliary system using endoscopic ultrasound; magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography of the pancreatobiliary system; and the role of the interventional radiologist in diagnosis and treatment of pancreaticobiliary diseases. Each chapter includes black-and-white figures, tables, and photographs; references are provided. One section of full-color photographs is included. The text concludes with a detailed subject index.
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Dietary Treatment of Gastrointestinal Diseases. IN: Buchman, A., ed. Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 63-76.
This chapter about the dietary treatment of gastrointestinal (GI) diseases is from a comprehensive textbook that compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders that affect the GI tract. The author defines medical nutrition therapy (MNT) as diet modification, nutrient supplementation, nutrition support, and nutrition counseling as modes of therapy for disease. The chapter focuses on dietary modifications that are used to treat hospitalized or ambulatory patients with diseases of the mouth, esophagus, stomach, intestine, liver, and pancreas. The chapter covers modifications in consistency, including the clear liquid diet, the soft low-residue diet, mechanically altered diets, and the liquid diet following oral surgery; a diet for gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD); a diet following gastrectomy, including dietary modifications for dumping syndrome, and those for gastric bypass or gastric stapling for obesity; a diet for lactose intolerance or hypolactasia; a gluten-restricted diet for celiac disease; MNT for inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, and the role of foods or dietary patterns in the etiology of IBD; a diet for ileostomy and colostomy; a diet for short bowel syndrome; a diet for acute and chronic pancreatitis; a diet to control diarrhea; a diet for constipation and diverticulosis; and sodium and protein restricted diets for liver disease, including concerns about ascites and sodium intake, and the use of protein restriction and branched chain amino acid formulas in patients with chronic liver disease and hepatic encephalopathy. The author concludes by cautioning that these diets should be used with moderation, particularly when they do not provide all nutrients. They may exacerbate existing nutrition problems and malabsorption, altered metabolism, and increased secretory losses of nutrients. 4 tables. 95 references.
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Gallstone Disease: Primary and Secondary Prevention. Best Practice & Research Clinical Gastroenterology. 20(6): 1063-1073. 2006.
This article reviews the primary and secondary prevention of gallstone disease. The authors first explore several risk factors for cholesterol gallstone formation, including prolonged fasting, rapid weight loss, total parenteral nutrition (TPN), and somatostatin treatment. In both asymptomatic and symptomatic gallstone patients, it has been claimed that treatment with the hydrophilic bile salt ursodeoxycholic acid (UDCA) reduces the risk of biliary colic and gallstone complications such as acute cholecystitis and acute pancreatitis. Prophylactic cholecystectomy may be beneficial in certain subgroups of asymptomatic gallstone carriers. The authors stress that randomized, double-blind, placebo-controlled trials that could support these contentions are lacking. However, in the general population, high fiber intake, low saturated fatty acid consumption, and nut consumption are associated with reduced risk of gallstones. Also, moderate physical activity appears to prevent gallstones. 3 tables. 95 references.
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Imaging of the Pancreatobiliary System Using Endoscopic Ultrasound. IN: Lichtenstein, G.; Ginsberg, G.; Ahmad, N., eds. The Clinician’s Guide to Pancreaticobiliary Disorders. Thorofare, NJ: Slack Incorporated. 2006. pp 311-326.
This chapter about endoscopic ultrasound imaging of the pancreatobiliary system is from a comprehensive text that covers the epidemiology, pathophysiology, diagnosis, and management of disorders of the pancreatic and biliary systems. The authors of this chapter note that endoscopic ultrasound (EUS) is an imaging technique that combines endoscopy and ultrasonography; an ultrasound transducer is mounted on the tip of the endoscope, allowing accurate imaging of lesions located within and adjacent to the gastrointestinal wall. The chapter covers instruments used in this technique, including echoendoscopes and intraductal probes; endosonography of the biliary system, including that done for choledocholithiasis and bile duct strictures; endosonography of the pancreas, including chronic pancreatitis and pancreatic endocrine tumors; endosonography of the gallbladder, finding microlithiasis or sludge, gallbladder polyps, and for gallbladder cancer staging; endosonography in ampullary carcinoma; endoscopic ultrasound-guided fine-needle aspiration; endosonography-guided celiac plexus neurolysis; and complications that may be encountered in EUS. The authors conclude by reiterating the strengths of EUS in obtaining high-resolution images of small lesions and to access those areas for tissue acquisition and potential therapeutic uses with a minimally invasive technique. The chapter is illustrated with black-and-white photographs of EUS studies. 8 figures. 9 references.
