Retrograde Cholangiopancreatography
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Retrograde Cholangiopancreatography
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. It is primarily performed by highly skilled and specialty trained gastroenterologists. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject a contrast medium into the ducts in the biliary tree and/or pancreas so they can be seen on radiographs. ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP can be performed for diagnostic and therapeutic reasons, although the development of safer and relatively non-invasive investigations such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound has meant that ERCP is now rarely performed without therapeutic intent. Medic ...
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Gallstone
A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of migrated gallstones within bile ducts. Most people with gallstones (about 80%) are asymptomatic. However, when a gallstone obstructs the bile duct and causes acute cholestasis, a reflexive smooth muscle spasm often occurs, resulting in an intense cramp-like visceral pain in the right upper part of the abdomen known as a biliary colic (or "gallbladder attack"). This happens in 1–4% of those with gallstones each year. Complications from gallstones may include inflammation of the gallbladder (cholecystitis), inflammation of the pancreas (pancreatitis), obstructive jaundice, and infection in bile ducts ( cholangitis). Symptoms of these complications may include pain that lasts longer than five hours, fever, yellowish skin, vomiting, da ...
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Obstructive Jaundice
Jaundice, also known as icterus, is a yellowish or, less frequently, greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme metabolism, liver dysfunction, or biliary-tract obstruction. The prevalence of jaundice in adults is rare, while jaundice in babies is common, with an estimated 80% affected during their first week of life. The most commonly associated symptoms of jaundice are itchiness, pale feces, and dark urine. Normal levels of bilirubin in blood are below 1.0  mg/ dl (17  μmol/ L), while levels over 2–3 mg/dl (34–51 μmol/L) typically result in jaundice. High blood bilirubin is divided into two types: unconjugated and conjugated bilirubin. Causes of jaundice vary from relatively benign to potentially fatal. High unconjugated bilirubin may be due to excess red blood cell breakdown, large bruises, gene ...
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Ampulla Of Vater
The ampulla of Vater, hepatopancreatic ampulla or hepatopancreatic duct is the common duct that is usually formed by a union of the common bile duct and the pancreatic duct within the wall of the duodenum. This common duct usually features a dilation ("''ampulla''"). The common duct then opens medially into the descending part of the duodenum at the major duodenal papilla. The common duct usually measures 2–10mm in length. The ampulla of Vater is an important landmark halfway along the second part of the duodenum marking the transition from foregut to midgut. Structure Sphincters Various smooth muscle sphincters regulate the flow of bile and pancreatic juice through the ampulla: the sphincter of the pancreatic duct, the sphincter of the bile duct, and the sphincter of Oddi. Variation The common bile duct and pancreatic duct may sometimes unite outside the duodenal wall, creating an unusually long common duct. The two ducts may also drain into the duodenum separately, o ...
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Major Duodenal Papilla
The major duodenal papilla (papilla of Vater) is a rounded projection in the duodenum into which the common bile duct and pancreatic duct drain. The major duodenal papilla is, in most people, the primary mechanism for the secretion of bile and other enzymes that facilitate digestion. Structure The major duodenal papilla is situated in the second part of the duodenum, 7–10 cm from the pylorus, at the level of the second or third lumbar vertebrae. It is surrounded by the sphincter of Oddi, a circular muscle, and receives a mixture of pancreatic enzymes and bile from the Ampulla of Vater, which drains both the pancreatic duct and biliary system. The junction between the foregut and midgut occurs directly below the major duodenal papilla. The major duodenal papilla projects less than a centimetre into the lumen of the duodenum. It appears rounded and is often covered by a fold on the uppermost side of the papilla; that is, the side which receives contents from the stomach. ...
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Self-expandable Metallic Stent
A self-expandable metallic stent (or SEMS) is a metallic tube, or stent that holds open a structure in the gastrointestinal tract to allow the passage of food, chyme, feces, stool, or other secretions related to digestion. Surgeons insert SEMS by endoscopy, inserting a fiber optics, fibre optic camera—either through the mouth or colon (anatomy), colon—to reach an area of narrowing. As such, it is termed an ''endoprosthesis''. SEMS can also be inserted using fluoroscopy where the surgeon uses an X-ray image to guide insertion, or as an adjunct to endoscopy. The vast majority of SEMS are used to alleviate symptoms caused by cancers of the gastrointestinal tract that obstruct the interior of the tube-like (or luminal) structures of the bowel — namely the esophagus, duodenum, common bile duct and colon. SEMS are designed to be permanent and, as a result, are often used when the cancer is at an advanced stage and cannot be removed by surgery. Composition and structure Self-expan ...
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Biliary Sludge
A bile duct is any of a number of long tube-like structures that carry bile, and is present in most vertebrates. The bile duct is separated into three main parts: the fundus (superior), the body (middle), and the neck (inferior). Bile is required for the digestion of food and is secreted by the liver into passages that carry bile toward the hepatic duct. It joins the cystic duct (carrying bile to and from the gallbladder) to form the common bile duct which then opens into the intestine. Structure The top half of the common bile duct is associated with the liver, while the bottom half of the common bile duct is associated with the pancreas, through which it passes on its way to the intestine. It opens into the part of the intestine called the duodenum via the ampulla of Vater. Segments The biliary tree (see below) is the whole network of various sized ducts branching through the liver. The path is as follows: bile canaliculi → canals of Hering → interlobular bile ...
