Pancreatitis

ISBN-13: 9783642803222 / Angielski / Miękka / 2011 / 377 str.

Paul G. Lankisch; Peter A. Banks

Opis

As we began to plan this book about 10 years ago, we wanted to write a practical book for medical students, doctors in training, internists, gas and surgeons faced with everyday clinical problems in troenterologists, the care of patients with acute and chronic pancreatitis. Now, 10 years lat er, our book has become much more than what we had originally intend ed, with so many new findings that have expanded our knowledge of pancreatic diseases, not to mention new imaging procedures and con trolled studies on the effectiveness of various therapies. Consequently, we decided to include: The state-of-the-art on diagnosis and therapy in inflammatory pan creatic diseases Recommendations for diagnosis and therapy based on the published results from experienced clinicians. In the many areas still untested we have relied on the decades of experience of the two authors on both sides of the Atlantic A discussion of unanswered questions for future research by physi cians interested in pancreatitis who can draw upon our bibliography of almost 1900 references complete through 1996. We also wanted to demonstrate with this work that two authors from two continents can come to common conclusions that can help physicians and students in their everyday clinical work and their clinical research. It is with deep gratitude that we acknowledge the assistance of Mrs. Gisela Ropte for years of patient cooperation, great precision, and initia tive, as well as that of Dr. Dr."

Spis treści

1 General Considerations: Embryology.- 1.1 Normal Development.- 1.2 Congenital Abnormalities.- 1.2.1 Aplasia, Hypoplasia, and Dysplasia.- 1.2.1.1 Definition.- 1.2.1.2 Clinical Presentation.- 1.2.1.3 Diagnosis.- 1.2.1.4 Treatment.- 1.2.2 Pancreas Divisum.- 1.2.2.1 Definition.- 1.2.2.2 Pathogenetic Implications.- 1.2.2.3 Clinical Presentation.- 1.2.2.4 Diagnosis.- 1.2.2.5 Treatment.- 1.2.3 Heterotopic Pancreas.- 1.2.3.1 Definition.- 1.2.3.2 Clinical Presentation.- 1.2.3.3 Diagnosis.- 1.2.3.4 Treatment.- 1.2.4 Annular Pancreas.- 1.2.4.1 Definition.- 1.2.4.2 Clinical Presentation.- 1.2.4.3 Diagnosis.- 1.2.4.4 Treatment.- 1.2.5 Congenital Cyst(s).- 1.2.5.1 Definition.- 1.2.5.2 Clinical Presentation.- 1.2.5.3 Diagnosis.- 1.2.5.4 Treatment.- References.- 2 General Considerations: Anatomy.- References.- 3 General Considerations: Physiology.- 3.1 Function of the Exocrine Pancreas.- 3.2 Pancreatic Enzymes.- 3.3 Enzyme Synthesis.- 3.4 Protective Mechanisms to Prevent Autodigestion.- 3.5 Pancreatic Secretagogues.- 3.5.1 Secretin.- 3.5.2 Cholecystokinin.- 3.5.3 Cholinergic Influence.- 3.6 Phases of Pancreatic Secretion.- 3.7 Ductular Secretion.- 3.8 Acinar Secretion.- 3.9 Action of Pancreatic Lipase.- 3.10 What Turns the Pancreas Off?.- References.- 4 General Considerations: Classification.