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Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
There is little evidence that early ERCP and sphincterotomy is helpful. Pseudocysts: These usually develop late and no treatment is required if they are small. Large and recurrent collections need drainage or surgical excision.Pancreatic abscess formation: Abscess is suggested by fever, neutrophil leucocytosis and deterioration about 1–2 weeks after the initial presentation. Intensive treatment with antibiotics and either surgical or percutaneous drainage is required.Necrotizing pancreatitis: Necrosectomy is usually indicated and can be done by laparoscopic necrosectomy, video-assisted retroperitoneal debridement (VARD), minimal access retroperitoneal pancreatic necrosectomy (MARPN) or the endoscopic transgastric route.
The liver, gallbladder and pancreas
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Dina G. Tiniakos, Alastair D. Burt
Sepsis in a necrotic pancreas may result in widespread suppuration or a pancreatic abscess. The causal organisms are Escherichia coli and other gut commensals. Another local effect is the formation of a pseudocyst – a localized collection of pancreatic juice and necrotic debris resulting from the disruption of the pancreatic ductal drainage. It is lined by granulation tissue and commonly forms in the lesser sac.
Diseases of the Hepatobiliary Tree and Pancreas Associated with Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Pancreatic abscess is usually a complication of pancreatitis or pseudocyst;232 rare causes include tuberculosis,233 and penetration of a peptic ulcer or duodenal diverticulum.234 The symptoms and signs are frequently nonspecific, and diagnosis is often difficult. The presence of moderate or spiking fever, accompanied by anorexia, weight loss, and abdominal (especially epigastric) tenderness, following pancreatitis (acute or chronic), abdominal trauma or biliary tract surgery should raise the clinician’s suspicion of this potentially life-threatening condition. CT scan may reveal gas within the pancreatic bed. Ultrasonography may disclose fluid-filled cavities with numerous internal echoes in the lesser sac. In all cases of suspected pancreatic abscess, radiologically guided percutaneous drainage is mandatory.235
Inherited causes of exocrine pancreatic insufficiency in pediatric patients: clinical presentation and laboratory testing
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Tatiana N. Yuzyuk, Heather A. Nelson, Lisa M. Johnson
HP generally presents as acute episodes of pancreatitis, manifesting with significant abdominal pain, nausea and vomiting, fever, and elevated amylase and/or lipase levels [43]. On imaging, pancreatic edema, acute fluid collections, peripancreatic inflammation, pancreatic or peripancreatic necrosis, and pancreatic abscess or pseudocysts may be observed [44]. Age at the onset can vary widely, but the median age of presentation is typically between 10–12 years [45]. Due to the inherent genetic defects, patients experience recurrent episodes of AP that rapidly progress to chronic pancreatitis, usually by early adulthood. Manifestations of chronic pancreatitis include fibrosis, calcification, and ductal fissure, which ultimately lead to EPI, fat malabsorption, and steatorrhea. Associated complications include weight loss, chronic pain, and frequent hospitalization [46].
Pancreatic echinococcosis
Published in Baylor University Medical Center Proceedings, 2019
Priti Soin, Pranav Sharma, Puneet Singh Kochar
Pancreatic echinococcosis is usually asymptomatic, due to its slow growth rate of 0.3 to 2.0 cm per year.1 Clinical presentation depends on the location. Pancreatic head cysts usually present as obstructive jaundice due to extrinsic compression of the common bile duct and mimic a choledochal cyst.7,8 Pancreatic body and tail cysts stay asymptomatic and usually present as an abdominal lump when they enlarge. Additional symptoms include epigastric pain, nausea, and vomiting.1 Complications include cholangitis, rupture into the biliary system or peritoneal cavity, pancreatic fistula, recurrent pancreatitis, and pancreatic abscess formation.7
Pharmacological and clinical profile of cefiderocol, a siderophore cephalosporin against gram-negative pathogens
Published in Expert Review of Clinical Pharmacology, 2021
Anselm Jorda, Markus Zeitlinger
Although no large cohort studies are available until now, several publications have already reported about the clinical experience with cefiderocol. Falcone et. al. provided a case serious of 10 critically ill patients with either bacteremia or VAP caused by carbapenem-resistant A. baumannii, S. maltophilia, or NDM-producing K. pneumoniae. All were treated with cefiderocol. Clinical success and survival rates after 30 days were 70% and 90%, respectively [85]. Furthermore, patients with various other infections caused by A. baumannii (including osteomyelitis, implant-associated infection, pleural empyema, and spondylodiscitis) were successfully treated with cefiderocol [86,87]. Patients with peritonitis, valve endocarditis, and implant-associated osteomyelitis caused by multidrug-resistant P. aeruginosa strains were also cured with cefiderocol [88–90]. A combination therapy of colistin and tigecycline against a prosthetic joint infection due to extensively drug-resistant Enterobacter hormaechei had to be discontinued because of the occurrence of nausea, anorexia, and renal failure. After the switch to cefiderocol, the patient fully recovered from the renal failure and the infection, and nausea and appetite normalized [91]. In contrast, Contreras et al. reported a fatal case of carbapenem-resistant K. pneumoniae infections in a renal transplant patient, who died of ischemic colitis and multiorgan failure despite aggressive treatment with cefiderocol, ceftazidime-avibactam, and polymyxin B [92]. In two further patients with pancreatic abscess and pleural empyema, P. aeruginosa strains were successfully cleared with cefiderocol but developed resistances against cefiderocol in subsequent infections [93,94].