Pancreatic sphincter

Droperidol is used as an adjunct in conscious sedation for endoscopic procedures. In one study, basal biliary sphincter pressures measured in 35 patients before and after droperidol were 56 and 48 mmHg the basal pancreatic sphincter pressures measured in 22 patients before and after droperidol were 92 and 67 mmHg (24). However, in another study basal pressures of the biliary sphincter and of the pancreatic sphincter were not significantly altered by droperidol (25). 

Serious compHcations of plastic stent placement are rare and most are related to the ERCP. Acute pancreatitis may occur in up to 5% of patients. Stenting may result in occlusion of the pancreatic sphincter due to edema or mechanical obstruction. Long stents, which extend into the intrahepatic ducts, are more likely to cause acute pancreatitis than short stents (Tamsky... 

Sphincter of Oddi A muscular valve separating the common bile duct from the duodenum. The sphincter of Oddi is the structure through which the common bile duct empties bile and pancreatic secretions into the duodenum. 

Bile is secreted by the liver, stored in the gallbladder, and used in the small intestine. It is transported toward the small intestine by the hepatic duct (from the liver) and the cystic duct (from the gallbladder), which join to form the common bile duct. Pancreatic juice is transported toward the small intestine by the pancreatic duct. The common bile duct and the pancreatic duct join to form the hepatopancreatic ampulla, which empties into the duodenum. The entrance to the duodenum is surrounded by the Sphincter of Oddi. This sphincter is closed between meals in order to prevent bile and pancreatic juice from entering the small intestine it relaxes in response to the intestinal hormone cholecystokinin, thus allowing biliary and pancreatic secretions to flow into the duodenum. 

Analgesics are given to reduce abdominal pain. In the past, parenteral meperidine (50 to 100 mg) every 3 to 4 hours was usually used because it causes less spasm of the sphincter of Oddi than other opioids. Meperidine is used less frequently today because it is not as effective as other opioids and is contraindicated in renal failure. Parenteral morphine is sometimes used, but it is thought to cause spasm of the sphincter of Oddi, increases in serum amylase and, rarely, pancreatitis. Hydromorphone may also be... 

Opiates can effect serum levels of enzymes and other substances whose homeostatic control depends on clearance through the liver (F8, G12, M15, N4, S19). In one reported case, the aspartate aminotransferase was within normal limits before the administration of codeine, but within 2 hours after the drug, the enzyme activity had risen to two times the normal value by 8 hours to eight times the normal activity, and within 24 hours it had returned to normal (F8). Increases in transaminase to levels 5-85 times the control value have been reported in 6 of 16 patients with disease of the biliary tree following the administration of codeine phosphate (2 grains) (B7, F8). Gross has shown that morphine, codeine, or mepheridine administration produce elevations of serum amylase or lipase (G12). These elevations have been attributed to constriction of the sphincter of Oddi and increased intraductal pressure on the pancreatic duct (G12, N4). 

The opioids contract biliary smooth muscle, which can result in biliary colic. The sphincter of Oddi may constrict, resulting in reflux of biliary and pancreatic secretions and elevated plasma amylase and lipase levels. 

G9. Guelrud, M., and Siegel, J. H., Hypertensive pancreatic duct sphincter as a cause of pancreatitis. Successful treatment with hydrostatic balloon dilatation. Dig. Dis. Sci. 29, 225-231 (1984). 

T8. Toouli, J., Roberts-Thomson, I. C., Dent, J., and Lee, J., Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis. Br. J. Surg. 72, 859—863 (1985). 

The peripheral effects concern the motility and tonus of gastrointestinal smooth muscle segmentation is enhanced but propulsive peristalsis is inhibited. The tonus of sphincter muscles is markedly raised (spastic constipation). The antidiarrhetic effect is used therapeutically (loperamide, p.180). Gastric emptying is delayed (pyloric spasm) and drainage of bile and pancreatic juice is impeded because the sphincter of Oddi contracts. Likewise, bladder function is affected specifically bladder emptying is impaired owing to an increased tone of the vesicular sphincter. 

