Pancreatic Stones

Rouimi, R, De Caro, J., Bonicel, J., Rovery, M., and De Caro, A., 1988, The disulfide bridges of the immunoreactive forms of human pancreatic stone protein isolated from pancreatic juice, FEES Lett. 229 171-174. 

O The most common causes of acute and chronic pancreatitis in adults are ethanol abuse and biliary stones. 

Treatment of chronic pancreatitis is aimed at removing the cause (ethanol abuse or biliary stones), providing analgesia, supplementing with pancreatic enzyme preparations, and implementing dietary restrictions. 

Maxzide Maxzide-25 Anti hypertensive Diuretic Tab Triamterene 75 mg. hydrochlorothiazide 50 mg Tab Triamterene 37.5 mg. hydrochbrothiazide 25 mg 1 tab qd jaundice, pancreatitis, interstitial nephritis, renal stones. 1-2 tab qd... 

Many dietary and environmental factors have been implicated as possible etiologic factors in the development of pancreatic cancer, but no definite causal relationships have been established. The strongest evidence points to cigarette smoking as a risk factor associated with pancreatic cancer (20-24). Occupational exposure to certain chemicals has also been linked to pancreatic carcinoma (25). Others in the high-risk group include stone miners, cement workers, gardeners, textile workers, and leather tanners (17,26). 

Other portions of the gastrointestinal tract can also be injured. Chronic alcohol ingestion is by far the most common cause of chronic pancreatitis in the Western world. In addition to its direct toxic effect on pancreatic acinar cells, alcohol alters pancreatic epithelial permeability and promotes the formation of protein plugs and calcium carbonate-containing stones. 

Pancreatic enzyme supplements are well tolerated. The capsules should be swallowed, not chewed, because pancreatic enzymes may cause oropharyngeal mucositis. Excessive doses may cause diarrhea and abdominal pain. The high purine content of pancreas extracts may lead to hyperuricosuria and renal stones. Several cases of colonic strictures were reported in patients with cystic fibrosis who received high doses of pancrelipase with high lipase activity. These high-dose formulations have since been removed from the market. 

For example, normal urine is supersaturated with calcium oxalate. To prevent formation of renal calculi (stones)719 an inhibitory glycoprotein is present and slows the formation and growth of crystals.720 Under some disease conditions calcium carbonate stones may form in pancreatic ducts. A17 kDa lectinlike glycoprotein called lithostatine has been proposed to inhibit stone formation by binding to certain planes on CaC03 microcrystals just as antifreeze proteins (Box 4-D) inhibit ice formation.721 However, this proposed function for lithostatine is doubtful.722 723 Pathological deposits of crystalline calcium pyrophosphate and basic calcium phosphates are sometimes present in joints,724 even in Neanderthal skeletons.725... 

Because of the severe pain, the physician (Patient 5) with exercise-induced acute renal failure (ALPE) made a self-diagnosis of acute pancreatitis. Initially, most patients are diagnosed as having ureteral stone, but some physicians diagnose lumbar pain or lumbar disc hernia. 

At the Emergency Outpatient Unit, most patients were initially diagnosed as having ureteral stone, or acute gastroenteritis based on vomiting/slight fever, or acute pancreatitis, lumbar pain, muscular pain, or lumbar disc hernia based on severe pain (Fig. 73). 

Acute inflammation Acute viral infections Kidney stones Preeclampsia Surgical trauma Transplant rejection Myocardial infarction CHF Pancreatitis Trauma... 

Normally there is very little fat in the feces. However, fat content in stools may increase because of various fat malabsorption syndromes. Such increased fat excretion is steatorrhea. Decreased fat absorption may be the result of failure to emulsify food contents because of a deficiency in bile salts, as in liver disease or bile duct obstruction (stone or tumor). Pancreatic insufficiency may result in an inadequate pancreatic lipase supply. Finally, absorption itself may be faulty because of damage to intestinal mucosal cells through allergy or infection. An example of allergy-based malabsorption is celiac disease, which is usually associated with gluten intolerance. Gluten is a wheat protein. An example of intestinal infection is tropical sprue, which is often curable with tetracycline. Various vitamin deficiencies may accompany fat malabsorption syndromes. 