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Indications and Contraindications to Enteral and Parenteral Nutrition. IN: Buchman, A., ed. Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 395-408.
This chapter about enteral nutrition (EN) and parenteral nutrition (PN) is from a comprehensive textbook that compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders that affect the gastrointestinal (GI) tract. The author outlines the indications and contraindications to EN and PN. The chapter considers the difficulties of assessing treatment methods and determining resource allocation and covers nutrition support in specific states, including perioperative nutrition support, liver disease, acute pancreatitis, inflammatory bowel disease, critical illness, patients undergoing chemotherapy or radiation therapy for cancer, pediatrics, pulmonary diseases including cystic fibrosis, AIDS, renal failure, cardiac disease, geriatrics, pregnancy, allergic disorders, and primary starvation. The author considers the potential limitations of the research data and summarizes the indications and contraindications for nutrition support. The author reminds readers that supplemental nutrition may be associated with complications, notably infection, and that stricter patient selection should be applied. 5 tables. 88 references.
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Malabsorption Syndrome. EndoNurse. 6(2): 40-41. April-May 2006.
This article familiarizes nurses with malabsorption syndrome, defined as an alteration in the ability of the intestine to absorb nutrients adequately into the bloodstream. Many different conditions affect fluid and nutrient absorption by the intestine, including cystic fibrosis, chronic pancreatitis, celiac disease (gluten intolerance), short bowel syndrome, Whipple’s disease, inflammatory bowel disease, and irritable bowel syndrome. The author outlines the symptoms of malabsorption syndrome, which can include anemia, diarrhea, steatorrhea (excessive fat in the stool), abdominal cramping, bloating, edema, malnutrition and weight loss, muscle cramping, perianal skin burning or itching, and the development of secondary nutritional deficiencies. The author stresses that fluid and nutrient monitoring and replacement are essential for any individual with malabsorption syndrome. Consultation with a dietitian to assist with nutritional support and meal planning is helpful. Medical management for malabsorption is dependent upon the cause, for example, treatment for celiac disease means the use of a lifelong gluten-free diet. References for the article are available at www.endonurse.com.
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New Approaches for the Treatment of Acute Pancreatitis. Journal of the Pancreas. 7(1): 79-91. January 2006.
This article reprints a slide show that outlines new approaches for the treatment of acute pancreatitis (AP). The authors present the main problem of acute pancreatitis, particularly in the severe form of the disease, as the difficulty of planning clinical studies that are capable of giving definitive, statistically-significant answers about the human benefits of the various proposed treatments that are developed through animal studies. The authors discuss the pathophysiology of acute pancreatitis; the re-evaluation of the drugs already available, such as gabexate mesylate, lexipafant, and somatostatin; the prevention of the infection of pancreatic necrosis; the Probiotic Prophylaxis in Patients with Predicted Severe Acute Pancreatitis (PROPATRIA) study; and the prevention of pain relapse after oral feeding in patients with mild or severe acute pancreatitis. The bulk of the article discusses several new therapeutic options for the management of acute pancreatitis, including therapeutic endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy, the use of early antibiotic treatment in necrotizing pancreatitis, and the use of enteral feeding. Numerous slides are reprinted, with brief captions for each. 51 figures. 51 references.
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Nutrition in Chronic Pancreatitis. IN: Buchman, A., ed. Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 253-262.
This chapter about nutrition in chronic pancreatitis is from a comprehensive textbook that compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders that affect the gastrointestinal (GI) tract. The authors remind readers that chronic pancreatitis produces a prolonged inflammatory state, resulting in a steadily progressive destruction of the pancreatic gland. Patients with chronic pancreatitis are predisposed to protein-energy malnutrition (PEM). The chapter covers the clinical manifestations of chronic pancreatitis, factors precipitating PEM, nutritional therapy, and adjunctive medical therapy for malnutrition. The authors stress that the success of nutritional therapy in this patient population depends on abstinence from alcohol and control of abdominal pain. Nutritional support varies depending on disease severity, from diet restriction with continued oral intake to provision of enteral or parenteral nutrients. Supplementation with pancreatic enzymes helps control pain and improve maldigestion. The authors conclude that careful patient assessment, design of the proper nutritional regimen, and documentation of response to therapy are all required to reduce the morbidity from this disease process. 3 tables. 85 references.
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Nutritional Support in Acute Pancreatitis. IN: Buchman, A., ed. Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 263-270.
