Sphincter Of Oddi Dysfunction

From Anvita Health Wiki

Contents 1 Epidemiology 2 Pathology 3 Clinical-manifestations 4 Laboratory 5 Diagnostic-procedures 6 Radiology 7 Complications 8 Management 9 More General Terms 10 Additional Terms 11 References

Epidemiology

• more prevalent among middle-aged women

Pathology

• papillary stenosis

• fixed anatomic narrowing of the sphincter of Oddi, typically due to fibrosis

• sphincter of Oddi dyskinesia

• manometric abnormalities of the sphincter of Oddi

• impedance of pancreatic juice & bile flow

Clinical-manifestations

• abdominal pain
• pain is characteristically sharp, postprandial, & located in the right upper quadrant or epigastrium
• pain may be associated with nausea &/or vomiting
• pain may last for several hours
• pain may radiate to the back or shoulder blades
• fever, chills, and jaundice are uncommon
• may also present with acute recurrent pancreatitis

Laboratory

• liver function tests may be abnormal

• serum alkaline phosphatase may be increased
• serum bilirubin may be increased

Diagnostic-procedures

• ERCP with sphincter of Oddi mannometry ( gold standard)

Radiology

• abdominal ultrasound (after fatty meal stimulation)
• biliary scintigraphy

Complications

• cholecystectomy common due to missed diagnosis

Management

• goal of treatment is to reduce sphincter of Oddi pressure, thereby improving drainage of biliary & pancreatic secretions into the duodenum
• medical, endoscopic, or surgical therapy
• medical therapy:

• calcium channel blockers & long-acting nitrates may reduce basal pressure & improve symptoms
• response rate of only about 75%
• not expected to be effective enough

• endoscopic sphincterotomy is the standard of therapy

• low morbidity and mortality rates
• response rates > 90%
• good results in long-term follow-up
• high complication rate of pancreatitis after endoscopic sphincterotomy

More General Terms

• gastrointestinal disease

Additional Terms

• sphincter of Oddi; sphincter of the hepatopancreatic/bilaropancreatic ampulla; Glisson sphincter

References

1. Sphincter of Oddi Dysfunction: Johns Hopkins University [1]
2. Wikipedia: Sphincter of Oddi dysfunction [2]
3. Petersen BT An evidence-based review of sphincter of Oddi dysfunction: part I, presentations with 'objective' biliary findings (types I and II). Gastrointest Endosc. 2004 Apr;59(4):525-34 PMID: [3]
4. Sherman S and Lehman GA Sphincter of Oddi Dysfunction: Diagnosis and Treatment JOP. J. Pancreas (Online) 2001; 2(6):382-400 [4]

sphincter of Oddi dysfunction