- 4.1 Marseille Classification of 1963.- 4.2 Cambridge Classification of 1983.- 4.3 Revised Pancreatitis Classification of Marseille 1984.- 4.4 Pancreatitis Classification of Marseille-Rome 1988.- 4.5 Pancreatitis Classification — Cambridge vs. Marseille: Features in Common and Differences.- 4.6 Classification System for Acute Pancreatitis of Atlanta 1992.- 4.7 Comment.- References.- 5 Acute Pancreatitis: Etiology.- 5.1 Biliary Tract Disease.- 5.2 Alcoholism.- 5.3 Obstruction of Pancreatic Ducts.- 5.3.1 Tumors.- 5.3.2 Duodenal Disorders.- 5.3.3 Pancreas Divisum.- 5.3.4 Helminthic Obstruction.- 5.3.5 Foreign Body Obstruction.- 5.4 Infections.- 5.5 Drugs.- 5.6 Toxins.- 5.7 Endocrine and Metabolic Disorders.- 5.7.1 Primary Hyperparathyroidism and Hypercalcemia.- 5.7.2 Pregnancy.- 5.7.3 Hyperlipemia.- 5.7.4 Uremia.- 5.7.5 Acute Intermittent Porphyria.- 5.7.6 Hypothermia.- 5.8 Vascular Disease.- 5.9 Trauma.- 5.10 Medical Procedures.- 5.10.1 Pancreatic Biopsy.- 5.10.2 Endoscopic Retrograde Cholangiopancreatography and Endoscopic Sphincterotomy.- 5.10.3 Sphincter of Oddi Manometry.- 5.11 Surgical Procedures.- 5.12 Cystic Fibrosis.- 5.13 Inborn Errors of Metabolism.- 5.14 Reye’s Syndrome.- 5.15 Kawasaki Disease.- 5.16 Hereditary Acute Pancreatitis.- 5.17 Idiopathic Acute Pancreatitis.- References.- 6 Acute Pancreatitis: Pathophysiology.- 6.1 Mechanisms of Pancreatic Injury.- 6.2 Gallstone-induced Acute Pancreatitis.- 6.3 Alcohol-induced Acute Pancreatitis.- 6.4 Concept of Oxidative Stress.- 6.5 Theories Explaining the Pathogenetic Mechanism of Acute Biliary Pancreatitis.- 6.6 The Pros and Cons of the Theories.- References.- 7 Acute Pancreatitis: Pathology.- 7.1 Gross Pathology.- 7.2 Histopathology.- 7.3 Sequential Changes and Outcome.- References.- 8 Acute Pancreatitis: Epidemiology.- References.- 9 Acute Pancreatitis: Diagnosis.- 9.1 Clinical Manifestation.- 9.1.1 Signs and Symptoms.- 9.1.2 Physical Examination.- 9.2 Laboratory Investigations.- 9.2.1 Enzymes.- 9.2.1.1 Serum Amylase.- 9.2.1.2 Macroamylasemia.- 9.2.1.3 Pancreatic Isoamylase.- 9.2.1.4 Urinary Amylase.- 9.2.1.5 Amylase-Creatinine Clearance Ratio.- 9.2.1.6 Serum Lipase.- 9.2.1.7 Macrolipasemia.- 9.2.1.8 Other Enzymes: Trypsin, Elastase-1, Phospholipase A.- 9.2.2 Other Laboratory Investigations.- 9.3 Imaging Procedures.- 9.3.1 Survey Film of the Abdomen.- 9.3.2 Chest Radiography.- 9.3.3 Barium Studies.- 9.3.4 Abdominal Ultrasound.- 9.3.5 Endoscopic Ultrasound.- 9.3.6 Computed Tomography.- 9.3.7 Magnetic Resonance Imaging.- 9.3.8 Endoscopic Retrograde Cholangiopancreatography.- 9.4 Synopsis of Diagnostic Procedures and Grading of Severity.- 9.4.1 Introduction.- 9.4.2 Early Prognostic Signs.- 9.4.2.1 Ranson’s Signs.- 9.4.2.2 Imrie’s Signs.- 9.4.2.3 Other Prognostic Systems.- 9.4.2.4 Peritoneal Lavage.- 9.4.2.5 Clinical Scoring Systems.- 9.4.2.6 APACHE-II Scores.- 9.4.2.7 Serum Markers.