Presentation
Ampullary adenomas may present with obstruction of the main gastrointestinal tract and/or biliary/pancreatic ducts. Common presentations include gastric outlet obstruction, gastrointestinal bleeding or acute pancreatitis. [karger.com]
An exquisite art program that focuses on clarity of presentation with an emphasis on anatomy, pathology, patient presentation, and clinical context. [books.google.com]
[…] to six weeks of life but may present as early as the first week). [bettersafercare.vic.gov.au]
At that time, she was treated with ipilumimab.Three years prior to presentation she developed a left inguinal lymph node recurrence, which was resected. [practicalgastro.com]
A 37-year-old female patient presented with a 2-weeks history of generalized weakness, nausea accompanied by intermittent passage of black, tarry stools. [happycampus.com]
Entire Body System
- Familial Adenomatous Polyposis
References Jagelman DG, DeCosse JJ, Bussey HJ: Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet 1988;i:1149–1151. Guyton DP, Schreiber H: Intestinal polyposis and periampullary carcinoma: Changing concepts. [karger.com]
adenomatous polyposis • Jaundice • GI bleeding from ampullary tumor • Weight loss • Abdominal pain • Elevated serum bilirubin • Anemia • CT scan: Dilation of the biliary tree and pancreatic duct; also for staging • Abdominal US: Dilated biliary tree [accesssurgery.mhmedical.com]
The most common inherited syndromes that increase ampullary cancer risk are familial adenomatous polyposis and Lynch syndrome, which is also known as hereditary nonpolyposis colorectal cancer. [mayoclinic.org]
Causes K-ras genetic mutations Mutations in tumor suppressor genes p53 DPC4/SMAD4 Chromosome 17p and 18q – loss of heterozygosity Familial adenomatous polyposis – FAP Smoking Diabetes mellitus Symptoms Progressive jaundice Loss of appetite Progressive [thegastrosurgeon.com]
Adenomas of the ampulla of Vater are rare neoplasms that occur sporadically or in the context of genetic syndromes such as familial adenomatous polyposis and sometimes turn into malignant adenocarcinomas [ 4, 5 ]. [jmedicalcasereports.biomedcentral.com]
Respiratoric
- Aspiration
Place an orogastric tube (8-10FG) on low-pressure suction (or aspirate with a syringe every 60 minutes and leave on free drainage). The amount and type (for example, bile-stained, faeculent) of fluid aspirated should be recorded. Place nil by mouth. [bettersafercare.vic.gov.au]
The 22 gauge needle used to collect the biopsy is specifically used in diagnosing pancreatic and non-pancreatic lesions where the tip of a fine needle aspiration (FNA) is not optimal. [practicalgastro.com]
Aspiration catheters in which one recording port is sacrificed to permit both end- and side-hole aspiration of intraductal juice and the perfusate are highly recommended for pancreatic manometry [42]. [joplink.net]
EUS with EUS-guided fine-needle aspiration as the first endoscopic test for the evaluation of obstructive jaundice. Gastrointest Endosc. 2001 Apr. 53(4):475-84. [Medline]. Friedman LS. The liver, biliary tract, and pancreas. [emedicine.medscape.com]
Gastrointestinal
- Clay-Colored Stool
Ampullary cancer care at Mayo Clinic Symptoms Signs and symptoms of ampullary cancer may include: Yellowing of the skin and eyes (jaundice) Clay-colored stools Abdominal pain Fever Bleeding from the rectum Nausea Vomiting Weight loss When to see a doctor [mayoclinic.org]
POTENTIAL SIGNS AND SYMPTOMS The symptoms of biliary obstruction can depend on the cause of the obstruction, some are outlined below: Most common symptoms can include light or clay-colored stools, dark urine and Nausea and vomiting typically present in [aimisrobotics.com]
Cardiovascular
- Hypotension
Confusion and hypotension predict about a 50% mortality rate and high morbidity. [msdmanuals.com]
It should be highlighted dehydration, tachycardia, hypotension, reduced urine output, fever, electrolytes alterations, and dry mucus membranes. [intechopen.com]
Liver, Gall & Pancreas
- Biliary Colic
These stones cause biliary colic, biliary obstruction, gallstone pancreatitis, or cholangitis (bile duct infection and inflammation). Cholangitis, in turn, can lead to strictures, stasis, and choledocholithiasis. [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]
Skin
- Ulcer
Esophagogastroduodenoscopy and ERCP showed a large round mass measuring 5 cm in diameter in the ampulla of Vater with ulcer crack. Endoscopic multiple biopsies from the mass including ulcer base were taken. [happycampus.com]
These are true diverticula and are usually secondary to duodenal or periduodenal inflammation, such as from previous ulcer disease. [radiopaedia.org]
Frequency The incidence of this complication decreased dramatically during the final quarter of the 20th century as elective gastric surgery for complications of peptic ulcer disease underwent a logarithmic decline. [laparoscopyhospital.com]
