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Cystic Fibrosis and Pancreatic Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Elissa M. Downs, Jillian K. Mai, Sarah Jane Schwarzenberg
Surgical interventions are guided by underlying risk factors and should be tailored to the patient’s presentation. ERCP with sphincterotomy, ductal dilatation, stenting, and/or stone removal can help relieve pancreatic obstructive processes. Adolescents with gallstone pancreatitis should undergo cholecystectomy to reduce progression of pancreatic inflammation and prevent further episodes of acute-on-chronic pancreatitis. Additional surgical procedures include those that improve pancreatic drainage such as a lateral pancreaticojejunostomy (Puestow) or those that resect a mass such as a pancreaticoduodenostomy (Whipple). These procedures are less commonly done in children versus adults due to different disease presentation and should be avoided in children with hereditary pancreatitis.
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Accompanying investigations include a CXR, which may show atelectasis and left-sided pleural effusions, and also an ultrasound scan, which is inferior to a CT scan, but which may show signs of pancreatic inflammation, such as peri-pancreatic fat stranding, fluid and calcification. CT scan with contrast is the most sensitive study demonstrating pancreatic dysmorphology, fat necrosis and pseudocysts. Patients on prolonged IV fluid managements should have dietary advice input with feeding considerations, including nasojejunostomy and parenteral nutrition. Patients with gallstone pancreatitis should ideally undergo a cholecystectomy operation in the same admission following stabilisation to reduce recurrence. Necrotic pancreatic tissue may require a necrosectomy and even debridement in case of multi-organ failure and CT evidence of necrosis.
Acute pancreatitis
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Robert Adams, Christopher Limb
ERCP Indicated in acute gallstone pancreatitis with persistent biliary obstruction or cholangitis, ideally within 72 hours. It should be used with caution due to the risks of the procedure, which could worsen the clinical situation and should only be requested following senior review.
Clinical importance of main pancreatic duct variants and possible correlation with pancreatic diseases
Published in Scandinavian Journal of Gastroenterology, 2020
Ana Dugic, Sara Nikolic, Steffen Mühldorfer, Milutin Bulajic, Raffaella Pozzi Mucelli, Apostolos V. Tsolakis, J.-Matthias Löhr, Miroslav Vujasinovic
It is proposed that this drainage pattern might have clinical significance in the case of gallstone obstruction. Due to the absence of a decompression mechanism via alternative pancreatic juice drainage through APD, the potential episode of acute pancreatitis in these individuals could be more severe than in the general population. Presumably, this hypothesis might be applied to all cases within group 3 with obliterated APD or absent APD, although this is still a subject of controversy [39]. In accordance with this, patients with pancreas divisum (type 4) could exhibit milder forms of acute gallstone pancreatitis, as postulated in the study conducted by Boon et al. [40]. It is proposed that the dominant drainage through MiP may have a protective role, because only the lesser part of exocrine pancreatic secretion occurs via ventral duct through obstructed MP, leaving a greater dorsal secretion intact [40,41].
Bioburden and transmission of pathogenic bacteria through elevator channel during endoscopic retrograde cholangiopancreatography: application of multiple-locus variable-number tandem-repeat analysis for characterization of clonal strains
Published in Expert Review of Medical Devices, 2019
Masoumeh Azimirad, Masoud Alebouyeh, Amir Sadeghi, Elham Khodamoradi, Hamid Asadzadeh Aghdaei, Amir Houshang Mohammad Alizadeh, Mohammad Reza Zali
Endoscopic retrograde cholangiopancreatography (ERCP) is used increasingly for diagnosis and treatment of pancreatobiliary diseases, including choledocholithiasis, gallstone pancreatitis, and bile duct or pancreatic duct stenosis [1]. Bacterial infection is the most morbid complications of ERCP, which can cause ERCP-related death through septic cholangitis, liver abscess, acute cholecystitis, and pancreatic pseudocyst [2]. During the procedure, bacteria can enter the biliary tract and colonize this tissue via contaminated device and its related instruments [3]. Difficulty in reprocessing, cleaning and disinfection of duodenoscopes, such as elevator mechanism, converted this medical device as a reservoir for life-threatening infections. The infection in this organ causes more frequently through enteric bacterial flora [4]. Several outbreaks were reported in association to used contaminated endoscopes during ERCP procedure in recent years [5–11]. Although these outbreaks were mainly related to Pseudomonas aeruginosa, Klebsiella spp., Enterococcus spp., Escherichia coli, and Staphylococci, sources of these bacteria and their transmission routes were not well characterized.
Choledocholithiasis in elderly patients with gallbladder in situ - is ERCP sufficient?
Published in Scandinavian Journal of Gastroenterology, 2018
Mafalda Sousa, Rolando Pinho, Luísa Proença, Jaime Rodrigues, João Silva, Catarina Gomes, João Carvalho
Choledocholithiasis is a common cause of hospitalization and may lead to cholangitis and gallstone pancreatitis. Once the diagnosis is confirmed, the common bile duct (CBD) stones should be removed usually by endoscopic retrograde cholangiopancreatography (ERCP) [1]. With increased life expectancy, the proportion of elderly patients with choledocholithiasis will increase and with this, the need for ERCP. Current recommendations suggest laparoscopic cholecystectomy in all patients with complications related to common bile duct stones with few relative or absolute contraindications [2]. The approach in patients with non-symptomatic/uncomplicated choledocholithiasis without associated cholelithiasis is more controversial, but generally cholecystectomy is also advocated to prevent biliary events [3,4]. However, adherence to these recommendations is low, especially in older patients [5].