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Autoimmune pancreatitis is a rare condition characterized by inflammation and scarring of the pancreas caused by an autoimmune process. It has been referred to by numerous names since its initial description in 1961. A national survey in Japan found a prevalence of 0.82 cases per 100,000 people. Clinical presentations include acute recurrent pancreatitis, painless obstructive jaundice that must be differentiated from pancreatic cancer, and subacute or late presentations involving a persistent pancreatic mass, an atrophic pancreas with possible calcifications, or unexplained steatorrhea.
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Autoimmune Pancreatitis
Autoimmune pancreatitis is the pancreatic manifestation of a systemic disorder that affects various organs, including the bile duct, retroperitoneum, kidney, and parotid and lacrimal glands. It represents a recently described subset of chronic pancreatitis that is immune mediated and has unique histologic, morphologic, and clinical characteristics. A hallmark of the disease is its rapid response to corticosteroid treatment. Although still a rare disease, autoimmune pancreatitis is increasingly becoming recognized clinically, leading to evolution in the understanding of its prognosis, clinical characteristics, and treatment.
Autoimmune pancreatitis
1) Autoimmune pancreatitis is characterized by lymphoplasmacytic infiltration and fibrosis of the pancreas that often dramatically responds to steroid therapy.
2) Diagnosis involves a combination of clinical, imaging, histological, and serological findings including elevated serum IgG4 levels and involvement of other organs.
3) Two subtypes exist - type 1 is associated with elevated IgG4, other organ involvement and a good response to steroids, while type 2 involves granulocytic epithelial lesions and is less responsive to steroids.
Cholecystitis
This document provides an overview of cholecystitis, including:
1. It defines cholecystitis as the inflammatory condition of the gallbladder and describes the types of acute cholecystitis.
2. It outlines the clinical features of acute cholecystitis including symptoms like colicky pain and signs like Murphy's sign.
3. It discusses the treatment options for acute cholecystitis which include conservative treatment, early cholecystectomy, or emergency cholecystostomy depending on the severity of the case.
Pancreatitis
Pancreatitis is inflammation of the pancreas that can be acute or chronic. Acute pancreatitis involves reversible injury to the pancreas and is commonly caused by alcoholism or gallstones. It presents as abdominal pain and involves the inappropriate activation of pancreatic enzymes that destroy pancreatic tissue. Chronic pancreatitis is a long-standing condition characterized by irreversible damage to the pancreas from prolonged inflammation, often due to alcoholism or duct obstruction, leading to permanent impairment of pancreatic function. Both forms involve inflammation, necrosis, and fibrosis of the pancreas.
Chronic pancreatitis
This document discusses pain management strategies for chronic pancreatitis. It begins with an overview of chronic pancreatitis and the mechanisms of pain, including ductal and parenchymal hypertension, pancreatic neuropathy, and neuroplasticity.
Conservative management approaches are outlined first, including lifestyle changes, pancreatic enzyme supplementation, and analgesics like amitriptyline. Endoscopic options for managing pancreatic duct obstructions and stones are then covered, such as sphincterotomy, stenting, and extracorporeal shockwave lithotripsy. Surgical interventions like lateral pancreaticojejunostomy are discussed as later options for intractable pain or complications.
Case presentation on Duodenal ulcer
DEFINITION:
A crater(ulcer) in the lining of the beginning of the small intestine (duodenum).
CAUSES OF DUODENAL ULCER
Infection with helicobacter pylori
Anti-inflammatory medicines
Other factors such as smoking, stress and drinking
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This document provides an overview of recent developments in pancreatic disorders and their treatment. It discusses chronic pancreatitis and its clinical features including abdominal pain and pancreatic insufficiency. It reviews approaches to pain management including medical, endoscopic, and surgical options. When considering surgery, it notes the goals of relieving pain while preserving endocrine and exocrine function. It also summarizes a study finding improved quality of life in pediatric patients after total pancreatectomy with islet autotransplantation.