This chapter about nutritional support in acute pancreatitis is from a comprehensive textbook that compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders that affect the gastrointestinal (GI) tract. The author reviews the pathophysiology of acute pancreatitis and considers the indications for enteral nutrition (EN) and parenteral nutrition (PN) in the management of acute pancreatitis. The chapter concludes with a detailed outline of the recommended practical management of patients who present to the hospital with acute pancreatitis. Enteral feeding is recommended over parenteral feeding. However, because it has not been proven that enteral feeding does not exacerbate pancreatitis, the author recommends distal jejunal feeding. The chapter includes a patient care algorithm for managing these patients. 7 figures. 20 references.
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Pancreatic Ductal Complications. IN: Lichtenstein, G.; Ginsberg, G.; Ahmad, N., eds. The Clinician’s Guide to Pancreaticobiliary Disorders. Thorofare, NJ: Slack Incorporated. 2006. pp 217-238.
This chapter about pancreatic ductal complications is from a comprehensive text that covers the epidemiology, pathophysiology, diagnosis, and management of disorders of the pancreatic and biliary systems. The author of this chapter notes that benign and malignant pancreatic diseases produce a variety of pancreatic duct (PD) abnormalities, including strictures, stones, and leaks. Strictures present as a narrowing of the PD, which most often occurs in the setting of pancreatitis or pancreatic cancer. Stones almost always occur in the setting of chronic pancreatitis and can be seen as filling defects within the opacified PD. Pancreatic duct leaks are characterized by extravasation of contrast media from the pancreatic duct and into surrounding tissues. Pancreatic duct leaks can lead to pseudocysts, fistula formation, and ascites. The author reviews the clinical manifestations, diagnostic approach, and treatment strategies for these complications. A final section briefly considers the expanding role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) in the evaluation and treatment of pancreatic ductal complications. The chapter is illustrated with black-and-white photographs. 9 figures. 5 tables. 28 references.
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Pathophysiology of Alcoholic Pancreatitis: An Overview. World Journal of Gastroenterology. 12(46): 7421-7427. December 14, 2006.
This article reviews the pathophysiology of alcoholic pancreatitis, a very painful and potentially fatal condition. Between 60 and 90 percent of pancreatitis patients have a history of chronic alcohol consumption. The authors review the updated literature on alcohol metabolism, its effects on gastrointestinal and pancreatic function and in causing pancreatic injury, and the genetic predisposition of alcohol-induced pancreatitis. The article also reviews prospective mechanisms of alcohol activating the signal transduction pathways and induction of oxidative stress parameters. A final section considers the cumulative effect of cigarette smoking and alcohol on chronic pancreatitis. The authors conclude that, despite numerous research studies, the pathogenesis of alcoholic pancreatitis remains obscure. 1 figure. 102 references.
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Role of Antibiotic Prophylaxis in the Treatment of Acute Pancreatitis. Journal of Clinical Gastroenterology. 40(2): 149-155. February 2006.
Acute pancreatitis is an inflammatory disorder, but it is not generally caused by infectious agents (such as bacteria). Yet the majority of patients who die of necrotizing pancreatitis do so as a consequence of infectious complications. This review article considers the role of antibiotic prophylaxis in the treatment of acute pancreatitis. The authors focus on studies that have investigated whether and which antibiotics penetrate sufficiently well into pancreatic necrosis and whether prophylactic antibiotic treatment of patients with acute pancreatitis is of clinical benefit. The authors conclude that there is still a case for treating necrotizing pancreatitis patients with broad-spectrum antibiotics (specifically carbapenems), but the extent of the beneficial effect and the number of patients expected to profit from this approach should not be overestimated. 5 tables. 63 references.
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Sex-Based Differences in Pancreatic and Biliary Disease. Practical Gastroenterology. 30(04): 49-67 p. April, 2006.
This article reviews the sex-based differences in pancreatic and biliary disease. The authors discuss algorithms for expediting diagnosis and treatment based on gender differences. The authors consider the hypotheses that anatomic, physiologic, and hormonal factors may contribute to sex-based differences in pancreatic and biliary diseases. Benign processes such as gallstones and gallbladder disease, choledochal cysts, and sphincter of Oddi dysfunction are significantly more common in females. Cystic neoplasia of the pancreas with malignant potential is also seen predominantly in females—more than 80 percent. By comparison, males are more commonly afflicted by primary sclerosing cholangitis (PSC), acalculous cholecystitis, and intraductal papillary mucinous neoplasms. Alcohol and gallstones account for approximately 70 percent of all cases of pancreatitis. The relative risk of developing acute pancreatitis due to gallstones is greater in men; however, there is a higher prevalence of gallstones in women, and gallstone pancreatitis is more common in women. 4 tables. 7 references.
