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Investigations In a jaundiced patient, the usual blood tests and ultrasound scan should be performed. Ultrasonography will determine if the bile duct is dilated. If it is, and there is a genuine suspicion Ludwig Courvoisier , 1843–1918, surgeon, Basel, Switze...

Learning objectives To understand: The anatomy and physiology of the pancreas • Investigations of the pancreas • Congenital abnormalities of the pancreas •

Management At presentation, more than 85% of patients with ductal adeno carcinoma are unsuitable for resection because of advanced disease. If imaging shows that the tumour is potentially resect able, the patient should be considered for surgical resection,...

Outcomes and follow-up of acute pancreatitis The overall mortality from acute pancreatitis has remained at 10–15% over the past 20 years. There is a clear responsibility before the patient is discharged to determine the aetiology of - the attack of pancreatiti...

PANCREATITIS Pancreatitis is inflammation of the pancreatic parenchyma. For clinical purposes, it is useful to divide pancreatitis into acute, which presents as an emergency , and chronic, which is a prolonged and frequently lifelong disorder resulting from th...

Pancreas divisum Pancreas divisum occurs when the embryological ventral and dorsal parts of the pancreas fail to fuse ( Figure 72.3 ). The dorsal pancreatic duct becomes the main pancreatic duct and drains most of the pancreas through the minor or accessory ...

Pancreatic function tests Pancreatic exocrine function can be assessed by directly measuring pancreatic secretion in response to a standardised stimulus. The stimulus to secretion can be physiological, e.g. ingestion of a test meal, as in the Lundh test, or p...

Pancreatic fistula Pancreatic fistula usually follows operative trauma to the gland or occurs as a complication of acute or chronic pancre atitis. It is important to define the site of the fistula and the epithelial structure with which it communicates (e.g. ext...

Pathology More than 85% of pancreatic cancers are ductal adeno carcinomas. The remaining tumours constitute a variety of pathologies with individual characteristics. Endocrine tumours of the pancreas are rare. These are cover ed in Chapter 57 Ductal adenocarc...

Physiology In response to a meal, the pancreas secretes digestive enzymes in an alkaline (pH /uni00A0 8.4) bicarbonate-rich fluid. Spontaneous secretion is minimal; the hormone secretin, which is released from the duodenal mucosa, evokes a bicarbonate-rich fluid...

pancreas This sometimes accompanies congenital disease of the kidneys and liver and occurs as part of the von Hippel–Lindau syndrome.

ACUTE ADYNAMIC NEUROMUSCULAR STATES OF THE SMALL INTESTINE WITH DILATATION: ILEUS Definition Ileus can be defined as: a disruption of the normal propulsive ability of the intestine due to a malfunction of contractile activity in the absence of mechanical obstruc...

APPLIED ANATOMY AND PHYSIOLOGY The intestine must subserve basic functions of moving contents from proximal to distal in a rhythmical fashion to allow mixing, digestion and absorption of contents. The motility of the intestine has been studied for more than ...

CHRONIC IMPAIRMENT OF INTESTINAL MOTILITY WITH DILATATION OF THE SMALL INTESTINE: INTESTINAL PSEUDO OBSTRUCTION Definition Intestinal pseudo-obstruction (IPO) is defined as: A clinical syndrome caused by severe impairment of intestinal motility leading to small ...

CHRONIC IMPAIRMENT OF INTESTINAL MOTILITY WITHOUT DILATATION Constipation and IBS are very common conditions and collec tively represent about a third of patients presenting to the aver age colorectal clinic in the Western world. They are presented here as sep...

Causes and risk factors The risk factors for ileus are listed in Summary box 73.3 Postoperative ileus (POI) occurs in 10–20% of patients under going elective major abdominal surgery and is usually defined by a failure to tolerate oral intake or pass stool 72 ho...

Causes of megacolon and megarectum Primary and secondary causes ( Table 73.4 ) vary between megarectum and megacolon. The most common disease to use the term megacolon is Hirschsprung’s disease (occurring in 1 in 5000 live births) (see Chapter 17 ). Actually ,...

Causes IPO is a rare disease. Approximately half of cases arise shortly after birth or in infancy , caused by a number of very rare enteric neuropathies and myopathies, including genetic and familial, inflammatory and degenerative forms. Other cases arise la...