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Biliary obstruction and leaks
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Papillary stenosis can refer to a fibrotic stricture of the papillary orifice due to previous instrumentation, e.g. passage of a bougie during surgical exploration of the CBD or following a previous endoscopic sphincterotomy. Functional papillary stenosis can be due to an associated duodenal diverticulum, a penetrating duodenal ulcer, or to biliary dyskinesia. This latter entity is normally referred to as sphincter of Oddi dysfunction or dyskinesia.
Encephalitozoon
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
Alexandra Valencakova, Lenka Luptakova, Monika Halanova, Olga Danisova
Encephalitozoon intestinalis principally colonizes the epithelium of the small intestine, more precisely the duodenum and proximal jejunum. However, the presence of E. intestinalis has also been noted in the terminal ileum and large bowel. E. intestinalis infects not only the villi but also the cryptic cells, invading macrophages, fibroblasts, and endothelial cells of the chorion. An alteration of the intestinal mucosa can be seen as a flattened epithelium with accumulation of fat and significant desquamation, with the subsequent atrophy of the villi and the brush border and the compensatory elongation and hyperplasia of the crypts reducing the absorption surface area up to 40%. Lymphoid exocytosis with edema, vesiculation, and enterocyte necrosis can be observed.47E. intestinalis can induce severe ulceration of the small bowel associated with mucosal atrophy, acute and chronic inflammation, and zones of submucosal macrophage infiltration.45 Dissemination of E. intestinalis infection throughout the organism induces inflammatory reactions in the infected organs, such as the liver, pancreas, lungs, and kidneys. The functional impairment results from the inevitable decline in enzymatic activities, malabsorption of lipids, and deficiencies in potassium and magnesium and vitamin B12. Infections of the bile duct can be associated with papillary stenosis (secondary to the inflammatory reaction), bile duct dilatation, alithiasic cholecystitis, and sclerosing cholangitis.48
The pancreas
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Pancreas divisum occurs when the embryological ventral and dorsal parts of the pancreas fail to fuse (Figure68.3). The dorsal pancreatic duct becomes the main pancreatic duct and drains most of the pancreas through the minor or accessory papilla. The incidence of pancreas divisum ranges from 5% in autopsy series to 10% in some ERCP and MRCP series. Pancreas divisum found incidentally in an asymptomatic person does not warrant any intervention. But the incidence of pancreas divisum ranges from 25-50% in patients with recurrent acute pancreatitis, chronic pancreatitis and pancreatic pain. The minor papilla is substantially smaller than the major papilla (and many of these patients probably have papillary stenosis). A large volume of secretions flowing through a narrow papilla probably leads to incomplete drainage, which may then cause obstructive pain or pancreatitis. Certainly in patients with idiopathic recurrent pancreatitis, pancreas divisum should be excluded. The diagnosis can be arrived at by MRCP, EUS or ERCP, augmented by injection of secretin if necessary. There may be changes indicative of obstruction or chronic inflammation in the dorsal duct system. Endoscopic sphincterotomy and stenting of the minor papilla may relieve the symptoms. Surgical intervention can take the form of sphincteroplasty, pancre- atojejunostomy or even resection of the pancreatic head.
Evaluation of risk factors for recurrent primary common bile duct stone in patients with cholecystectomy
Published in Scandinavian Journal of Gastroenterology, 2018
Eun Soo Yoo, Byung Moo Yoo, Jin Hong Kim, Jae Chul Hwang, Min Jae Yang, Kee Myung Lee, Soon Sun Kim, Choong Kyun Noh
Commonly, CBD stones are from gallbladder stones. However, in some patients, CBD stones recur after cholecystectomy. Even in some patients who underwent cholecystectomy, CBD stones recurred frequently after endoscopic removal of CBD stones. Several studies exist on the recurrence of bile duct stones after EST, and they indicated a wide range in the incidence of stone recurrence from 4 to 24% [3,9]. Primary CBD stones can recur after cholecystectomy because stones are formed in the bile duct due to bile stasis. A lot of papers have reported that bile duct stones are associated with bile duct stricture, papillary stenosis, periampullary diverticulum, reflux of the duodenal contents into the bile duct, and parasites or foreign bodies within the bile duct or other factors predisposing to stasis and encouraging bacterial overgrowth [10]. However, the risk factors are different from paper to paper.
Hypercholesterolemia due to lipoprotein-X manifesting as pseudohyponatremia in a patient with cholestasis
Published in Baylor University Medical Center Proceedings, 2023
Farhan Azad, Norah Abu Mughaedh, Abdurahman Alloghbi, Ibrahim Tawhari
On lipid panel, the triglyceride concentration was 566 mg/dL, total cholesterol was >2100 mg/dL, and low-density lipoprotein (LDL) cholesterol was 2187 mg/dL. Ion-specific electrode in a blood gas sample revealed sodium of 140 mmol/L. Serum protein electrophoresis and free light chain were within normal limits. In the absence of symptoms or leukocytosis, cholangitis was not suspected. Lipoprotein electrophoresis revealed the presence of Lp-X. An endoscopic retrograde cholangiopancreatography showed segmental biliary narrowing and poor distal biliary drainage consistent with papillary stenosis. A sphincterotomy was performed and a plastic biliary stent was placed. Four weeks later, the serum bilirubin was down to 0.9 mg/d, and sodium improved to 137 mmol/L.