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Autoimmune Pancreatitis
Autoimmune pancreatitis is the pancreatic manifestation of a systemic disorder that affects various organs, including the bile duct, retroperitoneum, kidney, and parotid and lacrimal glands. It represents a recently described subset of chronic pancreatitis that is immune mediated and has unique histologic, morphologic, and clinical characteristics. A hallmark of the disease is its rapid response to corticosteroid treatment. Although still a rare disease, autoimmune pancreatitis is increasingly becoming recognized clinically, leading to evolution in the understanding of its prognosis, clinical characteristics, and treatment.
Autoimmune pancreatitis
1) Autoimmune pancreatitis is characterized by lymphoplasmacytic infiltration and fibrosis of the pancreas that often dramatically responds to steroid therapy.
2) Diagnosis involves a combination of clinical, imaging, histological, and serological findings including elevated serum IgG4 levels and involvement of other organs.
3) Two subtypes exist - type 1 is associated with elevated IgG4, other organ involvement and a good response to steroids, while type 2 involves granulocytic epithelial lesions and is less responsive to steroids.
Cholecystitis
This document provides an overview of cholecystitis, including:
1. It defines cholecystitis as the inflammatory condition of the gallbladder and describes the types of acute cholecystitis.
2. It outlines the clinical features of acute cholecystitis including symptoms like colicky pain and signs like Murphy's sign.
3. It discusses the treatment options for acute cholecystitis which include conservative treatment, early cholecystectomy, or emergency cholecystostomy depending on the severity of the case.
Pancreatitis
Pancreatitis is inflammation of the pancreas that can be acute or chronic. Acute pancreatitis involves reversible injury to the pancreas and is commonly caused by alcoholism or gallstones. It presents as abdominal pain and involves the inappropriate activation of pancreatic enzymes that destroy pancreatic tissue. Chronic pancreatitis is a long-standing condition characterized by irreversible damage to the pancreas from prolonged inflammation, often due to alcoholism or duct obstruction, leading to permanent impairment of pancreatic function. Both forms involve inflammation, necrosis, and fibrosis of the pancreas.
Chronic pancreatitis
This document discusses pain management strategies for chronic pancreatitis. It begins with an overview of chronic pancreatitis and the mechanisms of pain, including ductal and parenchymal hypertension, pancreatic neuropathy, and neuroplasticity.
Conservative management approaches are outlined first, including lifestyle changes, pancreatic enzyme supplementation, and analgesics like amitriptyline. Endoscopic options for managing pancreatic duct obstructions and stones are then covered, such as sphincterotomy, stenting, and extracorporeal shockwave lithotripsy. Surgical interventions like lateral pancreaticojejunostomy are discussed as later options for intractable pain or complications.
Case presentation on Duodenal ulcer
DEFINITION:
A crater(ulcer) in the lining of the beginning of the small intestine (duodenum).
CAUSES OF DUODENAL ULCER
Infection with helicobacter pylori
Anti-inflammatory medicines
Other factors such as smoking, stress and drinking
Enfermedad del higado graso no alcoholico
This document discusses non-alcoholic fatty liver disease (NAFLD), which includes non-alcoholic fatty liver (over 5-10% fat content) and non-alcoholic steatohepatitis (fatty liver with inflammation, cell injury, and/or fibrosis). It defines NAFLD, examines its epidemiology and etiological factors. It also explores the disease's pathophysiology, diagnosis, and treatment, drawing information from multiple sources on these topics.
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This document provides an overview of recent developments in pancreatic disorders and their treatment. It discusses chronic pancreatitis and its clinical features including abdominal pain and pancreatic insufficiency. It reviews approaches to pain management including medical, endoscopic, and surgical options. When considering surgery, it notes the goals of relieving pain while preserving endocrine and exocrine function. It also summarizes a study finding improved quality of life in pediatric patients after total pancreatectomy with islet autotransplantation.
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- The patient has a history of chronic pancreatitis dating back to 2010 when she was diagnosed with a large pancreatic duct stone. She has undergone multiple procedures to treat this including ERCP and pancreaticojejunostomy.
- On current imaging the pancreatic duct remains dilated with a large stone present. The patient presents with ongoing upper abdominal pain.
