37 Alterations in Function of Gallbladder and Exocrine Pancreas

Question 1

majority of gallstones are…

Answer 1

cholesterol

Question 2

3 phases in formation of gallstones

Answer 2

1 SUPERSATURATION of bile w cholesterol
----causes precipitation of cholesterol
2 NUCLEATION of crystals
3 HYPOMOTILITY (stasis of bile)
-----allows for stone growth

Question 3

what determines likelihood of cholesterol gallstone formation?

Answer 3

relative concentrations of:
cholesterol
lecithin
bile acids

Question 4

lecithin

Answer 4

helps keep cholesterol from precipitating into crystals in bile

Question 5

Cholesterol Gallstone

risk factor

Answer 5

1 prolonged fasting/rapid weight loss
2 pregnancy
3 oral contraceptives
4 obesity
5 age
6 sex
7 variety of medical factors

Question 6

Pigment stones

Answer 6

25% of gallbladders

• contains micture of pigment polymers + Ca salt
• black: most common, idiopath, assoc cirrhosis/hemolysis
• brown: more common in dvlping counties, assoc w bacteria/infection/parasite

Question 7

Cholelithiasis

Answer 7

aka gallstone

• nativ amrcn>white
• women>men
• adults may be asymptomatic, no treatment needed
• children usually fr underlying issue, need gallbladder removed

Question 8

Biliary Colic

“colic”=sudden pain

Answer 8

• precipitated by meal
• persistent right upper ab pain, radiates to back
• N/V, sweating, flatus
• fatty food intolerance, belching, bloating, + epigastric burning

Question 9

Pancreatitis

Answer 9

inflammation of pancreas

—autodigestion of pancreas fr enzyme activation

Question 10

Pancreatitis

risk factors

Answer 10

• biliary tract disease
• hypertriglyceridemia
• ethanol-associated (66%)

Question 11

Pancreatitis

3 pathways

Answer 11

1 obstructin of pancreatic duct by stone or other cause
2 acinar cell injury
3 defective intracellular transport

Question 12

Pancreatitis

s/s

Answer 12

steady, boring pain in epigastrium or LUQ

• incr in severity
• severe tenderness on palpation
• radiates to back
• N/V

Question 13

Pancreatitis

diagnosis

Answer 13

Lipase preferred test

–incr in AMYLASE + LIPASE during first 12 hrs

Question 14

chronic pancreatitis can lead to___

Answer 14

diabetes mellitus due to destruction of islet cells