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Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
After removing the liver along with the right side of the lesser omentum, including the hepatic–duodenal ligament, incise the parietal peritoneum along the C-shaped duodenal convexity, then completely remove the tissue block. Starting at the pylorus, detach the duodenum and pancreas from the structures behind them, following the cleavage plane of the retropancreatic sphincter of Oddi (this structure is also called the hepatopancreatic sphincter, or Glisson’s sphincter). This structure controls the flow of secretions passing from the liver, pancreas, and gallbladder into the duodenum of the small intestine. It is actually composed of muscle located at the surface of the duodenum. It is located slightly distal to the point where the common bile duct and pancreatic duct join as they enter the descending duodenum to form the ampulla of Vater. The opening is on the inside of the descending duodenum, the sphincter of Oddi, is a muscular valve that controls the flow of digestive juices (bile and pancreatic juice) through the ampulla of Vater into the second part of the duodenum.
Biliary obstruction and leaks
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Sphincter of Oddi manometry is the ‘gold standard’ for this diagnosis, but manometry is only possible in 70% of these patients. Pressures in excess of 35–40 mmHg are diagnostic, and in two series this was the discriminatory test for prediction of response to sphincterotomy [20]. Long-term follow-up data are limited. More recently, the entity of pancreatic sphincter dysfunction has also been studied, with similar results.
Motility disorders
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
The sphincter of Oddi is a complex muscular structure surrounding the distal common bile duct, pancreatic duct and ampulla of Vater. Its major role is to regulate the delivery of bile and pancreatic juice into the duodenum. It also serves to prevent the reflux of duodenal contents into the pancreatobiliary tree. Sphincter of Oddi dysfunction is a controversial topic. Although an increasing amount is known about the physiology and pathophysiology of this structure, understanding is far from complete.
Multifactorial jaundice and pigmented choledocholithiasis secondary to warm autoimmune hemolytic anemia and alcoholic cirrhosis
Published in Baylor University Medical Center Proceedings, 2022
Colten Watson, Mazen Hassan, Grant Breeland
A chest x-ray revealed no acute processes, but an abdominal ultrasound showed intrahepatic ductal dilation and a thickened gallbladder wall (Figure 1). His common bile duct was 8 mm in diameter. A filling defect was found distally, measuring approximately 7 mm at the level of the sphincter of Oddi. Endoscopic retrograde cholangiopancreatography was performed based on the MRI impression (Figure 2) and led to complete removal of two pigmented gallstones via sphincterotomy and balloon extraction, as well as hemostasis of a bleeding lesion in the gastric antrum with argon plasma coagulation and ablation of an arteriovenous malformation in the gastric fundus. The final diagnosis was multifactorial jaundice and pigmented choledocholithiasis secondary to w-AIHA and alcoholic cirrhosis. Other diagnoses included acute gastrointestinal bleed in the gastric antrum and an arteriovenous malformation of the gastric fundus. The patient’s total bilirubin decreased to 24.6 mg/dL the following day (Figure 3), and he was initiated on 20 mg of prednisone. He was discharged with instructions to follow-up with hematology and hepatology within 7 days.
Emerging therapies in the management of Irritable Bowel Syndrome (IBS)
Published in Expert Opinion on Emerging Drugs, 2022
Jill E. Elwing, Hadi Atassi, Benjamin D. Rogers, Gregory S. Sayuk
Eluxadoline is a mixed µ- and kappa (κ)-Opioid receptor agonist and an antagonist of the delta (δ)-opioid receptor, and has an indication for the treatment of IBS-D. This unique opioid receptor effect profile may convey greater potential for durable effect as well as pain benefits and IBS [22]. Two phase 3 trials (26 and 52 weeks’ duration) demonstrated statistically greater combined endpoint response (≥ 30% reduction in baseline abdominal pain and Bristol Stool Form Scale(BSFS) <5, or no bowel movement for ≥50% of the study days) [23]. In a phase 4 randomized control trial (RELIEF), eluxadoline was shown to be effective in patients who were nonresponders to loperamide, this in spite of the shared µ-opioid receptor effect of these agents [24]. Rare but potentially serious adverse events (AEs) of sphincter of Oddi spasm and acute pancreatitis (with two deaths) have been observed in clinical trials and post-market reporting. Patients status-post cholecystectomy or with other pancreatitis risks (e.g. excess alcohol consumption or previous pancreatitis) are more susceptible to these events, and thus eluxadoline use is contraindicated in patients with these factors. ACG Guidelines make a conditional recommendation for use based on moderate quality of evidence [3].
Quality of life, performance status, and work capacity after post-endoscopic retrograde cholangiopancreatography pancreatitis
Published in Scandinavian Journal of Gastroenterology, 2018
Bonna Leerhøy, Daniel Mønsted Shabanzadeh, Andreas Nordholm-Carstensen, Lars Nannestad Jørgensen
The main explorative variable was PEP according to the revised Atlanta consensus definition [13]. PEP was defined as the presence of at least two of the following three features 24 hours after ERCP procedure: (1) upper abdominal pain consistent with AP, (2) serum amylase level exceeding at least three times the upper level of normal, or (3) diagnostic imaging findings consistent with AP. The severity level of PEP was defined as (1) mild: no organ failure or local or systemic complications, (2) moderate: presence of transient organ failure and/or local complications (peripancreatic fluid collections, pancreatic and peripancreatic necrosis, pseudocyst and walled-off necrosis determined by contrast-enhanced computed tomography), and (3) severe: persistent organ failure >48 h. Demographic variables included age, sex, body weight, change in body weight between baseline and follow-up, tobacco smoking (no, past, current), and duration of follow-up time. Alcohol consumption was reported according to the Danish Health Ministry for low-risk consumption and included as a three-level categorical variable with no consumption, maximum of 7 units per week for females and 14 for males, and those who consumed more. Sphincter of Oddi dysfunction was not evaluated in our institution during the study period and manometry was not performed.