- Surgical management options discussed include further endoscopic procedures, drainage procedures such as longitudinal pancreaticojejunostomy, or resectional procedures depending on the extent of disease. Pain control and enzyme supplementation are also important aspects of ongoing medical management.
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This document summarizes an article from the New England Journal of Medicine about acute pancreatitis. It provides details on the pathogenesis, diagnosis, and management of acute pancreatitis. It discusses risk factors, causes, predictors of severe disease, and treatments including fluid resuscitation, determining the cause, imaging studies, ERCP, and predicting outcomes. Key points are that acute pancreatitis results from inappropriate activation of pancreatic enzymes, risk factors are gallstones and alcohol, and predictors of severe disease include scoring systems assessing inflammation and organ failure.
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Chronic pancreatitis is characterized by progressive loss of exocrine and endocrine function. Pain is a major clinical feature and can be intermittent or continuous. Surgery is considered for intractable pain or complications. Different surgical options include drainage procedures like longitudinal pancreaticojejunostomy or resection procedures such as the Frey procedure. Appropriate timing of surgery and type of procedure depends on factors like disease severity and presence of complications.
Acute pancreatitis
A 22-year-old male presented with sudden onset of epigastric pain radiating to the back with no significant past medical history. On examination, he was in pain with normal vital signs and abdominal tenderness. This raises concern for acute pancreatitis. The document discusses definitions, diagnosis, assessment of severity, management of fluid replacement, antibiotics, nutrition, and other issues related to acute pancreatitis. Enteral nutrition is preferred over total parenteral nutrition for acute pancreatitis as it reduces mortality, organ failure, infections, and length of hospital stay.
Acute pancreatitis
This document discusses acute pancreatitis, including its anatomy and physiology, causes, pathogenesis, clinical presentation, predictors of severity, management, and treatment algorithms. It provides details on:
- The exocrine functions of the pancreas and mechanisms that normally protect it from premature enzyme activation.
- Etiologies of acute pancreatitis including gallstones, alcohol use, and other associated conditions.
- Scoring systems like Ranson criteria, CT severity index, and APACHE II that are used to predict severity and guide management.
- Diagnostic tests including serum amylase and lipase levels, CT scans, and C-reactive protein to evaluate for necrosis or infection.
- Initial supportive management focusing on fluid
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ACUTE PANCREATITIS ,INTRODUCTION, AETIOPATHOLOGY
This document discusses acute pancreatitis, including its definition, classification, incidence, etiology, pathogenesis, and pathophysiology. Acute pancreatitis is an inflammatory disease of the pancreas with varying degrees of severity from mild self-limiting inflammation to critical illness. It commonly results from alcohol use or gallstone disease. The pathogenesis involves acinar cell events and cytokine activation that determine the clinical course. Incidence is approximately 50 per 100,000 population per year in India and 49.3 per 100,000 in the United States.
Nutritional support in severe acute pancreatitis
1) Early enteral nutrition within 72 hours of admission has benefits over total parenteral nutrition in severe acute pancreatitis by helping to maintain gut integrity and reducing permeability.
2) Enteral nutrition should begin with trophic or small volume feeds through a nasojejunal tube if possible to reduce pressure on the pancreas and decrease risk of exacerbating pancreatitis.
3) Most patients can be fed enterally even if they develop pancreatic necrosis as long as they remain hemodynamically stable and have adequate gastric emptying. Total parenteral nutrition should only be used in rare situations.
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This document discusses chronic pancreatitis, including its definition, causes, symptoms, diagnostic tests, and surgical treatment options. It notes that chronic pancreatitis is characterized by irreversible morphological changes and permanent loss of pancreatic function. The main indications for surgery are intractable pain and complications. Surgical options include drainage procedures like longitudinal pancreaticojejunostomy or cyst-enterostomies, as well as resections like Whipple procedure or distal pancreatectomy. The goals of surgery are pain relief, control of complications, and improved quality of life. While surgery provides sustained pain relief in over 85% of patients, outcomes may be complicated by associated issues like portal hypertension.