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Diagnosis and Management of Chronic Pancreatitis. Postgraduate Medicine Journal. 81: 491-497. August, 2005.
This article reviews the diagnosis and management of chronic pancreatitis, an inflammatory condition that results in permanent structural changes in the pancreas that lead to impairment of the exocrine and endocrine functions of the organ. Topics include pathophysiology, diagnosis, differentiation of large duct versus small duct disease, management of malabsorption, management of pain, pancreatic enzymes, the use of octreotide, cholecystokinin antagonists, nerve blocks, oxidative stress, endoscopic treatment, surgery, pancreatectomy, and autologous islet cell transplantation. The authors emphasize the various manifestations that patients with chronic pancreatitis may exhibit and describe recent advances in medical and surgical therapy. In patients who have failed optimal medical management, endoscopic pancreatic therapy should be pursued before considering surgical options. 3 tables. 63 references.
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Gastrointestinal Conditions. Journal of the American College of Surgeons. 201(5): 940- 947. December 2005.
This article reports on new developments in surgery for gastrointestinal conditions, emphasizing new approaches to common diseases, and highlighting several common gastrointestinal diseases in which there is an emerging consensus. The author reviewed the major surgery journals for selection of articles about major advances in this area. Topics include hernia, small bowel obstruction, nasogastric decompression, bariatric surgery, gastroesophageal reflux disease, peptic ulcer disease, gastric cancer, hepatic (liver) resection, liver transplantation, portal hypertension, laparoscopic bile duct injuries, chronic pancreatitis, acute pancreatitis, hemorrhoids, preoperative bowel preparation, acute diverticulitis, and laparoscopic colectomy. In each area, the author briefly summarizes the main research studies of the past year. 44 references.
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Recurrent Acute and Chronic Pancreatitis: Complex Disorders with a Genetic Basis. Gastroenterology and Hepatology. 1(3): 195-205. October 2005.
Once viewed as a condition affecting mostly alcoholics, pancreatitis is now recognized in individuals of both genders and all ages and ethnicities. This article reviews recurrent acute and chronic pancreatitis, focusing on the genetic basis of these complex disorders. The authors note that researchers have sequenced a number of genes that have been shown to be predisposing risk factors for recurrent acute and chronic pancreatitis. In addition, genetic polymorphisms for signaling molecules driving inflammation and for enzymes protecting against oxidative stresses influence the severity of pancreatic inflammation in a particular individual. The Sentinel Acute Pancreatitis Event hypothesis model links events of acute pancreatitis to the process of chronic pancreatitis: Risk factors for these are similar and the same genetic mutations have been linked to both entities. The authors propose that it is the intersection of genetic predisposition to pancreatic injury, genetic predisposition for healing with a fibrosis pattern, and an appropriate environmental trigger that culminates in chronic pancreatitis. Thus, they conclude that recurrent acute and chronic pancreatitis are complex disorders with genetic bases. A final section briefly reviews patient management strategies, which are unfortunately limited to controlling symptoms rather than prevention or slowing progression of disease. 3 figures. 4 tables. 68 references.
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Inside Endoscopic Ultrasound. EndoNurse. 4(1): 34, 36-37. February/March 2004.
This article familiarizes nurses with recent technological advances in endoscopic ultrasound (EUS), a system that uses high frequency sound waves to provide imaging and information about the digestive tract and the surrounding tissues and organs. The article describes the uses of this technique, which include staging of cancers of the esophagus, lungs, stomach, pancreas, and rectum; evaluating chronic pancreatitis and other masses or cysts of the pancreas; studying bile duct abnormalities, including stones; studying the muscles of the lower rectum and anal canal in evaluating reasons for fecal incontinence; and studying submucosal lesions that may be present in the intestinal wall. The author describes the advantages that EUS has over other diagnostic and therapeutic imaging systems, reviews the disadvantages of this technique, and considers the nurse training that may be required in becoming familiar with the technique (particularly the aspiration biopsy needle apparatus). The author concludes with a section discussing the possible future advancements and uses of EUS. 2 references.
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Mayo Clinic Gastrointestinal Surgery. St. Louis, MO: Elsevier Science. 2004. 1020 p.
