No abstract

No abstract

The end of life can be a highly emotional and difficult time for patients and their families. Advance care planning for end-of-life care is one option for helping to mitigate the burden of this experience. Despite its advantages, gaps in end-of-life advance care planning participation persist, particularly among underserved segments of the U.S. population who might benefit from it. This column highlights barriers to end-of-life advance care planning among medically underserved populations and discusses opportunities for greater engagement.

Sphincter of Oddi Dysfunction (SOD) is a smooth muscle valve disorder regulating the flow of biliary and pancreatic secretions into the duodenum. SOD is categorized into three different types based on the Milwaukee classification system, with a prevalence of 1.5% in the general population. Type I patients have pain as well as abnormal liver enzymes and a dilated common bile duct. Type II SOD consists of pain and only one objective finding, and Type III consists of biliary pain only. The link between SOD and dyslipidemia is underappreciated. Increased biliary absorption of cholesterol in the form of biliary salts can increase the excretion and ultimately result in decreased serum cholesterol levels. It is important to consider SOD in patients with pain, elevated LFT’s and dyslipidemia despite statin therapy. In this article, a case of Type I SOD with recurrent pancreatitis is reviewed. This patient was initially diagnosed with acute pancreatitis secondary to hypertriglyceridemia. He had an additional episode of pancreatitis despite being on statin therapy with an improvement of triglycerides. SOD was then diagnosed with sphincterotomy after his second admission to the hospital. This resulted in the resolution of the patient’s symptoms and improvement of LFT’S. Manometry has long been considered the gold standard for diagnosis; however, it is not always available in low-resource settings. Therefore, endoscopic sphincterotomy is being considered for diagnosis as it can be diagnostic and therapeutic.