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Clin Med III > biliary diseases and pancreatitis > Flashcards

biliary diseases and pancreatitis Flashcards

1
Q

how do bile acids precipitate?

A
  • abnormal ratios of cholesterol, bile acids and lechtitin

- normally combine to form mixed micelles

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2
Q

cholestasis defintion

A
  • bile does not move from gallbladder to duodenum
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3
Q

cholelithiasis definition

A
  • formation of gallstones
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4
Q

choledocholithiasis definition

A
  • gallstone blockage in CBD
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5
Q

biliary colic definition

A
  • pain d/t blockage of cystic duct, usually gallstone
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6
Q

acute cholecystitis definition

A
  • painful inflammation of gallbladder

- usually d/t build up of bile when stone blocks cystic duct

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7
Q

cholangitis definition

A
  • bacterial infection on top of obstruction of biliary tree
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8
Q

common causes of cholestasis

A
  • bile duct stone*
  • procedural sequelae- ERCP
  • liver diseases
  • stricture of bile duct
  • sclerosing cholangitis
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9
Q

management of cholestasis

A
  • US to check of stone or obstruction
  • ERCP for stone removal
  • HIDA to check for gallbladder function
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10
Q

what type of stone are the majority of gallstones

A
  • cholesterol

- cholesterol + bilirubin + ca salts

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11
Q

cholelithiasis risk factors

A
  • four f’s: fat, female, fertile, forty
  • hypercholesterolemia
  • obesity, metabolic syndrome, DM
  • bariatric surgery, rapid weight loss
  • pregnancy, OCPs
  • crohns
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12
Q

clinical presentation of cholelithiasis

A
  • often asymptomatic
  • severe, intermittent RUQ pain, usually post-prandial
  • pain radiates to R shoulder or back
  • n/v
  • onset of sx at night > day
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13
Q

best imaging to dx cholelithiasis

A
  • US

- in an obese pt may need to try CT or HIDA

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14
Q

treatment for cholelithiasis

A
  • ERCP*- diagnostic and therapeutic
  • life style modifications
  • cholecystectomy
  • dissolve stones with medications- 50% success rate and very expensive
  • lithotripsy- uncommon
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15
Q

cholecystitis causes

A
  • mechanical- distension
  • chemical- lysolecithin
  • bacteria*- e coli, klebsiella, strep, clostridium
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16
Q

causes of acalculous cholecystitis

A
  • trauma, burns
  • ortho/ non-biliary post op pts
  • prolonged labor
  • parenteral nutrition
  • torsion, neoplasm
  • DM
  • atypical infections
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17
Q

triad of sx for cholecystitis

A
  • RUQ pain (severe)
  • fever
  • increased WBC
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18
Q

sx of cholecystitis

A
  • triad: RUQ pain, fever, WBC
  • pain may radiate to r shoulder
  • guarding/ rebound tenderness
    • murphy’s sign- less sensitive in elderly
  • fever/ chills, n/v- increased bili, alk phos, AST/ALT
  • pain similar to MI in female
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19
Q

imaging for cholecystitis

A
  • US to find stones, may see inflammation
  • *pain meds before US
  • HIDA, CT not as good
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20
Q

choledocholithiasis clinical presentation

A
  • RUQ pain
  • jaundice
  • clay colored stool
    • murphy’s sign
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21
Q

lab findings for choledocholithiasis

A
  • increased AST/ALT
  • increased direct bili
  • increased alk phos
  • increased amylase if pancreatic involvement
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22
Q

imaging for choledocholithiasis

A
  • RUQ US*
  • ECRP*
  • CT
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23
Q