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Sphincter Of Oddi
The sphincter of Oddi (SO) (also hepatopancreatic sphincter or Glisson's sphincter), is a sphincter, a muscular valve that, in humans and some animals, controls the flow of bile and pancreatic juice out of the gallbladder and pancreas respectively through the ampulla of Vater into the second part of the duodenum. It is named after Ruggero Oddi. Structure The sphincter of Oddi is a circular muscle band, or sphincter that surrounds the major duodenal papilla. Function The sphincter regulates the secretion of pancreatic juice and bile into the duodenum. It also prevents reflux of duodenal contents into the ampulla of Vater. By preventing reflux of the contents of the duodenum, the sphincter of Oddi prevents the accumulation of particulate matter and sludge in the bile ducts, reducing the risk of cholangitis. The sphincter of Oddi also allows retrograde filling of the gallbladder. The sphincter of Oddi is relaxed by the hormone cholecystokinin via vasoactive intestinal pep ...
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Pancreatic Cancer
Pancreatic cancer arises when cell (biology), cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a Neoplasm, mass. These cancerous cells have the malignant, ability to invade other parts of the body. A number of types of pancreatic cancer are known. The most common, pancreatic adenocarcinoma, accounts for about 90% of cases, and the term "pancreatic cancer" is sometimes used to refer only to that type. These adenocarcinomas start within the part of the pancreas that makes digestive enzymes. Several other types of cancer, which collectively represent the majority of the non-adenocarcinomas, can also arise from these cells. About 1–2% of cases of pancreatic cancer are neuroendocrine tumors, which arise from the hormone-producing neuroendocrine cell, cells of the pancreas. These are generally less aggressive than pancreatic adenocarcinoma. Signs and symptoms of the most-common form of pancreatic cancer may include jaundice, ...
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Magnetic Resonance Cholangiopancreatography
Magnetic resonance cholangiopancreatography (MRCP) is a medical imaging technique. It uses magnetic resonance imaging to visualize the biliary and pancreatic ducts non-invasively. This procedure can be used to determine whether gallstones are lodged in any of the ducts surrounding the gallbladder. Uses MRCP has been slowly replacing endoscopic retrograde cholangiopancreatography (ERCP) as investigation of choice. MRCP is highly accurate in diagnosing the biliary system, pancreatic duct and accessing surrounding solid organs. Several advantages offered by MRCP is its non-invasive nature, less costly, requires less examination time when compared to ERCP (30 minutes), fewer staff required, and does not require any ionising radiation. MRCP is used to diagnose gallstones. It can also diagnose choledochal cysts very reliably. Besides providing information regarding the biliary system, MRCP also provides information regarding surrounding solid organs and blood vessels, thus useful fo ...
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CT Scan
A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or radiology technologists. CT scanners use a rotating X-ray tube and a row of detectors placed in a gantry (medical), gantry to measure X-ray Attenuation#Radiography, attenuations by different tissues inside the body. The multiple X-ray measurements taken from different angles are then processed on a computer using tomographic reconstruction algorithms to produce Tomography, tomographic (cross-sectional) images (virtual "slices") of a body. CT scans can be used in patients with metallic implants or pacemakers, for whom magnetic resonance imaging (MRI) is Contraindication, contraindicated. Since its development in the 1970s, CT scanning has proven to be a versatile imaging technique. While CT is most prominently used in medical diagnosis, i ...
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Pancreatitis
Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormone A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...s. There are two main types, acute pancreatitis and chronic pancreatitis. Signs and symptoms of pancreatitis include epigastrium, pain in the upper abdomen, nausea, and vomiting. The pain often goes into the back and is usually severe. In acute pancreatitis, a fever may occur; symptoms typically resolve in a few days. In chronic pancreatitis, weight loss, steatorrhea, fatty stool, and diarrhea may occur. Complications may include infection, bleeding, diabetes mellitus, or problems with other organs. The two most common causes of acute pancreatitis ar ...
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Sphincter Of Oddi
The sphincter of Oddi (SO) (also hepatopancreatic sphincter or Glisson's sphincter), is a sphincter, a muscular valve that, in humans and some animals, controls the flow of bile and pancreatic juice out of the gallbladder and pancreas respectively through the ampulla of Vater into the second part of the duodenum. It is named after Ruggero Oddi. Structure The sphincter of Oddi is a circular muscle band, or sphincter that surrounds the major duodenal papilla. Function The sphincter regulates the secretion of pancreatic juice and bile into the duodenum. It also prevents reflux of duodenal contents into the ampulla of Vater. By preventing reflux of the contents of the duodenum, the sphincter of Oddi prevents the accumulation of particulate matter and sludge in the bile ducts, reducing the risk of cholangitis. The sphincter of Oddi also allows retrograde filling of the gallbladder. The sphincter of Oddi is relaxed by the hormone cholecystokinin via vasoactive intestinal pep ...
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