Fogel EL, Sherman S, Bucksot L, Shelly L, Lehman GA. Effects of droperidol on the pancreatic and biliary sphincters. Gastrointest Endosc 2003 58 488-92. 

Intrabiliaiy pressure may rise substantially after morphine (as much as 10 times in 10 minutes), due to spasm of the sphincter of Oddi. Sometimes biliary colic is made worse by morphine, presumably in a patient in whom the dose happens to be adequate to increase intrabiliary pressvue, but insufficient to produce more than slight analgesia. In patients who have had a cholecystectomy this can produce a syndrome sufficiently like a myocardial infarction to cause diagnostic confusion. Naloxone may give dramatic symptomatic relief, as may glyceryl trinitrate. Another result of this action of morphine is to dam back the pancreatic juice and so cause a rise in the serum amylase concentration. Morphine is therefore best avoided in pancreatitis but buprenorphine has less of this effect. 

To provide adequate analgesia. Opioids are generally satisfactory their potential disadvantage of contracting the sphincter of Oddi (and retarding the flow of pancreatic secretion) appears to be outweighed by their... 

Secretin is a 27-amino-aeid polypeptide that is slruciurally. similar to glucagon. The presence of acid in the. small intestine is the most important physiological stimulus for the secretion of secretin. The primary action of secretin Ls on pancreatic acinar cells that regulate the secretion of water and bicarbonate. Secretin also promotes the secretion of pancreatic enzymes, to a lesser extent. Secretin inhibits the release of gastrin and. therefore. ga.slric acid. It also increases stomach-emptying time by reducing the conlraction of the pyloric sphincter. ... 

Cerubidine daunorabidn. ceruletide [ban, inn, usan] (ceruletide diethylamine [jan, usan] caerulein) is a decapeptide present in the skin of Australian amphibians. It is a cholecystokinin receptor AGONIST that is a hypotensive AGENT. It contracts the gall bladder and relaxes the sphincter of Oddi, increases secretion of pancreatic enzymes, and contracts intestinal smooth... 

Obstruction of the pancreatic duct by a calculus or by carcinoma of the pancreas may increase serum LPS activity depending on the location of the obstruction and the amount of remaining functioning tissue. In patients with a reduced glomerular filtration rate, the serum LPS activity is increased. Thus care should be exercised in the interpretation of elevated serum LPS values in the presence of renal disease. Finally, investigation of the biliary tract by endoscopic retrograde pancreatography or treatment with opiates (which causes the sphincter of Oddi to contract) may increase serum LPS activity. 

The pancreas is 12 to 15 cm in length and lies across the posterior wall of the abdominal cavity. The head is located in the duodenal curve the body and tail are directed toward the left, extending to tlie spleen (Figure 48-2). Pancreatic digestive enzymes, in bicarbonate-rich juice, enter the duodenum through the ampulla of Vater and the sphincter of Oddi and mix with the food bolus as it passes through the small bowel. 

Structural Gallstone disease, sphincter of Oddi dysfunction, pancreas divisum, pancreatic tumors... 

Morphine decreases the propulsive contractions of the gastrointestinal tract, and biliary and pancreatic secretions are reduced. The end result, especially when morphine is administered over extended time periods, is constipation. Morphine-induced spasms of the sphincter of Oddi have been observed. However, the clinical significance of such an occurrence should be assessed on an individual basis. Although morphine s effect on the urinary bladder varies, urinary... 

Morphine reduces the activity of the entire gastrointestinal tract in that it reduces the secretion of hydrochloric acid, diminishes the motility of the stomach, and increases the tone of the upper part of the duodenum. These actions may delay passage of the stomach contents into the duodenum. Both pancreatic and biliary secretions are diminished, and this may also hinder digestion, hi the large intestine, the propulsive peristaltic wave in the colon is reduced, the muscle tone including that of the anal sphincter is increased, and the gastrocohc reflex (defecation reflex) is reduced. These actions, in combination, cause constipation, which seems to be a chronic problem among addicts. 

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