Recurrent acute pancreatitis(RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is cl...Recurrent acute pancreatitis(RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is classified as idiopathic RAP(IRAP). Idiopathic acute pancreatitis(IAP) is a diagnostic challenge for gastroenterologists. In view of associated morbidity and mortality, it is important to determine the aetiology of pancreatitis to provide early treatment and prevent recurrence. Endoscopic ultrasound(EUS) is an investigation of choice for imaging of pancreas and biliary tract. In view of high diagnostic accuracy and safety of EUS, a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. The present review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP. It elaborates the diagnostic approach to IAP in relation to EUS and other different modalities. Controversial issues in IAP like when to perform EUS, whether to perform after first episode or recurrent episodes, comparison among different investigations and the latest evidence significance are detailed.展开更多
Endoscopic ultrasonography(EUS) is considered a superior investigation when compared to conventional ultrasonography for imaging gall bladder(GB) lesions as it can provide high-resolution images of small lesions with ...Endoscopic ultrasonography(EUS) is considered a superior investigation when compared to conventional ultrasonography for imaging gall bladder(GB) lesions as it can provide high-resolution images of small lesions with higher ultrasound frequencies. Examination of GB is frequently the primary indication of EUS imaging. Imaging during EUS may not remain restricted to one station and multi-station imaging may provide useful information. This review describes the techniques of imaging of GB by linear EUS from three different stations. The basic difference of imaging between the three stations is that effective imaging from station 1 is done above the neck of GB, from station 2 at the level of the neck of GB and from station 3 below the level of the neck of GB.展开更多
The modern lifestyle caters to an increase in the incidence of peptic ulcer disease,gastroesophageal reflux disease and several other acid-related conditions of the gut. The drugs to prevent these conditions work eith...The modern lifestyle caters to an increase in the incidence of peptic ulcer disease,gastroesophageal reflux disease and several other acid-related conditions of the gut. The drugs to prevent these conditions work either through H2 receptor blockade or inhibition of the H^+, K^+ ATPase enzyme. Although proton pump inhibitors have been proven to be efficacious, they have a slow onset of action with limited resolution of symptoms in most patients. Potassium-competitive acid blockers(P-CABs) are novel drugs that bind reversibly to K^+ ions and block the H^+, K^+ ATPase enzyme, thus preventing acid production. P-CABs have a fast onset of action and have dose-dependent effects on acid production. Animal studies exist that differentiate the better results of P-CABs from proton pump inhibitors; further human trials will give a comprehensive picture of the results and will help to elucidate the therapeutic benefits of this new group of drugs.展开更多
The liver has eight segments, which are referred to by numbers or by names. The numbering of the segments is done in a counterclockwise manner with the liver being viewed from the inferior surface, starting from Segme...The liver has eight segments, which are referred to by numbers or by names. The numbering of the segments is done in a counterclockwise manner with the liver being viewed from the inferior surface, starting from Segment Ⅰ(the caudate lobe). Standard anatomical description of the liver segments is available by computed tomographic scan and ultrasonography. Endoscopic ultrasound(EUS) has been used for a detailed imaging of many intra-abdominal organs and for the assessment of intra-abdominal vasculature. A stepwise evaluation of the liver segments by EUS has not been described. In this article, we have described a stepwise evaluation of the liver segments by EUS. This information can be useful for planning successful radical surgeries, preparing for biopsy, portal vein embolization, transjugular intrahepatic portosystemic shunt, tumour resection or partial hepatectomy, and for planning EUS guided diagnostic and therapeutic procedures.展开更多
文摘Recurrent acute pancreatitis(RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is classified as idiopathic RAP(IRAP). Idiopathic acute pancreatitis(IAP) is a diagnostic challenge for gastroenterologists. In view of associated morbidity and mortality, it is important to determine the aetiology of pancreatitis to provide early treatment and prevent recurrence. Endoscopic ultrasound(EUS) is an investigation of choice for imaging of pancreas and biliary tract. In view of high diagnostic accuracy and safety of EUS, a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. The present review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP. It elaborates the diagnostic approach to IAP in relation to EUS and other different modalities. Controversial issues in IAP like when to perform EUS, whether to perform after first episode or recurrent episodes, comparison among different investigations and the latest evidence significance are detailed.
文摘Endoscopic ultrasonography(EUS) is considered a superior investigation when compared to conventional ultrasonography for imaging gall bladder(GB) lesions as it can provide high-resolution images of small lesions with higher ultrasound frequencies. Examination of GB is frequently the primary indication of EUS imaging. Imaging during EUS may not remain restricted to one station and multi-station imaging may provide useful information. This review describes the techniques of imaging of GB by linear EUS from three different stations. The basic difference of imaging between the three stations is that effective imaging from station 1 is done above the neck of GB, from station 2 at the level of the neck of GB and from station 3 below the level of the neck of GB.
文摘The modern lifestyle caters to an increase in the incidence of peptic ulcer disease,gastroesophageal reflux disease and several other acid-related conditions of the gut. The drugs to prevent these conditions work either through H2 receptor blockade or inhibition of the H^+, K^+ ATPase enzyme. Although proton pump inhibitors have been proven to be efficacious, they have a slow onset of action with limited resolution of symptoms in most patients. Potassium-competitive acid blockers(P-CABs) are novel drugs that bind reversibly to K^+ ions and block the H^+, K^+ ATPase enzyme, thus preventing acid production. P-CABs have a fast onset of action and have dose-dependent effects on acid production. Animal studies exist that differentiate the better results of P-CABs from proton pump inhibitors; further human trials will give a comprehensive picture of the results and will help to elucidate the therapeutic benefits of this new group of drugs.
文摘The liver has eight segments, which are referred to by numbers or by names. The numbering of the segments is done in a counterclockwise manner with the liver being viewed from the inferior surface, starting from Segment Ⅰ(the caudate lobe). Standard anatomical description of the liver segments is available by computed tomographic scan and ultrasonography. Endoscopic ultrasound(EUS) has been used for a detailed imaging of many intra-abdominal organs and for the assessment of intra-abdominal vasculature. A stepwise evaluation of the liver segments by EUS has not been described. In this article, we have described a stepwise evaluation of the liver segments by EUS. This information can be useful for planning successful radical surgeries, preparing for biopsy, portal vein embolization, transjugular intrahepatic portosystemic shunt, tumour resection or partial hepatectomy, and for planning EUS guided diagnostic and therapeutic procedures.
