Hemodynamic characterization of porcine hemorrhagic pancreatitis ascites fluid.

The hemodynamic reactions of hemorrhagic pancreatitis ascites fluid (HAF) were observed after intravascular injection in the pig. The HAF vascular reactions were compared to the reactions of known vasoactive agents in hopes of identifying the vasoactive agent(s) in HAF. Pancreatitis was induced in five pigs with pancreatic ductal injection of a bile/trypsin mixture. HAF from these pigs was injected into the portal vein of five anesthetized pigs which were monitored for changes in femoral artery pressure (FAP), cardiac output (CO), and portal pressure (PoVP). Trypsin was also tested in the same way in five additional pigs. HAF elevated PoVP, then lowered VAP, depressed CO, and exhibited tachyphylaxis. Trypsin did not cause tachyphylaxis. The effects observed after infusion of HAF are similar to the reported effects observed after injecting histamine, an agent previously implicated in hemorrhagic pancreatitis.

Endoscopic retrograde cholangiopancreatography.

The ERCP report in the patient's chart was compared with findings on common duct exploration or cystic duct cholangiography in 72 patients and found to have a sensitivity of 90.4 percent, a specificity of 98 percent, and an accuracy of 95.8 percent. Factors having the potential to influence the accuracy of ERCP were errors in interpretation by the surgeon and the radiologist and the operative technique of cholecystectomy. Also, the interval between the performance of the procedure and operation was particularly important in the patient with multiple small gallstones or small common duct stones. Small gallstones may spontaneously pass from the gallbladder to the common duct, or small common duct stones may spontaneously pass into the duodenum; therefore, the longer the interval between ERCP and operation, the greater the likelihood of a discrepancy. At operation, gallstones may be squeezed into the common duct during manipulation of the gallbladder unless the cystic duct is obstructed before manipulation of the gallbladder. We found ERCP sufficiently accurate to make cystic duct cholangiography unnecessary in most patients with cholelithiasis having a preoperative ERCP examination.