Consideration of endoscopic retrograde cholangiopancreatography in cases of acute biliary pancreatitis.

AIM: The important question to be answered in all cases of ABP is whether or not a calculous biliary obstruction is still present. Answering this question conditions subsequent management, including the need for endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to determine the relationship between persistent common bile duct stone (CBDS) and laboratory values, and dilation of bile duct in order to find possible significant associations in patients with acute biliary pancreatitis (ABP). METHODS: Retrospectively, statistical evaluation of a group of 76 patients with ABP who had received early ERCP. RESULTS: The prevalence of choledocholithiasis in patients > 70 years old was 54.2%, in patients < or = 70 years old it was 36.5%. Following cholecystectomy, CBDS was present in 81.8% of patients, p = 0.005. The probability of CBDS occurrence in patients > 70 years old with bile duct dilation was 81.3%; in the absence of bile duct dilation CBDS was not present, p < 0.001. The probability of CBDS occurrence in patients 70 years old with bile duct dilation was 57.7%, in the absence of bile duct dilation CBDS was present in 15.4%, p = 0.002. In patients with bile duct dilation predictive factors are as follows: bilirubin (Bi), after excluding patients with acute cholecystitis and cholangitis, p = 0.05; alanine aminotransferase (ALT) in patients 70 years old, p = 0.004; gamma-glutamyl transferase (GMT) in patients > 70 years old, p = 0.02. CONCLUSIONS: ERCP is indicated in patients with ABP if biliary obstruction is present and the presence of a ductal stone is suspected. From our results it is clear that the predictive parameter for choledocholithiasis is the dilation of the bile duct and previous cholecystectomy. In patients with bile duct dilation possible predictive factors are Bi, ALT, and GMT (Tab. 1, Fig. 8, Ref. 20).

[Validity of biochemical examinations in ascites in clinical practice]. / Validita biochemických vysetrení ascitu v klinickej praxi.

The authors examined, using biochemical, cultivation and cytological methods, ascites in 94 patients. They divided the patients into four groups: group 1 (36 patients)--malignant ascites, group 2 (35 patients)--cirrhotic ascites, group 3 (11 patients)--cardial ascites, group 4 (12 patients)--nephrogenic ascites. The authors tried to differentiate malignant ascites from non-malignant, based on biochemical parameters. As the composition of ascites is influenced by some factors (diuretics, dialysis) the authors recommend the use of biochemical analyses of ascites in clinical practice.

[Cholelithiasis and acute pancreatitis]. / Cholelitiáza a akútna pankreatitída.

The authors evaluate the results of treatment of acute pancreatitis at the surgical clinic in 1972-1988. In 64% biliary pancreatitis was involved. The group with a more severe, complicated course is formed by 22.1% patients. In that group the mortality rate was 21.6%. In 57% it was accounted for by patients with biliary pancreatitis. In the group with a mild course of pancreatitis (77.9% of patients) the mortality was 0.9%. The approach to treatment of cholelithiasis in the acute stage of pancreatitis must be considered on an individual basis. In the majority of patients disease of the biliary pathways can be treated after control of acute pancreatitis during the primary hospitalization. In some patients surgery of the biliary pathways during acute pancreatitis is indicated. The risk of operation is high. Therefore in some patients endoscopic papillosphincterotomy is indicated.