- 9.4.2.8 Urine Tests.- 9.4.2.9 Obesity.- 9.4.2.10 Chest X-ray.- 9.4.2.11 Summary.- 9.4.3 Organ Failure.- 9.4.4 Local Complications.- 9.4.5 Mortality.- References.- 10 Acute Pancreatitis: Complications.- 10.1 Local Complications.- 10.1.1 Acute Fluid Collection.- 10.1.2 Pancreatic Necrosis.- 10.1.3 Acute Pseudocyst.- 10.1.4 Pancreatic Abscess.- 10.2 Systemic and Other Extrapancreatic Complications.- 10.2.1 Shock.- 10.2.2 Renal Insufficiency.- 10.2.3 Respiratory Insufficiency.- 10.2.4 Cardiac Complications.- 10.2.5 Common Bile Duct Obstruction.- 10.2.6 Gastrointestinal Bleeding.- 10.2.7 Stenosis of an Adjacent Hollow Organ (Duodenum, Colon, Ureter).- 10.2.7.1 Stenosis of the Duodenum.- 10.2.7.2 Stenosis of the Colon.- 10.2.7.3 Stenosis of the Ureter.- 10.2.8 Ileus of the Small Intestine.- 10.2.9 Fat Necrosis.- 10.2.10 Pancreatic Encephalopathy.- 10.2.11 Cutaneous Manifestations.- 10.2.12 Ophthalmological Changes.- References.- 11 Acute Pancreatitis:Treatment.- 11.1 Basic Treatment.- 11.1.1 Goals.- 11.1.1.1 Limitation of Systemic Complications.- 11.1.1.2 Prevention of Pancreatic Necrosis.- 11.1.1.3 Prevention of Pancreatic Infection.- 11.1.2 Medical Management of Mild Pancreatitis.- 11.1.2.1 Supportive Care.- 11.1.2.2 Other Measures.- 11.1.2.3 Refeeding.- 11.1.3 Medical Management of Severe Pancreatitis.- 11.1.3.1 Fluid Resuscitation.- 11.1.3.2 Respiratory Care.- 11.1.3.3 Cardiovascular Care.- 11.1.3.4 Relief of Pain.- 11.1.3.5 Limitation of Systemic Complications.- 11.1.3.6 Treatment of Infection.- 11.1.3.7 Metabolic Complications.- 11.1.3.8 Nutritional Support.- 11.2 Treatment of Local Complications.- 11.2.1 Necrotizing Pancreatitis.- 11.2.1.1 Infected Necrosis of the Pancreas.- 11.2.1.2 Sterile Necrosis of the Pancreas.- 11.2.1.2.1 Necrotizing Pancreatitis With Clinical Improvement..- 11.2.1.2.2 Necrotizing Pancreatitis Without Clinical Improvement.- 11.2.2 Treatment of Pancreatic Pseudocyst.- 11.2.2.1 Medical Treatment.- 11.2.2.2 Surgical Treatment.- 11.2.2.3 Radiologic Treatment.- 11.2.2.4 Endoscopic Treatment.- 11.2.2.5 Pancreatic Pseudocysts Associated With Pancreatic Necrosis.- 11.2.2.6 Pancreatic Abscess.- 11.2.2.7 Smoldering Pancreatitis.- 11.3 Treatment of Systemic Complications.- 11.3.1 Shock.- 11.3.2 Renal Insufficiency.- 11.3.3 Respiratory Insufficiency.- 11.3.4 General Systemic Therapy (Removal of Activated Pancreatic Enzymes).- 11.4 Treatment of Metabolic Complications.- 11.4.1 Hyperglycemia.- 11.4.2 Hypocalcemia.- 11.4.3 Hypomagnesemia.- 11.5 Treatment of Extrapancreatic Complications.- 11.5.1 Obstruction of Common Bile Duct, Duodenum, Colon, and Ureter.- 11.5.1.1 Pancreatic Pseudocyst.- 11.5.2 Gastrointestinal Bleeding.- References.- 12 Acute Pancreatitis: Prognosis.- 12.1 Introduction.- 12.2 Etiology.- 12.3 Initial or Repeated Episodes.- 12.4 Severity.- 12.4.1 General.- 12.4.2 Clinical Parameters.- 12.4.3 Biochemical Severity Predictors.