Possible increase in serum conjugated bilirubin Obstruction of bile flow commonly due to common bile duct stone or pancreatic carcinoma Failure of bile secretion Extrahepatic cholestasis Intrahepatic cholestasis... 

There is epidemiologic evidence to suggest an increased prevalence of duodenal ulcers in patients with certain chronic diseases, but the pathophysiologic mechanisms of these associations are uncertain. A strong association exists in patients with systemic mastocytosis, multiple endocrine neoplasia type 1, chronic pulmonary diseases, chronic renal failure, kidney stones, hepatic cirrhosis, and ai-antitrypsin deficiency. An association may exist in patients with cystic fibrosis, chronic pancreatitis, Crohn s disease, coronary artery disease, polycythemia vera, and hyperparathyroidism. 

Endoscopic retrograde cholangiopancreatography is used to visualize and remove bile duct stones in patients with gallstone pancreatitis. 

Hyperparathyroidism results from oversecretion of PTH. This condition leads to excessive bone turnover and demineralization and must be treated by removal of the parathyroid gland. The disorder is classified into primary, secondary, and tertiary hyperparathyroidism. Sporadic primary hyperparathyroidism is the third most common endocrine disorder, after diabetes and hyperthyroidism. It is most common in females older than 55 years of age and the leading cause is a single adenoma, which secretes the hormone constitu-tively, without regulation. Symptoms can include osteopenia and bone fractures, renal stones resulting from hypercalciuria, peptic ulcer disease, and pancreatitis. In milder cases, patients are asymptomatic or suffer only muscle weakness, fatigue, and/or depression. 

Indications Cold accumulation interior repletion. Stomach and intestinal spasms, pyelonephritis, kidney stones, gallstones, pancreatitis, intestinal colic, hernia pain, sciatica, intercostal neuralgia, migraines, chronic colitis, and chronic pelvic inflammation... 

Michael was scheduled for endoscopic retrograde cholangiopancreatography (ERCP). (An ERCP involves cannulation of the common bile duct—and, if necessary, the pancreatic duct— through a tube placed through the mouth and stomach and into the upper small intestine.) With this technique, a stone can be snared in the common duct and removed to relieve an obstruction. 

Nelfinavir mesylate Viracept Adverse reactions Kidney stones, pancreatitis, diabetes or hyperglycemia, ketoacidosis and paresthesia all require medical attention less problematic are symptoms of generalized weakness, Gl disturbances, headaches, insomnia, taste perversion, dizziness, somnolence... 

Although CT-cholangiography can depict intrahepatic stones and the pancreatic duct better than MRCP, CT radiation exposure and potential contrast reactions have limited CT use (Mowat et al. 1976). 

The ductal abnormality in pancreas divisum may be diagnosed by MRCP often only after secretin stimulation (S-MRCP) (Fig. 4.16b,c). The duct of Santorini may be enlarged and the pancreas may demonstrate the characteristic features of pancreatitis. However, the detection of pancreas divisum at S-MRCP might be more difficult when stones or strictures are present in the ventral or dorsal pancreatic ducts (Manfredi et al. 2000). 

On US, an acute inflammationmayshowan increase in the duct calibers, with a diffuse swollen hypoechoic gland (Chao et al. 2000). Extrapancreatic fluid collections occur in about 50% of patients, mostly in the anterior pararenal space and this maybe the only finding. Some studies have found a correlation between the diameter of the pancreatic duct and serum lipase level. Early US is a helpful tool for identification of stones in the bihary tract in jaundice patients, and Doppler US may diagnose splenic vein thrombosis. 

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