Aim: to present modern methods of diagnosis and treatment of chronic pancreatitis for gastroenterologists, general practitioners and physicians.Chronic pancreatitis (CP) is a long-term inflammatory disease of the pancreas, manifested by irreversible morphological changes in the parenchyma and pancreatic ducts, which cause pain and/or persistent impairment of function. Current concept on the etiology of CP is reflected by the TIGAR-O classification. The criteria for establishing the diagnosis of CP include typical attacks of abdominal pain and/or clinical and laboratory signs of exocrine, endocrine insufficiency with the mandatory detection of characteristic morphological changes (calcifications in the parenchyma and pancreatic ductal stones, dilatation of the main pancreatic duct and its branches). CT, MRCP, and pancreatobiliary endosonography are recommended as the methods of choice to verify the diagnosis of CP. Conservative treatment of patients with CP is provided for symptom relief and prevention of complications. Individual cases with severe non-interactable abdominal pain, as well as a complicated course of the disease (development of ductal hypertension due to main pancreatic duct stones or strictures, obstructive jaundice caused by compression of the common bile duct, symptomatic postnecrotic cysts, portal hypertension due to compression of the portal vein or thrombosis of the splenic vein, persistent duodenal obstruction, pseudoaneurysm of the celiac trunk basin and the superior mesenteric artery) serve as an indication for endoscopic or surgical treatment. The Guidelines set out modern approaches to the diagnosis, conservative, endoscopic and surgical treatment of CP, and the prevention of its complications.Conclusion. The implementation of clinical guidelines can contribute to the timely diagnosis and improve the quality of medical care for patients with chronic pancreatitis.
In modern pancreatology, diagnostics of acute pancreatitis is one of the most complex and urgent problems. In recent decades, the incidence of acute pancreatitis (AP) has more than doubled and now it exceeds 25% among acute surgical diseases. Pancreonecrosis accounts for about 20–35% of all complications. General and postoperative mortality reaches 15–45%. Modern radiology methods in patients with AP and pancreatic necrosis aid in determination of disease form and its complications. In this article, the importance of radiological methods for treatment planning is reviewed. Close attention is paid to the interpretation of computer tomography (CT) data using various CT-scales and classifications. High incidence among young and healthy people highlights socio-economic significance of AP. Therefore, in this literature review, we focus on the publications and clinical cases of acute pancreatitis.
It is presented care report of the patient with liver alveococcosis. Survey confirmed parasitic invasion of both liver lobes. Radical alveococcectomy was impossible under these conditions since remnant liver volume was less than 30%. Treatment was divided into two stages. Moreover, it was decided to perform cryodestruction of parasitic tumor besides surgical intervention per se. Liver resection combined with cryodestruction of remnant parasitic tumor may be considered as radical treatment especially in redo surgery. Diagnosis, treatment, outcomes and literature review are comprehensively described in the article.
World literature data and our own findings of the influence of biomolecular markers expression on the prognosis of cholangiocarcinoma are analyzed. The most significant adverse predictors are tumorspread grade, positive regional lymph nodes, cell differentiation grade, perineural and microvascular invasion. Epithelial-mesenchymal transition grade is important for tumor progression in patients with portal cholangiocarcinoma and accordingly may be used as a predictor of long-term survival.
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