Biliary disease Flashcards
Asymptomatic gallstone in the gallbladder is called
Cholethiasis
3 factors that cause increased gallstone disease with age
1) decreased response to CCK
2) decreased motility
3) cholesterol saturation
Risk factors for gallstone disease
Family Hx
Obesity
Age
gender and hormones
Multiple pregnancy and high estrogen levels
increases risk of gallstones
- more cholesterol
If gallstone blocks the gallbladder duct and walls become irritated
acute cholecystisis
If the stone gets lodged in the CBD
Choledocholithiasis unless with infection -
ascending cholangitis
If stone gets blocked at the pancreatic duct
Pancreatitis
Constant RUQ due to cystic duct obstruction and distention of the GB - up to 24 hours
biliary colic
Treatment of biliary colic
IV fluids
analgesic
Elective cholecystectomy
3 bacteria that cause cholecystisis
E coli
Klebsiella
Enterococcus
acute cholecystisis is
biliary colic > 24 hours
- fever
- tachycardia
- leukocytosis
- positive murphy’s sign
How do you confirm the diagnosis of acute cholecystisis
Ultrasound
3 things you must get from anyone with upper abdo pain
- ECG
- Lipase
- CXR
treating acute cholecystisis
- Abx
- IV fluids
- Analgesics
What is ERCP used for
diagnosis and treatment of CBD stones
NOT gall bladder stones
MRCP is used for
Diagnosis of CBD stones
NOT gall bladder stones
complications of gallstones related to the GB
- acute cholecystisis
- carcinoma
- perforation
- gallstone ileus
complications of gallstones related to the Common bile duct
- obstructive jaundice
- cholangitis
- pancreatitis
Systemic complication of ascending cholangitis
Septic shock/bacteremia
Charcot’s triad
Jaundice
Fever
RUQ
Raynaud’s pentad
- jaundice fever RUQ hypotensive confusion
IN acute pancreatitis what function of the pancreas are we referring to?
Exocrine functions
Prognosis in Acute Pancreatitis
3-5% mortality
2 most common causes of pancreatitis
alcohol gall stones post- ERCP - cardiac sx CF
2 mechanisms for drug-induced pancreatitis
- immunolog-mediated allergic reaction
early onset - chronic tox metabolite accumulation
- late
patient with pancreatitis
leaning forward from retroperitoneal pain
Most specific and sensitive test for AP
- lipase!
Systemic effects associated with pancreatitis
- capillaries/vein coagulation pathways white cells blood vessels DIC
Imaging findings in acute pancreatitis
colon cut off sign
Most common form of organ failure from pancreas is
Renal
Treament of pancreatitis is
Fluids pain relief respiratory support nutrition ERCP
