Alterations in Function of the Gallbladder and Exocrine Pancreas

Question 1

Also called gallstones

Answer 1

Cholelithiasis

Question 2

*Etiology
Native Americans > American Caucasians
Women > men (2:1)
Adults: May be asymptomatic and not need treatment

Children: Usually from an underlying condition and need gallbladder removed

Answer 2

Cholelithiasis

Question 3

Biliary colic

type of _____Cholelithiasis

Answer 3

chronic

Question 4

Related to intermittent obstruction of cystic duct

Precipitated by a meal (infrequent schedule)

Answer 4

Biliary colic

Question 5

Persistent epigastric or right upper abdominal pain, often radiates to back
Nausea, vomiting, sweating, flatus

Answer 5

Biliary colic

Question 6

Increases steadily for >15 minutes, lasts several hours, then slowly decreases
Fatty food intolerance, belching, bloating, and epigastric burning

Answer 6

Biliary colic

Question 7

Chronic Cholelithiasis diagnoses is _____

Answer 7

ultrasound

Question 8

Watchful waiting
Cholecystectomy (surgical removal of the gallbladder)
treatment for ________

Answer 8

Chronic Cholelithiasis

Question 9

Chemical dissolution of gallstones
Lithotripsy (mechanical breaking up of gallstones within the gallbladder)
Treatment for _______

Answer 9

Chronic Cholelithiasis

Question 10

Inflammation of the gallbladder wall

Causes fibrosis and thickening

Answer 10

Cholecystitis

Question 11

*Related to continued presence of gallstones
*2 types
Acute
Chronic

Answer 11

Cholecystitis

Question 12

Acute inflammation of the gallbladder wall

Answer 12

Acute Cholecystitis

Question 13

Present in 90% of patients
Obstruction of cystic duct present in almost all patients: related to stasis of bile
Bacterial infection may be present

Answer 13

Acute Cholecystitis

Question 14

If untreated, escalates; gangrene may occur

Answer 14

Acute Cholecystitis

Question 15

Rupture
Peritonitis
can occur from _____

Answer 15

Acute Cholecystitis

Question 16

Septic shock
Localized abscess (empyema)
Cholecystoenteric fistula (fistula between gallbladder and GI tract)
can occur from ______

Answer 16

Acute Cholecystitis

Question 17

Severe right upper abdominal pain: radiates to back; abdominal tenderness; fever;

Answer 17

Acute Cholecystitis

Question 18

leukocytosis, mild elevations of bilirubin and serum transaminases

Answer 18

Acute Cholecystitis

Question 19

Abdominal ultrasound
Presence of stones
Thickened gallbladder wall
to diagnose

Answer 19

Acute Cholecystitis

Question 20

HIDA scan, CT, MRCA, ERCP

to diagnose

Answer 20

Acute Cholecystitis

Question 21

Laproscopic cholecystectomy: mainstay of therapy

for

Answer 21

Acute Cholecystitis

Question 22

Antibiotics (if bacterial infection)
Percutaneous catheter drainage or endoscopic drainage with stent placement (obstruction
used to treat

Answer 22

Acute Cholecystitis

Question 23

Gangrene, empyema, or emphysematous changes: surgical emergencies
for

Answer 23

Acute Cholecystitis

Question 24

Pain management
Chemodissolution (nonsurgical): use of bile acids/organic solvents to dissolve gallstone
Lithotripsy (nonsurgical)
Breaking up of gallstones using shockwaves
Stones <2 cm
treatment for

Answer 24

Acute Cholecystitis

Question 25

(nonsurgical): use of bile acids/organic solvents to dissolve gallstone

Answer 25

Chemodissolution

Question 26

(nonsurgical) Breaking up of gallstones using shockwaves Stones <2 cm

Answer 26

Lithotripsy

Question 27

Occurs in patients without preexisting gallstones | Males >50 years

Answer 27

Acalculous cholecystitis

Question 28

Tends to occur in the setting of major surgery, critical illness, trauma, burn-related injury, or TPN Rapid development of gangrene, perforation, emphysematous cholecystitis, and empyema

Answer 28

Acalculous cholecystitis

Question 29

Acalculous cholecystitis a type of _____cholecystitis

Answer 29

acute

Question 30

Inflammation of the pancreas | Autodigestion of the pancreas from enzyme activation

Answer 30

Acute Pancreatitis

Question 31

Predisposing factors | Biliary tract disease, hypertriglyceridemia, ethanol-associated (66%)

Answer 31

Acute Pancreatitis

Question 32

3 pathways Obstruction of the pancreatic duct by a stone or other cause (usually unknown) Acinar cell injury Defective intracellular transport

Answer 32

Acute Pancreatitis

Question 33

``` Steady, boring pain in epigastrium or LUQ Increases in intensity Severe tenderness on palpation Radiates or penetrates to back Nausea and vomiting symptoms of ```

Answer 33

Acute Pancreatitis

Question 34

Abdominal distention Hypoactive bowel sounds Low-grade fever symptoms of

Answer 34

Acute Pancreatitis

Question 35

WHATS THE PREFERRED TEST FOR ACUTE PANCREATITIS

Answer 35

lipase

Question 36

Increase in amylase and lipase during first 12 hr (indictative) Elevated aminotransferases, alkaline phosphatase and bilirubin used to diagnose

Answer 36

Acute Pancreatitis

Question 37

*Abdominal x-ray Ileus pattern; “sentinel loop”: distended loop of small bowel in area of pancreas *Abdominal ultrasound used to diagnose

Answer 37

Acute Pancreatitis

Question 38

GOLD STANDARD to diagnose Acute Pancreatitis

Answer 38

CT of abdomen

Question 39

*Reduce pancreatic secretions *Conservative management *Withhold oral feedings treatment for

Answer 39

mild to moderate acute pancreatitis

Question 40

*Nasogastric suction for adynamic ileus *IV fluid replacement *Analgesics treatment for

Answer 40

mild to moderate acute pancreatitis

Question 41

*Usually in ICU *Nutritional replacement: prevents tissue breakdown, may need TPN treatment for

Answer 41

severe pancreatitis

Question 42

*Calcium and magnesium administration *Control of hyperglycemia (insulin) *Prevent respiratory failure, acute renal failure, intraabdominal sepsis treatment for

Answer 42

severe pancreatitis

Question 43

*Mechanical ventilation and hemodialysis may be needed *Bacterial infection: antibiotics and aspirate fluid cultured; usually indicates poor prognosis *Surgical intervention (abscess or hemorrhage) Necrosectomy: debridement of devitalized tissue Pancreatectomy: major pancreatic resection Drains usually present treatment for

Answer 43

severe pancreatitis

Question 44

debridement of devitalized tissue; used to treat

Answer 44

Necrosectomy; severe pancreatitis

Question 45

major pancreatic resection; used to treat

Answer 45

Pancreatectomy; severe pancreatitis

Question 46

_____ is a collection of fluid within or adjacent to pancreas Complication of _____-

Answer 46

Pseudocyst; acute pancreatitis

Question 47

________ is a persistent leak in pancreatic duct into pleural space and mediastinum. Complication of ______

Answer 47

Pancreatic ascites; acute pancreatitis

Question 48

Painless and massive Detected by ultrasound or CT, fluid analysis obtained by aspiration Treatment: prolonged parenteral nutrition, stent

Answer 48

Pancreatic ascites

Question 49

Fever, tachycardia, abdominal mass, and tenderness | Management: endoscopic or surgical drainage

Answer 49

pseudocyst