Git j club chronic pancreatitis 16.
This document defines and discusses chronic pancreatitis. It begins by defining chronic pancreatitis as a progressive inflammatory disease of the pancreas that damages the gland and causes exocrine and endocrine dysfunction. It then classifies chronic pancreatitis into three main forms: chronic calcifying pancreatitis, chronic obstructive pancreatitis, and steroid-responsive pancreatitis. The document goes on to discuss risk factors, pathogenesis, clinical presentation, diagnosis, and management of chronic pancreatitis.
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This document discusses pancreatitis, including its definition, types, causes, pathophysiology, signs and symptoms, diagnostic studies, complications, and management. Pancreatitis is inflammation of the pancreas that can damage the organ through premature activation of digestive enzymes. It can be acute, with rapid onset but potential reversibility, or chronic, resulting from irreversible structural changes over many years. Gallstones and alcohol are major causes. Diagnostic tests include blood tests, imaging like CT scans, and procedures like ERCP. Complications involve infection, pancreatic cancer, or nutritional issues. Treatment involves managing pain, treating underlying causes, and surgery in some cases. Nursing care focuses on pain management, fluid and nutrition management, and addressing related risks
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- On current imaging the pancreatic duct remains dilated with a large stone present. The patient presents with ongoing upper abdominal pain.
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This document discusses acute pancreatitis, including its anatomy and physiology, causes, pathogenesis, clinical presentation, predictors of severity, management, and treatment algorithms. It provides details on:
- The exocrine functions of the pancreas and mechanisms that normally protect it from premature enzyme activation.
- Etiologies of acute pancreatitis including gallstones, alcohol use, and other associated conditions.
- Scoring systems like Ranson criteria, CT severity index, and APACHE II that are used to predict severity and guide management.
- Diagnostic tests including serum amylase and lipase levels, CT scans, and C-reactive protein to evaluate for necrosis or infection.
- Initial supportive management focusing on fluid
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1) Early enteral nutrition within 72 hours of admission has benefits over total parenteral nutrition in severe acute pancreatitis by helping to maintain gut integrity and reducing permeability.
2) Enteral nutrition should begin with trophic or small volume feeds through a nasojejunal tube if possible to reduce pressure on the pancreas and decrease risk of exacerbating pancreatitis.
3) Most patients can be fed enterally even if they develop pancreatic necrosis as long as they remain hemodynamically stable and have adequate gastric emptying. Total parenteral nutrition should only be used in rare situations.
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This case presentation describes a 60-year-old female patient who presented with 1 month of abdominal pain and 7 days of fever. Imaging revealed multiple rim-enhancing lesions in the liver consistent with pyogenic liver abscesses. The patient was diagnosed with pyogenic liver abscess and treated with intravenous antibiotics and drainage of the abscesses. Liver abscesses can have various causes but are often related to biliary tract or gastrointestinal infections. Diagnosis involves imaging and drainage or aspiration of pus is usually needed along with broad-spectrum intravenous antibiotics administered for at least 2 weeks.
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This document discusses immune reconstitution inflammatory syndrome (IRIS), where restoring immune function after an immunosuppressive event like HIV treatment causes inflammation. IRIS can occur when starting antiretroviral therapy for HIV and restoring the immune system leads to inflammation when fighting off opportunistic infections or cancers. Symptoms include worsening of existing infections or appearance of new infections, and treatment focuses on managing the inflammatory response with anti-inflammatory medications.
Myocarditis
This document discusses myocarditis, including its clinical presentation and findings on cardiac MRI. Regarding clinical presentation, it notes that symptoms can range from subclinical to fulminant heart failure, with the most common symptoms being chest pain, dyspnea, and arrhythmias. Cardiac MRI is useful for identifying myocarditis and can detect tissue edema, hyperemia, and fibrosis. Findings on MRI include increased T2 signal from edema, early contrast enhancement indicating hyperemia, and late gadolinium enhancement of replaced fibrotic tissue. Morphological abnormalities seen include transient increases in wall thickness and LV volumes during active myocarditis.