- 12.4.3.1 Scoring Systems.- 12.4.3.1.1 Ranson’s Prognostic Criteria.- 12.4.3.1.2 Imrie’s Prognostic Criteria.- 12.4.3.1.3 Bank’s Prognostic Criteria.- 12.4.3.1.4 Agarwal’s and Pitchumoni’s Simplified Prognostic Criteria.- 12.4.3.1.5 Hong Kong Criteria.- 12.4.3.1.6 APACHE-II Scores.- 12.4.3.1.7 Comparison of Multiple-Parameter Prognostic Systems.- 12.4.3.2 Peritoneal Lavage for Prognosis.- 12.4.3.3 Single Markers.- 12.4.4 Imaging Procedures.- 12.5 Systemic Complications.- 12.6 Mortality.- 12.7 Late Morphological and Functional Consequences of the Pancreas.- 12.8 Quality of Life.- References.- 13 Chronic Pancreatitis: Etiology.- 13.1 Alcohol-induced Chronic Pancreatitis.- 13.2 Idiopathic Chronic Pancreatitis.- 13.3 Tropical Pancreatitis.- 13.4 Hereditary Diseases of the Pancreas.- 13.4.1 Hereditary Pancreatitis.- 13.4.2 Cystic Fibrosis.- 13.5 Congenital Abnormalities Including Pancreas Divisum.- 13.6 Obstructive Chronic Pancreatitis.- 13.7 Drug-induced Chronic Pancreatitis.- 13.8 Stress-induced Chronic Pancreatitis.- 13.9 Radiation-induced Chronic Pancreatitis.- 13.10 Hyperparathyroidism.- References.- 14 Chronic Pancreatitis: Pathophysiology.- 14.1 Concept of Primary Intraductal Obstruction.- 14.2 Concept of Primary Toxic-Metabolic Action of Alcohol.- 14.3 Concept of Oxidative Stress.- 14.4 Concept of Necrosis-Fibrosis Sequence.- References.- 15 Chronic Pancreatitis: Pathology.- 15.1 Gross Pathology.- 15.2 Histopathology.- 15.3 Chronic Pancreatitis With Focal Necrosis.- 15.4 Chronic Pancreatitis With Segmental or Diffuse Fibrosis.- 15.5 Obstructive Chronic Pancreatitis.- References.- 16 Chronic Pancreatitis: Epidemiology.- References.- 17 Chronic Pancreatitis: Diagnosis.- 17.1 Clinical Manifestation.- 17.1.1 Signs and Symptoms.- 17.1.2 Physical Examination.- 17.2 Laboratory Investigations.- 17.2.1 Basic Laboratory Tests.- 17.2.2 Tests of Exocrine Pancreatic Function.- 17.2.2.1 General Remarks.- 17.2.2.2 Direct Pancreatic Function Tests.- 17.2.2.2.1 Determinations in Duodenal Juice.- 17.2.2.2.2 Secretin Test.- 17.2.2.2.3 Secretin-Cholecystokinin-Pancreozymin (Cerulein) Test.- 17.2.2.2.4 Lundh Test.- 17.2.2.3 Indirect Pancreatic Function Tests.- 17.2.2.3.1 Parotid Saliva Test.- 17.2.2.3.2 Serum Tests.- 17.2.2.3.3 Fecal Tests.- 17.2.2.3.4 Urine Tests.- 17.2.2.3.5 Value of Indirect Pancreatic Function Tests to Confirm or to Excluce Exocrine Pancreatic Insufficiency.- 17.2.2.3.6 Plasma Amino Acid Consumption Test.- 17.2.2.3.7 Breath Analysis Tests.- 17.2.2.3.8 Dual-Label Schilling Test.- 17.2.2.3.9 Pancreatic Polypeptide.- 17.2.3 Tests of Endocrine Pancreatic Function.- 17.3 Imaging Procedures.- 17.3.1 Conventional Radiology.- 17.3.2 Ultrasound and Computed Tomography.- 17.3.3 Magnetic Resonance Imaging.- 17.3.4 Endoscopic Retrograde Cholangiopancreatography.- 17.3.5 Endoscopic Ultrasound.- 17.3.6 Angiography.- 17.3.7 Pancreatic Duct Manometry.