By David C. Whitcomb MD PhD, Adam Slivka MD, Kenneth K. Lee
Problems of the pancreas have, long ago, been very problematical as the prognosis used to be usually made overdue throughout the ailment and no considerably invaluable interventions have been to be had. this example is speedily altering as new insights from a number of views are built-in and concerned with every one step of this complicated strategies. This factor of Gastroenterology Clinics of North the United States highlights a couple of components of fast development in inflammatory and neoplastic issues of the pancreas. every one bankruptcy represents the built-in wisdom and viewpoint of specialists within the box, and characterize the hottest research of those cutting-edge methods to complicated concerns within the review and therapy of pancreatic problems.
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Extra info for Advances in the Diagnosis and Treatment of Pancreatic Diseases, An Issue of Gastroenterology Clinics Vol 36 Issue 2
05%) was markedly elevated . 09 . A prior history of post-ERCP pancreatitis also confers a considerable increased risk for recurrence of this complication. 4%. [1,2,6,7]. In addition, if a patient has a history of recurrent acute pancreatitis, the incidence of pancreatitis ranges from 16% to 23% [4,6]. Unfortunately, these risk factors for post-ERCP pancreatitis are also thought synergistically to increase a patient’s risk for postprocedure pancreatitis regardless of the type of endoscopic therapy performed.
The extrapancreatic sites (and their diseases) that can be involved in patients with AIP include the salivary gland (sclerosing sialadenitis); bile duct (sclerosing cholangitis, distinctly different from primary sclerosing cholangitis); gallbladder (sclerosing cholecystitis); retroperitoneum (retroperitoneal fibrosis, not the isolated or idiopathic form); thyroid (Riedel’s thyroiditis); and orbit (orbital pseudotumor). The lesions at all these sites show similar histopathologic findings to those seen in AIP, including a fibroinflammatory process with numerous lymphocytes and plasma cells, occasional phlebitis, and infiltration by IgG4-positive cells [8,40,71].
Based on these studies of IgG4 staining in AIP, another diagnostic feature of AIP is the presence of a lymphoplasmacytic infiltrate with greater than 10 IgG4-positive cells/hpf in the pancreas . PATHOPHYSIOLOGY OF AUTOIMMUNE PANCREATITIS Both humoral and cellular immune mechanisms seem to be active in AIP. Because the characteristic histopathologic finding is a lymphoplasmacytic infiltrate involving the pancreatic duct or lobules, the ductal (or ductular) epithelium may be the primary immunologic target.