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(A) Focused radial endoscopic ultrasound (EUS) at the level of the papilla, illustrating a formal double duct sign with the pancreatic duct (PD) measuring 5 mm and the common bile duct (CBD) measuring 10 mm with stone material in the distal (arrow) and papillary CBD segments (asterisk). (B) Duodenoscopic visualization of the papilla during endoscopic retrograde cholangiography (ERC) confirming papillary stone impaction underlying acute biliary pancreatitis.

“Endoscopic Ultrasound First Policy” in Acute Pancreatitis of Presumed Biliary Origin

A 61-year-old patient without significant alcohol history presented with epigastric pain of 2 days’ duration, most recently aggravating and radiating into the back. Laboratory analysis indicated acute pancreatitis (ie, serum lipase 1839 U/L; procalcitonin 11.1 ng/mL) as well as moderately elevated liver function tests (ie, bilirubin 1.6 mg/dL). Abdominal ultrasound demonstrated gallbladder stones with normal […]

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doctor gives a physical examination of a patient

Gas Within the Bladder

To the Editor: An 83-year-old woman with a medical history of hypertension, chronic renal failure, and diabetes mellitus came to the emergency department of our clinic after 2 days of fever, asthenia, adynamia, and hypogastric abdominal pain associated with dysuria, polyuria, and bladder tenesmus. Her family reported that she had been increasingly fatigued in the […]

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Colonoscopic view of a mobile polypide in the ileocecum.

Colonic Anisakiasis

To the Editor: A 24-year-old man with a 2-week history of nausea, lower-right abdominal pain, and melena presented to the Gastroenterology outpatient clinic. He had no previous cardiovascular or gastrointestinal problems and denied any history of an allergy. In addition, the patient reported having eaten raw mackerel, sardines, and squid at a sushi restaurant 2 […]

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Feet fully extended and adducted.

Nutritional Nightmare: Hypoparathyroidism Secondary to Celiac Disease

A 33-year-old woman with history of diverticulitis status post hemicolectomy and idiopathic hypoparathyroidism presented with tetany and facial twitching for 3 months. She was transferred to a tertiary medical center for refractory tetany. She presented to her physician earlier in the week for diffuse muscle cramps and facial twitching. On review of her medical record, […]

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Screening for Hepatocellular Carcinoma in Patients with Cirrhosis: A Need to Increase Awareness

Hepatocellular carcinoma is the most common primary liver cancer, occurring largely in patients with cirrhosis. The incidence of hepatocellular carcinoma is rising in the US, as is its mortality, making hepatocellular carcinoma one of the leading causes of cancer-related deaths in the country.1 Despite the fact that early detection improves survival in patients with hepatocellular carcinoma, […]

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Upper gastrointestinal study with Gastrografin (Bracco Diagnostic Inc, Monroe Township, NJ) revealed irregularity of the distal antrum in the prepyloric region and marked narrowing of the pylorus, duodenal bulb, and postbulbar duodenum (arrow).

Gastric Crohn’s Disease: A Rare Cause of Intermittent Abdominal Pain and Vomiting

Crohn’s disease is a chronic idiopathic inflammatory disease that may involve any part of the gastrointestinal tract from the mouth to the anus. It most commonly affects the terminal ileum and cecum, and less commonly is isolated to the colon. Crohn’s disease involving the stomach or duodenum is uncommon and described in only 0.5% to 4% of […]

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