Pancreatic Fistula

In the setting of chronic pancreatitis, a pancreatic fistula is usually the result of a ductal disruption from an episode of acute pancreatitis. The diagnosis is made by finding a high amylase level (usually many thousands of U/L) in the fistula effluent. Some fistulas will close spontaneously, provided that ductal continuity can be re-established as healing occurs, infection is eradicated, and nutrition is adequate. However, the frequent presence of duct obstruction in chronic pancreatitis may make it less likely that the fistula will close. Parenteral nutrition is usually not required and most patients are able to eat a regular diet. There is no evidence that oral intake delays resolution of fistula. The use of somatostatin does not appear to hasten fistula closure, although if it is a high output fistula (ie, > 200 mL/d), the secretory inhibitor may simplify management of the patient. Fistulas that persist for as long as 1 year, or those whose anatomic characteristics preclude spontaneous closure (eg, duct obstruction between fistula and duodenal lumen, duct discontinuity), will require operative repair. This is best done by creating an anasta-mosis between the pancreatic duct at the point of the leak and a Roux-en-Y limb of jejunum. The success rate of operative repair is > 90%.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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