(ulcer of stomach) 胃潰瘍 gastroduodenal ulcer 胃十二指腸潰瘍 gastroesophageal junction食道胃接合部 gastroesophageal reflux胃食道逆流 gastrointestinal 胃腸の gastrojejunostomy胃空腸吻合術 gastroptosis胃下垂 glucose tolerance耐糖性 graft-versus-host disease (GVHD)移植片対宿主病 gram-negative bacilli [tokyo-med.ac.jp]
Most common site of duodenal ulcers A posterior duodenal ulcer may erode the gastroduodenal artery and cause an upper GI bleed. [amboss.com]
- Pruritus
[…] of heterozygosity Familial adenomatous polyposis – FAP Smoking Diabetes mellitus Symptoms Progressive jaundice Loss of appetite Progressive weight loss – anorexia Abdominal pain and back pain – back pain is an indication of advanced stages of cancer Pruritus [thegastrosurgeon.com]
Other symptoms of ampullary cancer include: Loss of appetite and weight loss Abdominal (belly) pain Back pain Pruritus, or skin itchiness, associated with the jaundice Stomach upset and vomiting Diarrhea Gastrointestinal bleeding Pancreatitis (inflammation [hopkinsmedicine.org]
During one episode, she had noticed pruritus and darkening of urine as well, which again resolved spontaneously. She had undergone an upper GI endoscopy 1 year earlier which did not provide a positive finding. [jmedicalcasereports.biomedcentral.com]
Cholestyramine and colestipol, used to treat pruritus, bind to bile salts and can exacerbate these vitamin deficiencies. [emedicine.medscape.com]
Neurologic
- Lethargy
Patients with cholangitis may have chills, mild pain, lethargy, and delirium, which indicate that infection has spread to the bloodstream (bacteremia). [encyclopedia.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]
Abdominal radiology (New York). 2016 Feb [PubMed PMID: 26867916] [8] Blumer SL,Zucconi WB,Cohen HL,Scriven RJ,Lee TK, The vomiting neonate: a review of the ACR appropriateness criteria and ultrasound's role in the workup of such patients. [statpearls.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]
Other Pathologies
- Lymphocytic Infiltrate
Biopsy specimens show villous atrophy, crypt hyperplasia, and intraepithelial lymphocytic infiltration. Function Dude Is Just Feeling Ill, Bro: The Duodenum is the site of Iron (Fe2+) absorption. The Jejunum is the primary site of Folate absorption. [amboss.com]
Biopsies from ERCP showed only chronic nonspecific duodenitis with lymphocyte infiltration. Ten days later, the patient underwent Whipple's operation (pancreaticoduodenectomy), since the tumor was highly suspicious for malignancy at endoscopy. [kjim.org]
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.de]
Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. You may have just one treatment or a combination of treatments. [urmc.rochester.edu]
Treatment of ampullary cancer The standard treatment for ampullary cancer is a pylorus preserving Whipple procedure. Five year survival for ampullary tumors is excellent if the tumor does not invade the adjacent pancreas. [surgery.ucsf.edu]
Since ERCP did not guarantee definitive treatment, the patient was referred to our surgical service. [elsevier.es]
Prognosis
Primary surgical treatment with curative intent should be performed although this type of carcinoma associates with dismal prognosis. [pancreas.imedpub.com]
[…] with prognosis and survival. [emedicine.medscape.com]
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]
Treatment and long-term prognosis are dependent upon the location of the mass. [gastrointestinalatlas.com]
Etiology
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
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]
We highlight the importance of high clinical suspicion and individualized treatment according to the patient's condition, severity, ALS etiology and locally available treatment possibilities. References 1. Cho YS, Lee TH, Hwang SO, et al. [scielo.isciii.es]
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]
Epidemiology
Ampullary carcinoma: Epidemiology, clinical manifestations, diagnosis and staging. https://www.uptodate.com/contents/search. Accessed Sept. 8, 2019. [mayoclinic.org]
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]
One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35, 825 cases in the United States. J Clin Oncol 2008; 26:3063-72. [PMID: 18565894] [pancreas.imedpub.com]
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]
The pathophysiological features in intestinal obstruction are summarized in Figure 4. 6. [intechopen.com]
In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed June 13, 2019. Ryan DP, et al. [mayoclinic.org]
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]
Prevention
Prevention Ampullary cancer is such a rare condition that experts aren’t sure what steps, if any, can be taken to prevent it. [hopkinsmedicine.org]
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]
[citation needed] The sphincter of Oddi controls the introduction of bile and pancreatic secretions into the duodenum, as well as preventing the entry of duodenal contents into the ampulla. [en.wikipedia.org]