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Ampulla of Vater Obstruction Syndrome


Presentation

  • An exquisite art program that focuses on clarity of presentation with an emphasis on anatomy, pathology, patient presentation, and clinical context.[books.google.com]
  • Presentation may be due to paraneoplastic processes - eg, thromboembolic disease. Abdominal pain: typically located in the epigastric region, radiating through to the back. Can present as simple back pain.[patient.info]
  • Ampullary neuroendocrine tumor presenting with biliary obstruction and gastric outlet obstruction.[jpalliativecare.com]
  • Presentation History - Chronic ALS Chronic ALS is caused by partial obstruction of the afferent loop and may be more difficult to diagnose than acute ALS.[laparoscopyhospital.com]
  • Due to the early presentation of ampullary tumors and relative distance from the mesenteric vessels, vascular involvement is uncommon.[abdominalkey.com]
Biliary Colic
  • Biliary colic occurs when the ducts become partially obstructed. More complete obstruction causes duct dilation, jaundice , and, eventually, cholangitis (a bacterial infection).[msdmanuals.com]
  • CHEMOTHERAPY Triclabendazole Single dose of 10 mg/kg Better absorption with fatty meal Adverse effect – biliary colic; antispasmodic to be administered concurrently Other drugs Bithionol dehydroemetine nitazoxanide 20.[slideshare.net]
  • They may cause severe pain (see biliary (colic) ) or they may pass into the common bile duct and cause obstructive jaundice or cholangitis.[encyclopedia.com]
  • The first symptom may be biliary colic, followed by fever and abdominal tenderness.[emedmd.com]

Workup

  • (ie, for staging purposes) Positron emission tomography (PET) or PET-CT scanning: PET or PET-CT scans can detect metastases that are too small to be reliably detected on a CT scan See Workup for more detail.[emedicine.medscape.com]
  • Diagnostic workup initially included abdominal computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen which demonstrated dilatation of the common bile duct.[hoajonline.com]
  • Choledocholithiasis Duodenal Ulcers Gallbladder Cancer Gallbladder Tumors Lymphoma, Non-Hodgkin Pancreatic Cancer Pancreatitis, Chronic Papillary Necrosis Papillary Tumors Other Problems to be Considered: Duodenal carcinoma Adenoma at the ampulla of Vater WORKUP[oncology-articles.blogspot.com]

Treatment

  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.com]
  • Collection of Medical Illustrations (the CIBA "Green Books") has been expanded and revised to capture current perspectives in hepatology, pancreatology, and gastroenterology - from normal anatomy and physiology through pathophysiology, diagnostics and treatment[books.google.com]
  • Treatment When symptoms are severe, standard treatment is to perform an endoscopic procedure called ERCP (endoscopic retrograde cholangiopancreatography) . ERCP is a procedure for the examination or treatment of the bile duct and pancreatic duct.[iffgd.org]
  • Treatment Treatment depends on what is causing the obstruction; your doctor will advise you about your treatment options.[liverandpancreas.co.uk]

Prognosis

  • PMID: 1729790 Prognosis Tarnasky PR Expert Rev Gastroenterol Hepatol 2016 Dec;10(12):1359-1372. Epub 2016 Nov 2 doi: 10.1080/17474124.2016.1251308.[ncbi.nlm.nih.gov]
  • If left untreated, it is fatal Prognosis will depend on the presence of associated cardiac, tracheo-esophageal, anal, renal, or skeletal abnormalities (VATER) Double Bubble Sign.[learningradiology.com]
  • Primary surgical treatment with curative intent should be performed although this type of carcinoma associates with dismal prognosis.[pancreas.imedpub.com]
  • Treatment and long-term prognosis are dependent upon the location of the mass.[gastrointestinalatlas.com]
  • In a series of 45 patients, expression of CA 19-9 labeling intensity and apical localization both were statistically significant predictors of poor prognosis.[emedicine.medscape.com]