This book focuses on the major diseases treated by gastrointestinal surgeons, from the esophagus to the anal canal. The presentation has a definite clinical orientation and a major emphasis on practical applications as they are applied at the Mayo Clinic. Sections on etiology, pathophysiology, pathology, and diagnosis are also included by are purposely not the emphasis of the chapters. The book offers 49 chapters: the experience of being a Mayo Clinic surgeon; gastroesophageal reflux disease (GERD) and esophageal hiatal hernia; achalasia and other esophageal motility disorders; epiphrenic esophageal diverticula; cancer of the esophagus; gastric adenocarcinoma, primary gastric lymphoma; peptic ulcer; disorders of gastrointestinal motility and emptying after gastric operations; morbid obesity; hepatocellular carcinoma and intrahepatic cholangiocarcinoma; hepatic metastases from extrahepatic cancers; benign tumors and cysts of the liver; liver diseases necessitating liver transplantation; biliary stone disease; benign biliary strictures; cancer of the gallbladder; pancreatic and periampullary carcinoma; islet cell tumors; acute and chronic pancreatitis; pancreas transplantation after complications of diabetes mellitus; cystic tumors of the pancreas; thrombocytopenia and other hematologic disorders; malignant tumors of the small intestine; villous tumors of the duodenum; small intestinal diverticula; Crohn's disease; small bowel obstruction; acute mesenteric ischemia; acute mesenteric venous thrombosis; chronic mesenteric ischemia; visceral artery aneurysms; colonic motor disorders (constipation); diverticular disease of the colon; colon cancer; ischemic colitis; appendicitis; chronic ulcerative colitis; colonic volvulus; familial adenomatous polyposis; cancer of the rectum; common anorectal problems; rectal prolapse and solitary rectal ulcer syndrome; abdominal trauma; unclosable abdomen and the dehisced wound; ventral and incisional hernias; open repair of inguinal hernia; endoscopic inguinal hernia repair; and common pediatric gastrointestinal disorders. Each chapter is illustrated with line drawings, black and white photographs, and some color plates. References are provided with each chapter and a detailed subject index concludes the text.
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Medical Treatment of Acute Pancreatitis. Gastroenterology Clinics of North America. 33(4): 855-869. December 2004.
Acute pancreatitis (AP) is one of the most common diseases in gastroenterology. This article reviews the medical treatment of acute pancreatitis. Topics covered include prognostic markers for the severity of acute pancreatitis; enteral nutrition versus total parenteral nutrition; nasogastric tube or orally feeding; prevention of ulcers and gastritis in pancreatitis patients; fluid resuscitation and rehydration; treatment of pain; the role of antibiotics in treatment of acute pancreatitis; endoscopic sphincterotomy; and obsolete treatment concepts. During the last decade, an increasing incidence of AP was observed, mostly because of a higher sensitivity of diagnostic tests. The authors stress that discrimination between mild edematous disease (75 percent to 85 percent of all cases) with mortality below 1 percent, and severe hemorrhagic-necrotizing pancreatitis (15 percent to 25 percent of all cases) with a fatal outcome in 10 percent to 24 percent is important. Both clinical courses can occur regardless of the underlying etiology of the disease. Eighty percent of all cases of AP are linked etiologically to gallstone disease or immoderate alcohol consumption, while pancreatitis caused by hypercalcemia (excessive amounts of calcium in the blood), hyperlipidemia (high levels of blood lipids, including cholesterol), or infectious agents is rare. The authors emphasis that the requirement for frequent clinical assessments, laboratory studies, and reevaluation of organ destruction employing CT or MRI strongly argues against treating these patients on an outpatient basis. 2 figures. 2 tables. 54 references.
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What's New in General Surgery: Gastrointestinal Conditions. Journal of the American College of Surgeons. 199(5): 748-756. November 2004.
This article reviews recent publications and research reports regarding treatment for benign and malignant disease of the gastrointestinal system. The author focuses on randomized prospective trial of controversial topics in gastrointestinal surgery. Topics include the surgical treatment of gastroesophageal reflux disease (GERD), endoscopic treatment of GERD, Barrett's esophagus, achalasia (swallowing disorders), esophageal malignancy (cancer), bariatric surgery (procedures for clinical severe obesity), surgery for gastric cancer (including adenocarcinoma and gastric lymphoma), benign biliary problems (gallstones, common bile duct stones, cholecystectomy-related problems), portal hypertension, liver ascites, liver cancer, chronic pancreatitis, pancreatic cancer, and small intestine problems, including fistulas associated with Crohn's disease. In each section, the author briefly reviews the findings of recent research studies. 50 references.
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