Myocarditis
This document discusses myocarditis, including its clinical presentation and findings on cardiac MRI. Regarding clinical presentation, it notes that symptoms can range from subclinical to fulminant heart failure, with the most common symptoms being chest pain, dyspnea, and arrhythmias. Cardiac MRI is useful for identifying myocarditis and can detect tissue edema, hyperemia, and fibrosis. Findings on MRI include increased T2 signal from edema, early contrast enhancement indicating hyperemia, and late gadolinium enhancement of replaced fibrotic tissue. Morphological abnormalities seen include transient increases in wall thickness and LV volumes during active myocarditis.
Myocarditis
This document discusses myocarditis, including its clinical presentation and findings on cardiac MRI. Regarding clinical presentation, it notes that symptoms can range from subclinical to fulminant heart failure, with the most common symptoms being chest pain, dyspnea, and arrhythmias. Cardiac MRI is useful for identifying myocarditis and can detect tissue edema, hyperemia, and fibrosis. Findings on MRI include increased T2 signal from edema, early contrast enhancement indicating hyperemia, and late gadolinium enhancement of replaced fibrotic tissue. Morphological abnormalities seen include transient increases in wall thickness and LV volumes during active myocarditis.
Mr feb 7 2014
Cryptogenic organizing pneumonia (COP), formerly known as bronchiolitis obliterans pneumonia, is a type of diffuse interstitial lung disease where the primary area of injury is the alveolar wall. It is characterized by the excessive proliferation of granulation tissue within the alveolar ducts and airspaces. The disease typically affects people in their fifth or sixth decade of life equally in men and women. Symptoms often mimic community-acquired pneumonia and include cough, dyspnea, weight loss, and flu-like illness. Diagnosis requires histopathologic identification of organizing pneumonia lesions from surgical lung biopsy. Treatment involves systemic glucocorticoids or immunosuppressants if unresponsive to steroids.
Nails
This document provides an overview of nail abnormalities and their potential causes or associations. It describes nail features such as color, shape, thickness, ridges, and other characteristics. Common abnormalities are discussed like spooned nails, clubbing, Beau's lines, and Mees' lines. Specific conditions are linked to certain nail findings, for example iron deficiency with spoon nails or cardiovascular issues with clubbing. The hand is also reviewed showing deformities and their related nerves or diseases. Overall, the document serves as a guide to interpreting nail exams and relating physical findings to underlying patient conditions or exposures.
Mr2414
Neuroendocrine tumors (NETs) can secrete functional hormones and commonly metastasize to the liver. Management depends on the specific tumor type and location. Carcinoid tumors of the appendix smaller than 1 cm require only appendectomy, while larger or higher grade tumors warrant right hemicolectomy. Multiple endocrine neoplasia (MEN) syndromes involve specific tumor patterns and genetic mutations. A woman with a 0.8 cm well-differentiated carcinoid tumor in her appendix requires no further intervention after appendectomy.
Mr 2 3-14
This document appears to be a medical record for a patient named Christopher Dado dated February 3rd, 2014. It references an article from the New England Journal of Medicine from the year 1953. In 3 sentences or less, this summarizes the key details and context contained in the brief document.
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Raza mr 3.24.14
- 2. Autoimmune pancreatitis • Numerous names • Sclerosis of the pancreas (Sarles, 1961) • Chronic sclerosing pancreatitis • Lymphoplasmacyticsclerosing pancreatitis • Nonalcoholic duct destructive pancreatitis • Sclerosing pancreatitis • Sclerosingpancreaticocholangitis • Autoimmube chronic pancreatitis • Autoimmune pancreatitis (Yoshida, 1995)
- 4. Autoimmune pancreatitis epidemiology • National survey in Japan (2002) • Prevalence – 0.82/100,000
- 5. Clinical presentation • Acute: • Acute/recurrent episodes of pancreatitis - rare • Painless obstructive jaundice (ddx pancreatic cancer) • Subacute/late: • Persistent pancreatic mass • Atrophic pancreas +/- calcifications • Unexplained steatorrhea