- 17.4 Synopsis of Diagnostic Procedures.- 17.4.1 General.- 17.4.2 Case History.- 17.4.3 Physical Examination.- 17.4.4 Basic Laboratory Tests.- 17.4.5 Basic Imaging Procedures.- 17.4.6 Gastroscopy.- 17.4.7 ERCP or Function Test: Which Step Next?.- References.- 18 Chronic Pancreatitis: Complications.- 18.1 General.- 18.2 Intrapancreatic Complications.- 18.2.1 Pancreatic Calcifications.- 18.2.1.1 Treatment.- 18.2.2 Pancreatic Pseudocysts.- 18.2.2.1. Treatment.- 18.2.3 Abscess.- 18.2.3.1 Treatment.- 18.2.4 Acute Necrotizing Pancreatitis.- 18.2.4.1 Treatment.- 18.2.5 Pancreatic Carcinoma.- 18.2.5.1 Treatment.- 18.3 Extrapancreatic Complications.- 18.3.1 Stenosis of Adjacent Viscera.- 18.3.1.1 Duodenal Stenosis.- 18.3.1.1.1 Treatment.- 18.3.1.2 Colonic Stenosis.- 18.3.1.2.1 Treatment.- 18.3.2 Stenosis of the Common Bile Duct.- 18.3.2.1 Treatment.- 18.3.3 Peptic Ulcer.- 18.3.3.1 Treatment.- 18.3.4 Gastrointestinal Bleeding.- 18.3.4.1 Treatment.- 18.3.5 Pleural Effusion.- 18.3.5.1 Treatment.- 18.3.6 Ascites.- 18.3.6.1 Treatment.- 18.3.7 Splenic Changes.- 18.3.7.1 Treatment.- 18.3.8 Osseous Lesions.- 18.3.8.1 Treatment.- 18.3.9 Metabolic Consequences.- 18.3.9.1 Treatment.- 18.3.10 Associated Diseases.- 18.3.10.1 Treatment.- 18.3.11 Extrapancreatic Carcinomas.- 18.3.11.1 Treatment.- References.- 19 Chronic Pancreatitis: Treatment.- 19.1 Pain.- 19.1.1 Definition and Mechanisms.- 19.1.1.1 Pancreatic Causes.- 19.1.1.1.1 Acute Inflammation.- 19.1.1.1.2 Increased Intrapancreatic Pressure.- 19.1.1.1.3 Parenchymal Abnormalities.- 19.1.1.1.4 Pancreatic Pseudocysts.- 19.1.1.1.5 Neural Inflammation.- 19.1.1.2 Extrapancreatic Causes.- 19.1.2 Conservative Treatment.- 19.1.2.1 Oral Pancreatic Enzyme Therapy.- 19.1.2.2 Endoscopic Treatment.- 19.1.2.3 Nerve Block.- 19.1.3 Surgical Treatment.- 19.2 Exocrine Pancreatic Insufficiency.- 19.2.1 Definition and Mechanisms.- 19.2.2 Salient Clinical Features.- 19.2.3 Pancreatic Enzyme Replacement.- 19.2.3.1 Aim.- 19.2.3.2 Indications.- 19.2.3.3 Choice of Enzyme Preparations.- 19.2.3.4 Choice of Administration Schedule.- 19.2.4 Interactions, Contraindications and Side Effects.- 19.2.5 Control of Response.- 19.2.6 Failure to Respond.- 19.2.7 Gastric Acid Inactivation of Pancreatic Enzyme Preparations.- 19.2.8 Nonsimultaneous Gastric Emptying of Pancreatic Enzyme Preparations With the Food.- 19.2.9 Factors Preventing Total Elimination of Steatorrhea.- 19.2.10 Conclusions, Recommendations, and Future Aspects.- 19.3 Endocrine Pancreatic Insufficiency.- 19.3.1 Definition and Mechanisms.- 19.3.2 Treatment of Endocrine Pancreatic Insufficiency.- 19.4 Postoperative Syndromes.- 19.4.1 Definition.- 19.4.2 Disease-related Postoperative Pain Symptoms.- 19.4.3 Exocrine Pancreatic Insufficiency.- 19.4.3.1 Treatment.- 19.4.4 Endocrine Pancreatic Insufficiency.- 19.4.4.1 Treatment.- 19.4.5 Surgery-related Sequelae.