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Pancreatic Duct Obstruction


Presentation

  • We present the case of a 65-year-old man with a pancreatic nonfunctioning neuroendocrine tumor causing main pancreatic duct obstruction that presented as excessive hyperglycemia.[ncbi.nlm.nih.gov]
  • A side-to-side isoperistaltic gastro-jejunostomy was also performed if duodenal stenosis was present.[em-consulte.com]
  • Similar to our case, 17 of 20 patients presenting with AOSPD had a history significant for chronic pancreatitis. Of the 20 patients, 10 had a prior pancreatic procedure within 1 month of presentation.[acgcasereports.gi.org]
  • Tumors of the body and tail are often larger at the time of presentation. Carcinoma of the ampulla has the best prognosis, because these lesions are detected at a smaller size/cause symptoms of presentation earlier.[med-ed.virginia.edu]
Splenectomy
  • The only peroperative complication was a splenic puncture treated by splenectomy. Median hospital stay was 12 days (range, 8-29 days). Postoperative complications (table I) occurred in 6 patients (16 %).[em-consulte.com]
  • Resection of the tail of the pancreas or combined resection with splenectomy is done if the stones are located in the tail of the pancreas. Sometimes the stones are found in the head or the tail of the main duct of the pancreas.[saudisurgj.org]
Pseudotumor
  • During the period under study, patients with voluminous inflammatory pseudotumors of the pancreatic head, pseudo-aneurysms, hemorrhagic pseudocysts, or suspected cancer developing on chronic pancreatitis were treated by pancreatic resection and excluded[em-consulte.com]
Camping
  • Attitudes Karen: “When he came home from the hospital, Dale looked like someone from a concentration camp. It was traumatizing. I thought to myself, I have two choices here. I can live my life as if cancer’s around every corner.[pancreatica.org]
Abdominal Pain
  • Upper Abdominal Pain In Pancreatic Cancer : Abdominal pain is a common symptom. It often radiates to the middle or upper back and worsens after eating or when lying down. Upper abdominal pain commonly occurs with advanced pancreatic cancer.[columbiasurgery.org]
  • Symptoms of chronic pancreatitis include abdominal pain, nausea, vomiting, weight loss, diarrhea, and diabetes. Abdominal pain is the most common presenting symptom. The abdominal pain is typically epigastric and radiates to the back.[pancreapedia.org]
  • It may also be used to rule out other conditions that can cause abdominal pain.[nyulangone.org]
  • Case Report A 66 year old female patient presented to the emergency department with severe abdominal pain and vomiting.[saudisurgj.org]
  • Pancreatitis Pancreatic duct blockages can lead to pancreatitis, an inflammatory process that can cause severe abdominal pain, vomiting, and diarrhea.[hopkinscf.org]
Colic
  • (bilious) (infantile) (intestinal) (recurrent) (spasmodic) R10.83 ICD-10-CM Diagnosis Code R10.83 Colic 2016 2017 2018 2019 Billable/Specific Code Pediatric Dx (0-17 years) Applicable To Colic NOS Infantile colic Type 1 Excludes colic in adult and child[icd10data.com]
  • […] atrophic pancreas (duct) (senile) 577.8 Burke's syndrome 577.8 Calcification pancreas 577.8 Calculus, calculi, calculous 592.9 pancreas (duct) 577.8 Cirrhosis, cirrhotic 571.5 pancreas (duct) 577.8 Clarke-Hadfield syndrome (pancreatic infantilism) 577.8 Colic[icd9data.com]
  • Biliary colic that recurs at any point after a cholecystectomy should prompt evaluation for possible choledocholithiasis. Failure of bile salts to reach the intestine results in fat malabsorption with steatorrhea.[emedicine.medscape.com]
  • The differential diagnosis of acute pancreatitis includes a perforated gastric or duodenal ulcer, mesenteric infarction, strangulating intestinal obstruction, ectopic pregnancy, dissecting aneurysm, biliary colic, appendicitis, diverticulitis, inferior[chirhoclin.com]
Clay-Colored Stool
  • Dark urine and light or clay-colored stools can also be associated with jaundice. Jaundice occurs when bilirubin, a component of bile, builds up in your blood.[columbiasurgery.org]
Epigastric Pain
  • Although there is occasionally no pain, severe epigastric pain may last many hours or several days.[chirhoclin.com]
Choking
  • Most important – so much so that Karen still chokes up at the memory: “You feel like you have to be such a trooper, because they’re the sick one. You’re witnessing every bit of it, so you often feel helpless. Allow for that – for your own humanity.[pancreatica.org]
Pancreatic Pain
  • The principal indication for pancreatico-jejunostomy was persistent invalidating pancreatic pain unresponsive to analgesic treatment.[em-consulte.com]
  • pain Pancreatic trypsinogen deficiency Pancreatitis (inflammation of pancreas) from gallstone Pancreatitis, gallstone Pseudolipomatosis hypertrophy of pancreas Pseudopancreatic cholera syndrome Subcutaneous nodular fat necrosis in pancreatitis 577.8[icd9data.com]
  • Medical treatment of chronic pancreatic pain is often unsatisfactory.[chirhoclin.com]
  • Introduction In patients with chronic pancreatitis, pain is the predominant symptom and remains a therapeutic challenge.[nejm.org]
Fear
  • The fear was always really there, especially since we were being followed so closely. Five years is just hanging out there. Whenever he went for his checkups, I would hold my breath each time.[pancreatica.org]
Stroke
  • Prescription of anticoagulants to prevent clots from forming and potentially causing a stroke.[pathology.jhu.edu]
  • Four patients died from causes unrelated to their chronic pancreatitis: stroke, myocardial infarction, cirrhosis with ascites, perforation of a colonic diverticulum in a patient with cirrhosis.[em-consulte.com]
Neglect
  • However, it is often neglected in follow up. This study was to review the outcomes of pancreatic duct obstruction and explore the prevention of pancreatic duct obstruction.[ncbi.nlm.nih.gov]

