Alterations in Function of the Gallbladder and Exocrine Pancreas Flashcards
Also called gallstones
Cholelithiasis
*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
Cholelithiasis
Biliary colic
type of _____Cholelithiasis
chronic
Related to intermittent obstruction of cystic duct
Precipitated by a meal (infrequent schedule)
Biliary colic
Persistent epigastric or right upper abdominal pain, often radiates to back
Nausea, vomiting, sweating, flatus
Biliary colic
Increases steadily for >15 minutes, lasts several hours, then slowly decreases
Fatty food intolerance, belching, bloating, and epigastric burning
Biliary colic
Chronic Cholelithiasis diagnoses is _____
ultrasound
Watchful waiting
Cholecystectomy (surgical removal of the gallbladder)
treatment for ________
Chronic Cholelithiasis
Chemical dissolution of gallstones
Lithotripsy (mechanical breaking up of gallstones within the gallbladder)
Treatment for _______
Chronic Cholelithiasis
Inflammation of the gallbladder wall
Causes fibrosis and thickening
Cholecystitis
*Related to continued presence of gallstones
*2 types
Acute
Chronic
Cholecystitis
Acute inflammation of the gallbladder wall
Acute Cholecystitis
Present in 90% of patients
Obstruction of cystic duct present in almost all patients: related to stasis of bile
Bacterial infection may be present
Acute Cholecystitis
If untreated, escalates; gangrene may occur
Acute Cholecystitis
Rupture
Peritonitis
can occur from _____
Acute Cholecystitis
Septic shock
Localized abscess (empyema)
Cholecystoenteric fistula (fistula between gallbladder and GI tract)
can occur from ______
Acute Cholecystitis
Severe right upper abdominal pain: radiates to back; abdominal tenderness; fever;
Acute Cholecystitis
leukocytosis, mild elevations of bilirubin and serum transaminases
Acute Cholecystitis
Abdominal ultrasound
Presence of stones
Thickened gallbladder wall
to diagnose
Acute Cholecystitis
HIDA scan, CT, MRCA, ERCP
to diagnose
Acute Cholecystitis
Laproscopic cholecystectomy: mainstay of therapy
for
Acute Cholecystitis
Antibiotics (if bacterial infection)
Percutaneous catheter drainage or endoscopic drainage with stent placement (obstruction
used to treat
Acute Cholecystitis
Gangrene, empyema, or emphysematous changes: surgical emergencies
for
Acute Cholecystitis
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
Acute Cholecystitis
(nonsurgical): use of bile acids/organic solvents to dissolve gallstone
Chemodissolution
(nonsurgical)
Breaking up of gallstones using shockwaves
Stones <2 cm
Lithotripsy
Occurs in patients without preexisting gallstones
Males >50 years
Acalculous cholecystitis
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
Acalculous cholecystitis
Acalculous cholecystitis a type of _____cholecystitis
acute
Inflammation of the pancreas
Autodigestion of the pancreas from enzyme activation
Acute Pancreatitis
Predisposing factors
Biliary tract disease, hypertriglyceridemia, ethanol-associated (66%)
Acute Pancreatitis
3 pathways
Obstruction of the pancreatic duct by a stone or other cause (usually unknown)
Acinar cell injury
Defective intracellular transport
Acute Pancreatitis
Steady, boring pain in epigastrium or LUQ Increases in intensity Severe tenderness on palpation Radiates or penetrates to back Nausea and vomiting symptoms of
Acute Pancreatitis
Abdominal distention
Hypoactive bowel sounds
Low-grade fever
symptoms of
Acute Pancreatitis
WHATS THE PREFERRED TEST FOR ACUTE PANCREATITIS
lipase
Increase in amylase and lipase during first 12 hr (indictative)
Elevated aminotransferases, alkaline phosphatase and bilirubin
used to diagnose
Acute Pancreatitis
*Abdominal x-ray
Ileus pattern; “sentinel loop”: distended loop of small bowel in area of pancreas
*Abdominal ultrasound
used to diagnose
Acute Pancreatitis
GOLD STANDARD to diagnose Acute Pancreatitis
CT of abdomen
*Reduce pancreatic secretions
*Conservative management
*Withhold oral feedings
treatment for
mild to moderate acute pancreatitis
*Nasogastric suction for adynamic ileus
*IV fluid replacement
*Analgesics
treatment for
mild to moderate acute pancreatitis
*Usually in ICU
*Nutritional replacement: prevents tissue breakdown, may need TPN
treatment for
severe pancreatitis
*Calcium and magnesium administration
*Control of hyperglycemia (insulin)
*Prevent respiratory failure, acute renal failure, intraabdominal sepsis
treatment for
severe pancreatitis
*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
severe pancreatitis
debridement of devitalized tissue; used to treat
Necrosectomy; severe pancreatitis
major pancreatic resection; used to treat
Pancreatectomy; severe pancreatitis
_____ is a collection of fluid within or adjacent to pancreas
Complication of _____-
Pseudocyst; acute pancreatitis
________ is a persistent leak in pancreatic duct into pleural space and mediastinum. Complication of ______
Pancreatic ascites; acute pancreatitis
Painless and massive
Detected by ultrasound or CT, fluid analysis obtained by aspiration
Treatment: prolonged parenteral nutrition, stent
Pancreatic ascites
Fever, tachycardia, abdominal mass, and tenderness
Management: endoscopic or surgical drainage
pseudocyst