management for choledocholithiasis

A
  • ERCP to decompress/ remove stones

- allow pt to stabilize for 72 hours before lap chole

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24
Q

charcot’s triad

A
  • for cholangitis
  • severe RUQ pain
  • fever
  • jaundice
  • requires immediate intervention to avoid shock
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25
reynolds pentad
- for cholangitis - Severe RUQ pain - fever - jaundice - hypotension - acute mental status change - medical emergency
26
sx of cholangitis
- chacot's triad - reynolds pentad - pruritis - dark urine - clay colored stool (acholic)
27
imaging for cholangitis
- US | - ERCP
28
management of cholangitis
- requires admission - ERCP for stone removal - elective lap chole later - IV abx: amp + gent or cipro +/- flagyl - may need ICU admission
29
primary sclerosing cholangitis
- inflammation, scarring and stricture of bile ducts from chronic biliary disease - usually dx in 30-50s - increased risk of cholangiocancer - assoc with IBD
30
management for primary sclerosing cholangitis
- balloon dilation - eventual liver transplant - prognosis is 12-17 years without transplant
31
si/sx of primary sclerosing cholangitis
- pain - F/C, night sweats - progressive obstructive jaundice, pruritis - fatigue, anorexia, indigestion - hepatomegaly
32
general causes of pancreatitis
- compression/ obstruction of ampulla of vater | - reflux of bile and contents into duodenum and pancreatic duct
33
subtypes of acute pancreatitis
- acute interstitial- inflammation/ edema of pancreas and peripancreatic tissues, stone, EtOH - acute necrotic- autodigestion due to release of trypsinogen -> trypsin - hemorrhagic
34
chronic pancreatitis
- due to longstanding damage of pancreas | - pancreas stops functioning properly
35
what are the lab markers for pancreatic issues
- amylase- short half life (24 hours) | - lipase- more specific for pancreas but no correlation between severity of lipase and pancreatitis
36
risk factors for pancreatitis
- cholelithiasis/ choledocholithiasis* - EtOH* - trauma - hyperTG/ hyper Ca - certain meds or infections - idiopathic- 20%
37
acute pancreatitis sx
- severe/ sudden onset mid epigastric pain - pain eased by leaning forward - pain may radiate to back - f/n/v - abdominal distention - steatorrhea - cullens or grey turner sight
38
imaging for dx of acute pancreatitis
- US- rule in/out biliary involvement - CT- imaging of choice - ERCP, caution- may exacerbate
39
complications of acute pancreatitis
- multisystem organ failure - ileus - pseudocyst (rare) - pancreatic necrosis
40
management of acute pancreatitis
- admission, assess severity - ID underlying cause - analgeisa, antiemetics, serial labs and monitoring - clear fluids -> low fat diet, possible parenteral nutrition
41
ways to assess severity of acute pancreatitis
- ranson score - apache II score - SIRS score - BISAP
42
mild acute pancreatitis
- without local complications | - self limited in 3-7 days
43
mod acute pancreatitis
- transient organ failure < 48 hours - local systemic complications minus organ failure - +/- local complications
44
severe acute pancreatitis
- persistent organ failure > 48 hours | - CT scan recommended to assess for necrosis
45
chronic pancreatitis
- chronic inflammation, fibrosis, progressive destruction of exocrine and endocrine function - irreversible - pancreatic atrophy
46
what is the most common cause for chronic pancreatitis
- alcohol abuse
47
sx of chronic pancreatitis
- abdominal pain - anorexia, maldigestion, weight loss - n/v, steatorrhea - tenderness over pancreas during attack
48
dx of chronic pancreatitis
- can be challenging - no biomarker - amylase and lipase +/- elevation - LFTs +/- elevation - glucose +/- elevation - secretin abnormal when >60% of pancreatic exocrine function lost
49
imaging of choice for chronic pancreatitis
- CT for initial dx
50
treatment for chronic pancreatitis
- low fat diet, no alcohol - steatorrhea may be treated with FDA approved pancreatic enzymes - mgmt of pain may be challenging -> opioid addiction - endoscopic tx: sphincterectomy, stenting, stone extraction - whipple, total pancreatectomy, or autologous islet cell transplant
51
complications of chronic pancreatitis
- narcotic addiction - DM/ impaired glucose tolerance - gastroparesis - malabsorption - biliary stricture - pancreatic carcinoma
52
diverticulosis
- sac like protrusion of colon - mucosa and submucosa herniate through muscle layer - usu incidentally dx on colonoscopy
53
diverticular bleed
- painless bleeding of diverticula | - BRBPR
54
diverticulitis
- inflammation of diverticulum - simple vs complicated - complicated= abscess, obstruction, perforation, fistula
55
where do most diverticula occur?
- sigmoid colon
56
risk factors for diverticulosis
- age - constipation - diet- high fat, red meat - obesity - genetics- CT disorders - physical inactivity
57
sx of diverticulitis
- LLQ abdomina pain- constant - n/v/f - change in bowel habits- usu constipation - tender palpable mass- due to stool build up
58
dx of diverticulitis
- CT with IV contrast * | - cbc with diff, bmp, urinalysis
59
medical management of diverticulitis
- cipro + flagyl** - augmentin - ertapenem or zosyn IV - 2nd or 3rd gen ceph + flagyl - analgesia and antiemetics - NPO -> clear diet -> normal diet
60
surgical options for diverticulitis
- one stage procedure: colon resection with primary anastomosis - two stage procedure: colonic resection and end stage colostomy, primary anastamosis with diverting ileostomy
61
follow up for diverticulitis
- colonoscopy 6 weeks after dx - dietary modifications- high fiber/ long term fiber supplementation - avoid seeds, nuts, corn possibly
62
what is the most common cause of overt lower GI bleed
- diverticular bleed - usually spontaneously stop - mostly due to right colonic diverticula
63
si/sx of diverticular bleed
- PAINLESS hematochezia, maroon colored stool - bloating, cramping, urge to defecate - if a lot of blood loss may be hemodynamically unstable
64
dx of diverticular bleed
- colonoscopy - nuclear scintigraphy- tagged RBC scan - angiography
65
management of diverticular bleeds
- IVFs, NS, blood transfusion PRN - +/- NGT to r/o upper GI - surgical intervention not commonly needed
66
surgical options for diverticular bleeds
- colonoscopy with epi or endoscopic tamponade - angiography- infuse with vasoconstricting meds or embolization - segemental colectomy last line

Clin Med III (26 decks)

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