Workup

Pancreatic Duct Obstruction
  • Although fibrosis is a major characteristic of chronic pancreatitis (CP) induced by pancreatic duct obstruction, it is unclear whether pancreatic duct obstruction itself activates PSCs.[ncbi.nlm.nih.gov]

Treatment

  • New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer. National Cancer Institute of the United States. National Cancer Institute of Canada. ‎[books.google.de]
  • Endoscopic dilatation is one of the treatment options for stenosis of pancreaticogastrostomy (PG). However, the failure of endoscopic dilatation necessitates surgical approaches.[ncbi.nlm.nih.gov]
  • None of the patients had undergone previous endoscopic procedures for the treatment of biliary or pancreatic disorders.[em-consulte.com]
  • Armed with the extra confidence, Dale decided to proceed with the recommended treatment, consisting of a bookended three days of 5-FU, surrounding 25 days of radiation. Treatment is a surreal time in some ways.[pancreatica.org]

Prognosis

  • BACKGROUND: The prognosis of pancreatic ductal adenocarcinoma remains very poor, but is better in patients with a small tumor without local infiltration.[ncbi.nlm.nih.gov]
  • To keep learning about pancreatic cancer: Overview Causes Symptoms Genetics Diagnosis Treatment Prognosis Coping[columbiasurgery.org]
  • Outlook (Prognosis) If the blockage is not corrected, it can lead to life-threatening infection and a dangerous buildup of bilirubin. If the blockage lasts a long time, chronic liver disease can result.[stlukes-stl.com]
  • But not the difficult prognosis. But she feels sure that Dale knew, even if he doesn’t now recall. He went straight to the Internet, began reading voraciously, and grew visibly depressed. She finally had to tell him to just stop reading.[pancreatica.org]

Etiology

  • Advances in the Etiology of Chronic Pancreatitis. Dig Dis 28 p324-329, 2010. Available online at through . Accessed April 2011.[labtestsonline.org]
  • Article 143 Downloads 1 Citations Opinion statement The treatment of pancreatic duct strictures is based on an accurate assessment of the etiology of the disease, and then the degree of symptomatology.[link.springer.com]
  • Her medical history was significant for type 2 diabetes and chronic pancreatitis of unclear etiology, possibly hereditary given a history of pancreatic cancer on her maternal side.[acgcasereports.gi.org]
  • Etiology and Pathogenesis Biliary tract disease and alcoholism account for 80% of hospital admissions for acute pancreatitis.[chirhoclin.com]

Epidemiology

  • National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program. Cancer stat facts: pancreatic cancer. Available online at . Accessed March 31, 2019. Medical University of South Carolina Digestive Disease Center.[labtestsonline.org]
  • Epidemiology of alcohol-related liver and pancreatic disease in the United States. Arch Intern Med 168:649–656, 2008. PMID: 18362258[pancreapedia.org]
  • The epidemiology and impact of pancreatic diseases in the United States. Curr Gastroenterol Rep 2005;7:90-5. [ PUBMED ] 9. Ochiai K, Kaneko K, Kitagawa M, Ando H, Hayakawa T.[saudisurgj.org]
  • Epidemiology, aetiology and outcome of acute and chronic pancreatitis: An update. Best Pract Res Clin Gastroenterol. 2008;22(1):45-63. 6. Anderson R, Eckerwall G, Haraldsen P. Novel strategies for the management of severe acute pancreatitis.[tmj.ro]
  • Epidemiology United States data The incidence of biliary obstruction is approximately 5 cases per 1000 people. Race-related demographics The racial predilection depends on the cause of the biliary obstruction.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pancreatic physiology, pathophysiology, acute and chronic pancreatitis. Gastrointestinal Teaching Project, American Gastroenterological Association. 2003.[pancreapedia.org]
  • Most studies of the pathophysiology of chronic pancreatitis are performed with patients who drink alcohol.[aafp.org]
  • […] in the hepatodudoenal ligament and then courses through the head of the pancreas for approximately 2 cm; it joins the terminal part of the pancreatic duct to form the ampulla of Vater before passing through the papilla of Vater into the duodenum. [1] Pathophysiology[emedicine.medscape.com]
  • PATHOPHYSIOLOGY The precise mechanism by which obstruction of the sphincter of Oddi by a gallstone or microlithiasis (sludge) causes pancreatitis is unclear, although it probably involves increased ductal pressure.[tmj.ro]

Prevention

  • This study was to review the outcomes of pancreatic duct obstruction and explore the prevention of pancreatic duct obstruction.[ncbi.nlm.nih.gov]
  • Preventing a recurrence is a major goal of treatment, with efforts focused on identifying the underlying cause and triggers to prevent future episodes.[pancreasfoundation.org]
  • Prevention Be aware of any risk factors you have, so that you can get prompt diagnosis and treatment if a bile duct becomes blocked. The blockage itself may not be preventable. References Anstee QM, Jones DEJ. Liver and biliary tract disease.[stlukes-stl.com]
  • Prevention Be aware of any risk factors you have, so that you can get prompt diagnosis and treatment if a bile duct becomes blocked. The blockage itself may not be preventable. References Fogel EL, Sherman S.[mountsinai.org]

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