Acute biliary pancreatitis.
The development of acute pancreatitis occurs in 4-8% of patients with symptomatic gallstones. Individuals predisposed to acute pancreatitis tend to have small gallstones (with or without larger gallstones), a wide cystic duct and a common channel between the biliary and pancreatic ducts. The importance of this relationship is demonstrated by the ability of urgent endoscopic sphincterotomy (ES) to improve the outcome of a predicted severe attack and to virtually abolish recurrent attacks in patients who are unable to undergo cholecystectomy. Cholesterolosis is an established cause of acute pancreatitis, occurring in up to 29% of cases with cholesterolosis. Biliary crystals are an important marker of microlithiasis or a propensity to form further gallstones following their passage into the duodenum following an attack. A combination of ultrasonography and a serum liver transaminase of > 60 IU/I (< 48 hr o an attack) are necessary to provide optimum sensitivity and specificity for gallstones as a prompt for the use of ERCP and ES in severe cases. Biliary sludge as a cause of acute pancreatitis is not proven. 25-30% of patients will develop complications with a mortality of around 8%. Urgent diagnosis of gallstones and treatment by ES can result in substantial improvement in outcome.
Curran
F T
FT
Academic Department of Surgery, City Hospital, Birmingham.
Neoptolemos
J P
JP
D000208:Acute Disease; D001646:Bile / Q000737:chemistry; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002784:Cholesterol / Q000032:analysis; D004796:Clinical Enzyme Tests; D004724:Endoscopy; D006801:Humans; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology*; D011379:Prognosis; D012680:Sensitivity and Specificity; D009803:Sphincter of Oddi / Q000601:surgery; D000637:Transaminases / Q000097:blood
D002784:Cholesterol; D000637:Transaminases