Acute biliary pancreatitis.

Autor: Curran FT; Academic Department of Surgery, City Hospital, Birmingham., Neoptolemos JP
Jazyk: angličtina
Zdroj: Annali italiani di chirurgia [Ann Ital Chir] 1995 Mar-Apr; Vol. 66 (2), pp. 197-202.
Abstrakt: The development of acute pancreatitis occurs in 4-8% of patients with symptomatic gallstones. Individuals predisposed to acute pancreatitis tend to have small gallstones (with or without larger gallstones), a wide cystic duct and a common channel between the biliary and pancreatic ducts. The importance of this relationship is demonstrated by the ability of urgent endoscopic sphincterotomy (ES) to improve the outcome of a predicted severe attack and to virtually abolish recurrent attacks in patients who are unable to undergo cholecystectomy. Cholesterolosis is an established cause of acute pancreatitis, occurring in up to 29% of cases with cholesterolosis. Biliary crystals are an important marker of microlithiasis or a propensity to form further gallstones following their passage into the duodenum following an attack. A combination of ultrasonography and a serum liver transaminase of > 60 IU/I (< 48 hr o an attack) are necessary to provide optimum sensitivity and specificity for gallstones as a prompt for the use of ERCP and ES in severe cases. Biliary sludge as a cause of acute pancreatitis is not proven. 25-30% of patients will develop complications with a mortality of around 8%. Urgent diagnosis of gallstones and treatment by ES can result in substantial improvement in outcome.
Databáze: MEDLINE