- 19.4.5.1 Sequelae of Gastric Resection.- 19.4.5.2 Sequelae of Biliodigestive Anastomosis.- 19.4.5.3 Sequelae of Duct Drainage.- 19.5 Evaluation of Follow-up Results.- 19.5.1 Quality of Life.- 19.5.2 Evaluation of Conservative and Surgical Treatment Results.- 19.5.3 Outlook.- References.- 20 Chronic Pancreatitis: Prognosis.- 20.1 Introduction.- 20.2 Pain.- 20.2.1 Painless Pancreatitis.- 20.2.2 Does Pain Decrease Differently in the Alcohol-induced and Idiopathic Chronic Pancreatitis?.- 20.2.3 Does Pain Decrease With the Duration of the Disease?.- 20.2.4 Does Pain Decrease With Progressing Exocrine Pancreatic Insufficiency?.- 20.2.5 Does Pain Decrease When Pancreatic Calcifications and/or Duct Abnormalities Occur?.- 20.2.6 Does Pain Decrease With Alcohol Abstinence?.- 20.2.7 Does Pain Decrease After Surgery?.- 20.3 Exocrine Pancreatic Insufficiency.- 20.4 Endocrine Pancreatic Insufficiency.- 20.5 Complications.- 20.6 Pancreatic and Extrapancreatic Carcinomas.- 20.7 Quality of Life.- 20.8 Mortality.- 20.9 Factors of Prognosis.- References.- 21 Addendum: Hereditary Pancreatic Diseases.- 21.1 Hereditary Pancreatic Diseases Associated With Exocrine Pancreatic Insufficiency.- 21.1.1 Cystic Fibrosis.- 21.1.1.1 General.- 21.1.1.2 Pathology.- 21.1.1.3 Clinical Presentation.- 21.1.1.4 Diagnosis.- 21.1.1.5 Treatment.- 21.1.2 Shwachman Syndrome.- 21.1.2.1 General.- 21.1.2.2 Pathology.- 21.1.2.3 Clinical Presentation.- 21.1.2.4 Diagnosis.- 21.1.2.5 Treatment.- 21.1.3 Johanson-Blizzard Syndrome.- 21.1.3.1 General.- 21.1.3.2 Pathology.- 21.1.3.3 Clinical Presentation.- 21.1.3.4 Treatment.- 21.1.4 Sideroblastic Anemia.- 21.1.5 Isolated Defects.- 21.2 Hereditary Diseases of the Exocrine Pancreas Associated With Pancreatitis.- 21.2.1 Hereditary Pancreatitis.- 21.2.1.1. Definition.- 21.2.1.2 Pathology.- 21.2.1.3 Clinical Presentation.- 21.2.1.4 Diagnosis.- 21.2.1.5 Treatment.- 21.2.1.6 Prognosis.- 21.2.2 Antitrypsin Deficiency.- 21.2.3 Inborn Errors of Metabolism.- References.

Blurb

This book is for internists and surgeons in clinics and private practice as well as for medical students, all with an interest in acute and chronic pancreatitis. Comprehensive, up-to-date, and clinically oriented, this book is particularly useful for patient care. Particular attention is given to diagnosis and treatment. Included is also recognition and management of important complications such as necrotizing pancreatitis, pancreatic pseudocysts, and pancreatic insufficiency. Medical and surgical options in both acute and chronic pancreatitis are described in detail. Figures, tables and algorithms illustrate important concepts. The book gives not only the actual state of the art based on established literature, but also brings the experience of both authors from the two sides of the Atlantic to bear on controversial areas. The bibliography is complete through 1996 with approximately 1900 references.