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Gastrointestinal Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Gareth Davies, Chris Black, Keeley Fairbrass
The gut is a muscular tube running from mouth to anus, with three main layers (Figure 10.1), each region adapted for a specific function (Table 10.1; Figure 10.2). Via the ampulla of Vater in the duodenum, the pancreas and liver deliver enzymes and bile acids, respectively, to assist with digestion.
Gastrointestinal and genitourinary systems
Published in Helen Butler, Neel Sharma, Tiago Villanueva, Student Success in Anatomy - SBAs and EMQs, 2022
For each of the following questions, select the most appropriate answer from the above list of options. Each option may be used once, more than once or not at all. The pancreatic duct joins with which other structure to enter the duodenum at the ampulla of Vater?Which structure is found between the neck of the gall bladder and the cystic duct?The hepatic duct joins with which structure to form the common bile duct?Which structure is responsible for the formation of bile?The breakdown of which structure results in the formation of unconjugated bilirubin?
Survival Analysis
Published in Trevor F. Cox, Medical Statistics for Cancer Studies, 2022
This was the fourth trial in a series of five trials to date, for pancreatic cancer by the European study Group for Pancreatic Cancer (ESPAC), although Trial number 2 never came to fruition. Figure 3.22 shows a diagram of the pancreas. The pancreas has two functions, (i) to produce enzymes and secrete them into the small intestine for breaking down food and (ii) to produce insulin which regulates glucose in the body. The most common type of pancreatic cancer is “ductal” where the tumour develops around the pancreatic duct. Ampullary cancers occur in the “Ampulla of Vater” where the pancreatic and bile ducts meet the small intestine. Peri-ampullary cancers occur around the area. Pancreatic cancer has a notoriously poor survival rate with only of patients surviving more than 5 years, but longer for those diagnosed at an early stage. Patients with peri-ampullary cancers can fare better.
Heating of metallic biliary stents during magnetic hyperthermia of patients with pancreatic ductal adenocarcinoma: an in silico study
Published in International Journal of Hyperthermia, 2022
Oriano Bottauscio, Irene Rubia-Rodríguez, Alessandro Arduino, Luca Zilberti, Mario Chiampi, Daniel Ortega
The bile duct is a tube that connects the gallbladder and the duodenum in the small intestine to transport there the bile, where it performs essential tasks for food digestion [11]. This tube is part of the biliary tree, which starts in the liver. The part of this tree that comes out from the gallbladder is called cystic duct which is joined along with the common hepatic duct into the common bile duct. This goes through the pancreas and joins with the pancreatic duct, ending up in the ampulla of Vater in the duodenum. It is very common to see that the tumor blocks this path in pancreatic ductal adenocarcinoma (PDAC) patients, avoiding the bile to reach the small intestine [12]. This is clinically shown as jaundice (yellow colored skin) due to the accumulation of bilirubin in the blood, which is a component of the bile.
Factors associated with acute pancreatitis in patients with impacted duodenal papillary stones: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2022
Ming Li, Ao Wang, Shaohua Ren, Zhenyu Wang, Qing Wang, Chengyue Gou, Weichuan Zhao, Li Zhang, Ning Li
Possible mechanisms underlying AGP include the migration of small calculi to the distal part of the common bile duct leading to transient functional obstruction of the pancreatic duct [27] and impaction of a large calculus in the distal common bile duct resulting in persistent mechanical obstruction of the pancreatic duct. Recognized causes of AGP include microcalculi (<3 mm) and small calculi (<5 mm), as well as cholesterol crystals and biliary sludge that are difficult to detect during imaging examinations [41–43]. It might be expected that the size of the impacted stone would influence the risk of acute pancreatitis, but this has not been investigated previously for AGP caused by IPS. The present study found no significant difference in stone size between the pancreatitis and non-pancreatitis groups. Calculi ≤ 0.5 cm in diameter (which were present in 51.7% of patients with pancreatitis) may migrate more easily than larger stones to the distal part of the common bile duct near the orifice of the pancreatic duct, although we were unable to verify whether the impacted stones caused an obstruction of the ampulla of Vater (leading to pancreaticobiliary reflux) or pancreatic duct. Slightly larger stones (> 0.5 cm and ≤ 1 cm in diameter) might obstruct the pancreatic duct directly or the orifice of the pancreatic duct indirectly by lateral compression of the septum of the pancreaticobiliary duct [28]. Further work is needed to determine how the stone size and the anatomy of the pancreatic and biliary ductal systems might interact to increase the risk of AGP.
Investigational PARP inhibitors for the treatment of biliary tract cancer: spotlight on preclinical and clinical studies
Published in Expert Opinion on Investigational Drugs, 2021
Rutika Mehta, Anthony C Wood, James Yu, Richard Kim
Biliary tract cancers (BTCs) are a rare group of malignancies that account for 3–5% of all cancers worldwide. These include cholangiocarcinoma (CCA), gallbladder cancer (GBC), and cancer of the ampulla of Vater arising from different anatomic regions of the biliary tree. CCA comprises intrahepatic cholangiocarcinoma (iCCA), perihilar CCA, and distal CCA. Perihilar and distal CCAs are together referred to as extrahepatic cholangiocarcinomas (eCCAs) [1]. The only definitive treatment for BTCs remains surgical excision. As the majority of patients present at an advanced stage, the prognosis for BTC is dismal, with 5-year survival of metastatic CCA being 2% [2]. The current standard for frontline treatment of BTC is gemcitabine plus cisplatin which demonstrated overall survival (OS) and progression-free survival (PFS) benefit over single-agent gemcitabine. In spite, the median OS with the combination did not extend beyond 1 year [3]. After progression on gemcitabine and cisplatin, until recently, there was no randomized study to define second line treatment. However, in 2019, Lamarca et al. presented their data from the Phase III randomized study ABC-06. The study compared active symptoms control (ASC) with ASC plus 5-fluropyrimidine/oxaliplatin. The addition of chemotherapy demonstrated median OS of 6.2 months as compared to 5.3 months with ASC alone (p = 0.031) [4].