By Ian Beckingham
Queen's scientific Centre, Nottingham, united kingdom. offers an outline of the illnesses of the liver, pancreas, and gall bladder. For citizens, scientific scholars, and common practitioners. Covers universal and infrequent stipulations and comprises algorithms for prognosis and therapy. colour illustrations. Softcover.
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Additional info for ABC of liver, pancreas and gall bladder
The role of prophylactic antibiotics in severe pancreatitis remains unclear, but recent randomised trials have shown a marginal benefit with antibiotics that have good penetration into pancreatic tissue (such as high dose cefuroxime and imipenem). Patients with severe gallstone pancreatitis and biliary sepsis or obstruction benefit from endoscopic retrograde cholangiopancreatography and removal of stones from the common bile duct within the first 48 hours of admission. However, the benefit of sphincterotomy is equivocal in patients without biliary obstruction.
This is characterised by pancreatic necrosis and associated cytokine activation resulting in multiple organ dysfunction syndrome. The necrotic process mainly affects the peripancreatic tissue (mostly fat) and may spread extensively along the retroperitoneal space behind the colon and into the small bowel mesentery. The necrotic tissue can become infected, probably by translocation of bacteria from the gut. 1 Causes of acute pancreatitis Gallstones 80% Alcohol Idiopathic: 10% Endoscopic retrograde cholangiopancreatography or sphincterectomy: 5% x Miscellaneous: 5% Hyperlipidaemia Trauma Hyperparathyroidism Viral (mumps, Epstein-Barr virus, cytomegalovirus coxsackievirus) Drug induced (thiazide diuretics, angiotensin converting enzyme inhibitors, oestrogens, corticosteroids, azathioprine) Anatomical (pancreas divisum, annular pancreas) Parasites (Ascaris lumbricoides) x x x x } Clinical presentation Acute pancreatitis should always be considered in the differential diagnosis of patients with acute abdomen.
Factors that increase the risk of death include shock, adult respiratory distress syndrome, disseminated intravascular coagulation, immunodeficiency states, severe hypoalbuminaemia, diabetes, ineffective surgical drainage, and associated malignancy. 2 Computed tomogram showing multifocal liver abscess in segment IV. 3 Drainage requirements for liver abscesses x None—multiple small abscesses that respond to antibiotics (Obstruction of bile duct must be excluded as a cause and endoscopic retrograde cholangiopancreatography with stenting performed if necessary) x Percutaneous aspiration—abscesses < 6 cm x Percutaneous catheter drainage—abscesses >6 cm x Open surgery Failed percutaneous drainage Very large or multilocular abscesses Associated intra-abdominal infection requiring surgery such as bile duct stones About 10% of the world’s population is chronically infected with Entamoeba histolytica.