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Acute recurrent pancreatitis
GA Lehman
History,
physical examination, simple laboratory and radiological
tests, and endoscopic retrograde cholangiopancreatography
(ERCP) are able to establish the cause of recurrent
acute pancreatitis in 70% to 90% of patients. Dysfunction
of the biliary and/or pancreatic sphincter, as identified
by sphincter of Oddi manometry, accounts for the majority
of the remaining cases. The diagnosis may be missed
if the pancreatic sphincter is not evaluated. Pancreas
divisum is a prevalent congenital abnormality that is
usually innocuous but can lead to recurrent attacks
of acute pancreatitis or abdominal pain. In select cases,
endoscopic sphincterotomy of the minor papilla can provide
relief of symptoms and prevent further attacks. A small
proportion of patients with idiopathic pancreatitis
have tiny stones in the common bile duct (microlithiasis).
Crystals can be visualized during microscopic analysis
of bile that is aspirated at the time of ERCP. Neoplasia
is a rare cause of pancreatitis, and the diagnosis can
usually be established by computerized tomography or
ERCP. A wide variety of medications can also cause recurrent
pancreatitis. ERCP, sphincter of Oddi manometry, and
microscopy of aspirated bile should be undertaken in
patients with recurrent pancreatitis in whom the diagnosis
is not obvious.
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