Diverticular Bleeding DEFINITION: Bleeding diverticulum; See also Bowel- Diverticulosis & Diverticulitis (Chapter 2.14) EPIDEMIOLOGY: Those with diverticulosis will develop diverticular bleeding 3-5% of the time After angiodysplasia, diverticula hemorrhage is…

Acute GI Bleed Pearls (Gastrointest Endosc 2004;60:497-504) PRE-ENDOSCOPY Questions to ask: Nature and duration of bleed: When did it start? First time/Recurrent? Symptoms: Fever, Pain, Dyspepsia, Hematemesis/Coffee grounds, Hematachezia/Melena/BRBPR, Clots…

Potpourri PANCREAS ANATOMY AND PHYSIOLOGY Anatomy Retroperitoneal, between L4-5 spine Arterial supply: gastroduodenal, SMA, splenic; Venous drainage: portal & splenic; Nerves: vagal (stimulatory), sympathetic (inhibitory) Note thrombosis of the splenic…

Sphincter of Oddi Dysfunction DEFINITION: The Sphincter of Oddi (SO) is a fibromuscular sheath that encircles the terminal portion of the common bile duct, pancreatic duct, and common channel in…

Pancreatitis: Chronic DEFINITION: Chronic Pancreatic (CP) implies the presence of parenchymal fibrosis, and loss of glandular function Marseilles-Rome/Sarles classification: Lithogenic (Calcifying) CP: Largest group, ETOH is leading cause and is…

Pancreatitis: Acute (Am J Gastroenterol 2006;101:2379-2400 & 1997;92:377-86. N Engl J Med 2006;354:2142-50. J Hepatobil Pancreat Surg 2006;13:56-60) DEFINITION: Acute pancreatitis: inflammatory condition of the pancreas that may extend to…

Pancreatic Carcinoma (Gastroenterology 1999;117:1463-84) DEFINITION: Adenocarcinoma, well-differentiated, arising from pancreatic ductal epithelium (90% of cases) Most arise in the head of pancreas (80%) See also Pancreas/Biliary- Cystic Disease of the…

Cystic Disease of the Pancreas (Surgical Oncology 2005;14:155-78. Pancreas 2002;25:217-21) DEFINITION: True pancreatic cyst has epithelia cell lining (account for only 10-15% of all cystic lesions of the pancreas) Pancreatic…

Cholelithiasis & Choledocholithiasis CHOLELITHIASIS Definition: “Gallstones” “Sludge” (microlithiasis): super-concentrated mixture of bile acids, bilirubin, cholesterol, mucus, and proteins Discharge into cystic duct & CBD can cause Acalculous Cholecystitis or ‘Idiopathic…

Cholecystitis & Cholangitis CHOLECYSTITIS Definition: Inflammation of the gallbladder Etiologies: E. coli, Klebsiella, Enterococcus, and Enterobacter are the usual pathogens DDX: hepatitis, liver mets, pancreatitis, pseudocyst, PUD, pyelonephritis, renal stones,…