Etiology

  • Etiology Expert Rev Gastroenterol Hepatol 2016 Dec;10(12):1359-1372. Epub 2016 Nov 2 doi: 10.1080/17474124.2016.1251308.[ncbi.nlm.nih.gov]
  • The jejunal limb is subject to adhesion formation, internal herniation, volvulus, anastomotic obstruction, and other etiologies of ALS, as described above. Contraindications Surgical correction of ALS has no absolute contraindications.[laparoscopyhospital.com]
  • Biliary cysts: etiology, diagnosis and management. World J Gastroenterol 2012;18:4801–4810. 25. Lee HK, Park SJ, Yi BH, Lee AL, Moon JH, Chang YW. Imaging features of adult choledochal cysts: a pictorial review. Korean J Radiol 2009;10:71–80. 26.[kjronline.org]
  • Etiology is probably infection, most likely with cytomegalovirus , Cryptosporidium sp, or microsporidia . Resources In This Article[msdmanuals.com]
  • Definition / general By definition, centered in ampulla of Vater, arises from ampullary intestinal mucosa If advanced, cannot distinguish tumor origin between ampulla, distal common bile duct or pancreas Etiology May arise from villous adenoma or villoglandular[pathologyoutlines.com]

Epidemiology

  • Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology[brainscape.com]
  • FASCIOLIASIS Etiology: Zoonosis caused by trematode Fasciola hepatica Fasciola gigantica Epidemiology F. hepatica – temperate zones F. gigantica – tropical zones Now has become global in distribution 4.[slideshare.net]
  • Between 1973 and 2005, 5,625 cases were recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute.[emedicine.medscape.com]
  • Epidemiology Frequency United States Adenocarcinoma of the ampulla of Vater is a relatively uncommon tumor that accounts for approximately 0.2% of gastrointestinal tract malignancies and approximately 7% of all periampullary carcinomas.[emedicine.medscape.com]
  • We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data (1992-2013) to conduct a population-based, case-control study. Cases (n 32,443) had primary hepatobiliary cancer.[readbyqxmd.com]
Sex distribution
Age distribution

Pathophysiology

  • This book in The Netter Collection of Medical Illustrations (the CIBA "Green Books") has been expanded and revised to capture current perspectives in hepatology, pancreatology, and gastroenterology - from normal anatomy and physiology through pathophysiology[books.google.com]
  • ERCP and endoscopic manometry seem to be useful in clarifying the pathophysiology of symptomatic choledochocele and ACPBD [ 20 - 23 ].[omicsonline.org]
  • The pathophysiology and signs and symptoms associated with ALS result from partial or complete obstruction of the afferent loop.[laparoscopyhospital.com]
  • Pathophysiology and Natural History Most gallstones are composed primarily of cholesterol, with smaller amounts of mucus, calcium bilirubinate, and protein.[clevelandclinicmeded.com]
  • Pathophysiology Periampullary carcinoma includes tumors arising in the head, neck, or uncinate process of the pancreas, tumors arising in the distal common bile duct, tumors arising in the duodenum, as well as tumors arising from the ampulla of Vater.[emedicine.medscape.com]

Prevention

  • Because of its location, this cancer can cause obstruction of the common bile duct and prevent bile from flowing into the intestine and out of the body.[medicinenet.com]
  • […] through the ampulla: the sphincter of the pancreatic duct , the sphincter of the bile duct , and the sphincter of Oddi . [ citation needed ] The sphincter of Oddi controls the introduction of bile and pancreatic secretions into the duodenum, as well as preventing[en.wikipedia.org]
  • Following recovery from an acute attack, the prevention of further attacks should be the primary goal.[britannica.com]
  • Bile duct disease – the commonest indication for ERCP is the investigation and treatment of jaundice due to bile duct obstruction, preventing bile draining into the gut.[netdoctor.co.uk]
  • Prevention The formation of gallstones cannot be prevented.[encyclopedia.com]

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