Biliary disease & pancreatitis Flashcards
epi of gall stones
- 10% of pop
- incidence up with age
- cholesterol in west, pigment in east
- genetics most important
4 predisposing factors
- age
- fam hx/ ethnicity
- gender/hormones - F>M
- obesity
reasons age implicated (3)
- higher bilary chol
- GB motility goes down
- less sentive to CCK
reasons for females
- E makes gall bladder static
- pregnancy increases
2 reasons related to obesity
- lipid metabolism means increased biliary chol. secretion
2. related to rapid weight loss
natura Hx of stones
20% will require surgery over 20 years
- only surg once Sx emerge
3 clinical syndromes related to stones
- biliary colic
- acute cholecystitis
- chronic cholecstitis
def. biliary colic
CONSTANT RUQ pain due to cystic duct obst. and distension of the gall bladder
- sudden upset and lasting up to 24 hrs
- esp. after a big fatty meal
3 treatments
- rehysdrate
- analgesics
- elective lap. cholecytectomy
path of acute cholecyctitis
- duct obst.
- GB ischemia and irritation
- secondary infection
def, of cholecystitis
- same Sx as acute cholic, but:
- pain >24hrs
- Sx of systemic infaction
- murphy sign
- palpable mass in 20%
DDx for gall pain
- ulcer
- appendidicits
- pancreatitis
- MI
- pneuminia
treat of acute chole
- IV fluids, anal, ABs
- 75% better without surgery
- ealry surg. can help prevent recurrence and complications
def. chronic chole
- chronic inflammation of gall bladder due to stones
- GB wall usually thickened
- GB may be small and contracted
- Sx usually long standing colic
diagnosis of gall stones
- may cause high LFTs and WBC
- ultrasound is main method
- ERCP
- MRCP
why US?
easy, cheap, reliable
- high accuracy
- reveals size and shape of stones
2 general complications of stones
- related to bladder
2. related to duct
4 complications related to Bladder
- acute cystitis
- perf
- gall stone illeus
- GB carcinoma
4 complications related to duct
- choledocholitiaitis (in CBD)
- obs. jaundice
- cholangitis
- biliary pancreatitis
def. choledocholitiaitis
- in CBD (10-15% of cases)
- increases with age
- get out with ERCP
def. obs. jaundice
- may be first manifestation
-
def. cholangitis
- dev. in presence of bile obs. and infection
- obs>intraluminal pressure>reflux of bact to hepatic veins>systemic circ
def. charcots triad
fever, jaundice, RUQ pain
def. raynauds pentad
fever, jaundice, RUQ pain, hypotension, confusion = emergncy
mgmt of cholangitis
- fluids
- ABs for gr- and gr+ anarobes
- biliary decompression
def. biliary pancreatitis
transient blockage of ampulla of vader leads to pancreatitis
treatment of stones
- cholecystectomy
- laprascopic
