[A personalized approach to recurrent abdominal pain syndrome based on clinical and laboratory algorithms]. / Personalizirovannyi podkhod k patsientam s retsidiviruyushchim abdominal'nym bolevym sindromom na osnove sozdaniya algoritmov kliniko-laboratornykh obsledovanii.

OBJECTIVE: To optimize the diagnosis of abdominal pain syndrome occurring under the «mask¼ of acute pancreatitis via algorithms for clinical and laboratory examination. MATERIAL AND METHODS: We have retrospectively and prospectively analyzed patients with abdominal pain syndrome. We selected all patients with acute pancreatitis who repeatedly applied with abdominal pain syndrome to polyclinics and hospitals between 2017 and 2021. A personalized algorithm for patients with abdominal pain syndrome occurring under the «mask¼ of acute pancreatitis has been developed. This algorithm underlies an information system for decision-making support. RESULTS: An optimal diagnostic algorithm is needed in reception departments of hospitals and polyclinics. This one depends on equipment of hospitals and needs to be constantly improved. When refusing hospitalization and discharging patients with recurrent pain syndromes, physicians should orient the doctors of general network to use more informative methods. Indeed, the last ones may be unavailable in reception departments and various districts due to technical, qualification and organizational shortcomings. CONCLUSION: Advanced clinical and laboratory diagnostic methods based on the above-described algorithm are necessary for recurrent abdominal pain syndrome occurring under the «mask¼ of acute pancreatitis.

[Retrograde colangiopancreatography (RCG) and endoscopic papillosphincterography (EPG) in new scheme of endosurgical strategy of treatment of cholecystitis accompanied by bilirubinemia].

The article is devoted to the substantiation of strategy changes in acute cholecystitis and the bilirubinemia of obscure etiology. At the first stage the treatment was started from RCG in 120 patients and RCG with EPG in 232 patients. The results obtained were not very good, there being many organizational problems. At the second stage the laparoscopic cholecystectomy with drainage of the common bile duct (228 patients) were performed in 248 patients with acute cholecystitis and increased bilirubin from 29.54 till 167.16 millimole/l. Futhermore, the postoperative transdrainage cholangiography was made in 184 (74.2%) patients, the stones or the obstruction of bile secretion weren't found. The classical intervention on common bile duct was required only to 4 patients, for the rest EPG was performed according to the indications. EPG was the most effective and the results were the best.