Endoscopic retrograde

Only one study to date has been conducted on the treatment of acute pancreatitis with antioxidants. Clemens et al. (1991) were unable to show any difference in the incidence or severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in a prospective, randomized, double-blind, placebo-controlled trial of allopurinol. However, Salim (1991) performed a similar trial of the effect of allopurinol and DMSO in patients with pain from recurrent pancreatitis, and found significant benefit. On the basis that depletion of antioxidants is important in the pathogenesis of chronic pancreatitis, the administration of a cocktail of antioxidants was assessed for its effect on pain in this disease. Treatment with a combination of organic selenium, d-carotene, vitamins C and E, and methionine was of benefit in the initial pilot study, and in a placebo-controlled trial (San-dilands etal., 1990 Uden et al., 1990). 

EPA Eicosapentaenoic acid EpDIF Epithelial-derived inhibitory factor also known as epithelium/derived relaxant fector EPO Eosinophil peroxidase EPOR Erythropoietin receptor EPR Effector cell protease EPX Eosinophil protein X ER Endoplasmic reticulum ERCP Endoscopic retrograde cholangiopancreatography E-selectin Endothelial selectin formerly known as endothelial leucocyte adhesion molecule-1 (ELAM-1)... 

O In the Western hemisphere, acute pancreatitis is caused mainly by ethanol use/abuse and gallstones. Other common causes of acute pancreatitis include hypertriglyceridemia, endoscopic retrograde cholangiopancreatography (ERCP), and autodigestion due to early activation of pancreatic enzymes. Numerous medications have also been implicated as causes of acute pancreatitis (Table 20-1). 

FIGURE 20-2. Algorithm for evaluation and treatment of acute pancreatitis. ERCP, endoscopic retrograde cholangiopancreatography. (From Berardi RR, Montgomery PA. Pancreatitis. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 726, with permission.)... 

CRNP Certified Registered Nurse Practitioner ERCP Endoscopic retrograde cholangiopancreatography... 

Endoscopic retrograde cholangiopancreatography A procedure that combines the use of an endoscope with x-rays to examine the ducts that drain the liver, gallbladder, and pancreas. 

Alderman S, Kailas S, Goldfarb S, et al. Cholestatic hepatitis after ingestion of chaparral leaf confirmation by endoscopic retrograde cholangiopancreatography and liver biopsy. J Clin Gastro 19(3) 242-247, 1994. 

FIGURE 28-1. Algorithm of guidelines for evaluation and treatment of acute pancreatitis. (ERCP, endoscopic retrograde cholangiopancreatography.)... 

Removal of biliary tract gallstones with endoscopic retrograde cholangiopancreatography or surgery usually resolves AP and reduces the risk of recurrence. Surgery may be indicated in AP to treat pseudocyst, pancreatic abscess, and to drain the pancreatic bed if hemorrhagic or necrotic material is present. 

Endoscopic retrograde cholangiopancreatography is the most sensitive and specific diagnostic test, but it is reserved for patients in whom the diagnosis cannot be established by imaging techniques because of the potential for complications. 

Ayub K, Imada R, Slavin J. Endoscopic retrograde cholangiopancreatography in gallstone-associated acute pancreatitis. Cochrane Database Syst Rev 2004. 

Abbreviations ARDS, Acute respiratory distress syndrome ERCP, Endoscopic retrograde cholangiopancrea-topography. 

D7. Dieviere, J., Moine, O., VanLaethem, J.L.,Eisendrath, P., Ghilain, A., Severs, N., andCohard, M., Interleukin 10 reduces the incidence of pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography. Gastroenterology 120, 498-505 (2001). 

Michalodimitrakis M, Christodoulou P, Tsatsakis AM, Askoxilakis I, Stiakakis I, Mouzas I. Death related to midazolam overdose during endoscopic retrograde cholangiopancreatography. Am J Forensic Med Pathol 1999 20(l) 93-7. 

Hintze, R.E., Adler, A., Veltzke, W., Abou-Rebyeh, H., Hammerstingl, R., Vo, T., Felix, R. Clinical significance of magnetic resonance cholangiopancreatography (MRCP) compared to endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 1997 29 182-187... 

Endoscopic retrograde cholangiopancreatography and transhepatic cholangiography in patients with suspected obstructive jaundice. A randomized study. Scand. X Gastroenterol. 1982 17 731-735... 

Ito, M., Kato, T., Sano, K., Hotchl, M. Disseminated Candida tropicalis infection following endoscopic retrograde cholangiopancreatography. J. 

A 65-year-old man presented with severe abdominal pain 90 minutes after taking codeine and low-dose paracetamol. Serum amylase and lipase were significantly raised. Liver function tests were moderately abnormal. Abdominal ultrasound and CT scan showed edematous pancreatitis. Endoscopic retrograde cholangiography showed a papilla with a spastic appearance and an abnormal bile duct. He recovered completely, but 3 months later took codeine and paracetamol after a hemorrhoidectomy abdominal pain recurred 1 hour later and acute pancreatitis was confirmed. 

In 27 patients who received intrahepatic floxuridine, total dose 20-41 mg/kg extrahepatic biliary sclerosis was discovered by CT scan and ultrasound, followed by endoscopic retrograde cholangiopancreatography and/or percutaneous cholangiography in three cases (4). Radiological findings included complete obstruction of the common hepatic duct in one case, common hepatic duct stenosis in two cases, common bile duct obstruction in one case, and intrahepatic bile duct dilatation without identifiable obstruction in one case... 

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