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Typhoid infection of the gallbladder Salmonella Typhi or Salmonella Typhimurium can infect the gallbladder. Acute or, more frequently , chronic cholecystitis occurs, with the patient becoming a typhoid carrier excreting the bacteria in the bile. Gallstones may...

Ultrasonography Transabdominal ultrasonography (USG) ( Figure 71.7 initial imaging modality of choice as it is accurate, readily John Benjamin Murphy , 1857–1916, surgeon, Mercy Hospital, Chicago, IL, USA. operator dependent and may be compromised by excessiv...

Xanthogranulomatous cholecystitis Xanthogranulomatous cholecystitis ( Figure 71.30 ) is an uncommon inflammation of the gallbladder, more frequently seen in India and Japan. It is more common in females. - It is caused by extravasation of bile into the gallbl...

ANATOMY AND PHYSIOLOGY Anatomy The name ‘pancreas’ is derived from the Greek ‘pan’ (all) and ‘kreas’ (flesh). For a long time, its glandular function was not understood and it was thought to act as a cushion for the stomach. The pancreas is situated in the retr...

Acute pancreatitis Incidence Acute pancreatitis accounts for 3% of all cases of abdominal pain among patients admitted to hospital in the UK. The hospital admission rate for acute pancreatitis is 9.8 per year per 100 /uni00A0 000 population in the UK, althou...

Annular pancreas This is the result of failure of complete rotation of the ventral pancreatic bud during development, so that a ring of pancre - atic tissue surrounds the second or third part of the duodenum. It is most often seen in association with cong...

CARCINOMA OF THE PANCREAS Pancreatic cancer is the seventh leading cause of cancer deaths in men and women worldwide. In the USA it follows lung cancer and colorectal cancer as the third most common cause of cancer death. In the UK, it is the tenth most commo...

CONGENITAL ABNORMALITIES Cystic fibrosis This is inherited as an autosomal recessive condition. It occurs most frequently among white people, in whom it is the most common inherited disorder (incidence of 1:2000 live births in the UK). Cystic fibrosis (CF) deve...

Chronic pancreatitis Chronic pancreatitis is a progressive inflammatory disease in which there is irreversible destruction of pancreatic tissue. Its clinical course is characterised by severe pain and, in the later stages, exocrine and endocrine pancreatic ins...

Clinical features Jaundice secondary to obstruction of the distal bile duct is the most common symptom that draws attention to ampul - - lary and pancreatic head tumours. It is characteristically painless jaundice but may be associated with nausea and epigas...

Ectopic pancreas Islands of ectopic pancreatic tissue can be found in the submu - cosa in parts of the stomach, duodenum or small intestine (including Meckel’s diverticulum), the gallbladder, adjoining - the pancreas, in the hilum of the spleen and within ...

Endoscopic ultrasonography Endoscopic ultrasonography (EUS) is performed using a special endoscope that has a high-frequency ultrasonic transducer at its tip. When the endoscope is in the lumen of the stomach or duodenum, the pancreas and its surrounding vascu...

FURTHER READING Braganza JM, Lee SH, McCloy RF , McMahon MJ. Chronic pancreati - tis. Lancet 2011; 377 : 1184–97. Conroy T , Hammel P , Hebbar M et al . FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med 2018; 379 : 2395–406. Jar...

INJURIES TO THE PANCREAS External injury Presentation and management The pancreas is not frequently damaged in blunt abdominal trauma but when it occurs it is often associated with injuries to other viscera, especially the liver, the spleen and the duode num. ...

INVESTIGATIONS Estimation of pancreatic enzymes in body fluids Investigations of the pancreas are listed in Table 72.2 . When the pancreas is damaged, enzymes such as amylase, lipase, trypsin, elastase and chymotrypsin are released into the serum. Measurement ...

Iatrogenic injury This can occur in several ways: /uni25CF Injury to the tail of the pancreas during splenectomy , resulting in a pancreatic fistula. /uni25CF Injury to the pancreatic head and the accessory pancreatic duct (Santorini), which is the main duct i...

Imaging investigations Ultrasonography Ultrasonography is the initial investigation of choice in patients with jaundice to determine whether or not the bile duct is dilated, the coexistence of gallstones or gross disease within the liver such as metastases. I...

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