Sphincter of Oddi dysfunction

Acute pancreatitis is acinar-cell autodigestion and inflammation of the pancreas, most often from gallstones or alcohol, diagnosed by the revised Atlanta criteria and graded mild, moderately severe, or severe by organ failure. Management centers on early goal-directed lactated Ringer's resuscitation, analgesia, early enteral feeding, and timed ERCP for gallstone pancreatitis with cholangitis, reserving antibiotics for confirmed infected necrosis.

Chronic pancreatitis is irreversible fibro-inflammatory destruction of the pancreas that produces abdominal pain along with exocrine and endocrine insufficiency, most often from long-term alcohol use in adults and cystic fibrosis in children. Diagnosis rests on CT or MRI showing calcifications and ductal change, and management combines alcohol and tobacco cessation, staged analgesia, pancreatic enzyme replacement, and endoscopic or surgical drainage for ductal obstruction.

Choledocholithiasis is a gallstone that has migrated into the common bile duct, causing obstructive jaundice and cholestatic liver chemistries and predisposing to acute cholangitis and gallstone pancreatitis. Risk is stratified by ASGE criteria and confirmed by MRCP, endoscopic ultrasound, or therapeutic ERCP, which clears the duct before same-admission cholecystectomy.

Cholelithiasis is the presence of gallstones in the gallbladder, most often cholesterol stones from bile supersaturation, and is asymptomatic in most patients. Symptomatic disease presents as biliary colic, self-limited postprandial right upper quadrant pain without fever, diagnosed by right upper quadrant ultrasound and treated with elective laparoscopic cholecystectomy.

Acute cholecystitis is inflammation of the gallbladder from cystic duct obstruction, most often by a gallstone, presenting with RUQ pain lasting more than 6 hours, fever, and a positive Murphy sign. Diagnosis follows the Tokyo Guidelines TG18 criteria and severity grade, and treatment combines IV antibiotics with early laparoscopic cholecystectomy, or cholecystostomy in patients too unstable for surgery.

Acute cholangitis is a bacterial infection of an obstructed biliary tree, classically presenting as Charcot triad of fever, right upper quadrant pain, and jaundice and progressing to septic shock when drainage is delayed. Diagnosis follows the Tokyo Guidelines and severity grade, and treatment combines prompt broad-spectrum antibiotics with biliary drainage, most often by ERCP.

Peptic ulcer disease is a mucosal break in the stomach or duodenum caused chiefly by Helicobacter pylori infection or NSAID use, diagnosed by upper endoscopy with biopsy of gastric ulcers to exclude malignancy. Treatment eradicates H. pylori when present, stops the ulcerogenic drug, and heals the ulcer with a proton pump inhibitor, while its complications of bleeding, perforation, and obstruction drive most of its morbidity.

Irritable bowel syndrome is a functional disorder of gut-brain interaction diagnosed clinically by Rome IV criteria, recurrent abdominal pain related to defecation, stool frequency, or stool form, without alarm features. Management is subtyped by stool pattern, with fiber and dietary change first, then IBS-C secretagogues or IBS-D antidiarrheals and antibiotics, and low-dose tricyclics or antispasmodics for pain.

Gastroparesis is delayed gastric emptying without mechanical obstruction, most often from longstanding diabetes, prior gastric surgery, or an idiopathic postviral course, presenting with nausea, vomiting, early satiety, and postprandial fullness. Diagnosis requires upper endoscopy to exclude obstruction followed by objective gastric emptying testing, and management progresses from glycemic control and dietary change through time-limited prokinetics to device or endoscopic therapy for refractory disease.

Dyspepsia is chronic or recurrent epigastric pain, burning, postprandial fullness, or early satiety that is organic when a structural, metabolic, or drug cause is found and functional when Rome IV criteria are met after a negative workup. Management starts with an alarm-feature screen that mandates prompt upper endoscopy, then test-and-treat for Helicobacter pylori, then an empiric proton pump inhibitor trial, reserving a tricyclic or prokinetic agent for confirmed functional disease.

Pancreatic ductal adenocarcinoma usually presents late, with painless obstructive jaundice from a head-of-pancreas mass, weight loss, and sometimes new-onset diabetes or migratory thrombophlebitis. Pancreas-protocol CT defines resectability, endoscopic ultrasound with fine-needle aspiration confirms tissue diagnosis, and only complete surgical resection with pancreaticoduodenectomy offers a chance of cure, which most patients cannot receive.