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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
Q

reynolds pentad

A
  • for cholangitis
  • Severe RUQ pain
  • fever
  • jaundice
  • hypotension
  • acute mental status change
  • medical emergency
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26
Q

sx of cholangitis

A
  • chacot’s triad
  • reynolds pentad
  • pruritis
  • dark urine
  • clay colored stool (acholic)
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27
Q

imaging for cholangitis

A
  • US

- ERCP

28
Q

management of cholangitis

A
  • requires admission
  • ERCP for stone removal
  • elective lap chole later
  • IV abx: amp + gent or cipro +/- flagyl
  • may need ICU admission
29
Q

primary sclerosing cholangitis

A
  • inflammation, scarring and stricture of bile ducts from chronic biliary disease
  • usually dx in 30-50s
  • increased risk of cholangiocancer
  • assoc with IBD
30
Q

management for primary sclerosing cholangitis

A
  • balloon dilation
  • eventual liver transplant
  • prognosis is 12-17 years without transplant
31
Q

si/sx of primary sclerosing cholangitis

A
  • pain
  • F/C, night sweats
  • progressive obstructive jaundice, pruritis
  • fatigue, anorexia, indigestion
  • hepatomegaly
32
Q

general causes of pancreatitis

A
  • compression/ obstruction of ampulla of vater

- reflux of bile and contents into duodenum and pancreatic duct

33
Q

subtypes of acute pancreatitis

A
  • acute interstitial- inflammation/ edema of pancreas and peripancreatic tissues, stone, EtOH
  • acute necrotic- autodigestion due to release of trypsinogen -> trypsin
  • hemorrhagic
34
Q

chronic pancreatitis

A
  • due to longstanding damage of pancreas

- pancreas stops functioning properly

35
Q

what are the lab markers for pancreatic issues

A
  • amylase- short half life (24 hours)

- lipase- more specific for pancreas but no correlation between severity of lipase and pancreatitis

36
Q

risk factors for pancreatitis

A
  • cholelithiasis/ choledocholithiasis*
  • EtOH*
  • trauma
  • hyperTG/ hyper Ca
  • certain meds or infections
  • idiopathic- 20%
37
Q

acute pancreatitis sx

A
  • 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
Q

imaging for dx of acute pancreatitis

A
  • US- rule in/out biliary involvement
  • CT- imaging of choice
  • ERCP, caution- may exacerbate
39
Q

complications of acute pancreatitis

A
  • multisystem organ failure
  • ileus
  • pseudocyst (rare)
  • pancreatic necrosis
40
Q

management of acute pancreatitis

A
  • admission, assess severity
  • ID underlying cause
  • analgeisa, antiemetics, serial labs and monitoring
  • clear fluids -> low fat diet, possible parenteral nutrition
41
Q

ways to assess severity of acute pancreatitis

A
  • ranson score
  • apache II score
  • SIRS score
  • BISAP
42
Q

mild acute pancreatitis

A
  • without local complications

- self limited in 3-7 days

43
Q

mod acute pancreatitis

A
  • transient organ failure < 48 hours
  • local systemic complications minus organ failure
  • +/- local complications
44
Q

severe acute pancreatitis

A
  • persistent organ failure > 48 hours

- CT scan recommended to assess for necrosis

45
Q

chronic pancreatitis

A
  • chronic inflammation, fibrosis, progressive destruction of exocrine and endocrine function
  • irreversible
  • pancreatic atrophy
46
Q

what is the most common cause for chronic pancreatitis

A
  • alcohol abuse
47
Q

sx of chronic pancreatitis

A
  • abdominal pain
  • anorexia, maldigestion, weight loss
  • n/v, steatorrhea
  • tenderness over pancreas during attack
48
Q

dx of chronic pancreatitis

A
  • can be challenging
  • no biomarker
  • amylase and lipase +/- elevation
  • LFTs +/- elevation
  • glucose +/- elevation
  • secretin abnormal when >60% of pancreatic exocrine function lost
49
Q

imaging of choice for chronic pancreatitis

A
  • CT for initial dx
50
Q

treatment for chronic pancreatitis

A
  • 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
Q

complications of chronic pancreatitis

A
  • narcotic addiction
  • DM/ impaired glucose tolerance
  • gastroparesis
  • malabsorption
  • biliary stricture
  • pancreatic carcinoma
52
Q

diverticulosis

A
  • sac like protrusion of colon
  • mucosa and submucosa herniate through muscle layer
  • usu incidentally dx on colonoscopy
53
Q

diverticular bleed

A
  • painless bleeding of diverticula

- BRBPR

54
Q

diverticulitis

A
  • inflammation of diverticulum
  • simple vs complicated
  • complicated= abscess, obstruction, perforation, fistula
55
Q

where do most diverticula occur?

A
  • sigmoid colon
56
Q

risk factors for diverticulosis

A
  • age
  • constipation
  • diet- high fat, red meat
  • obesity
  • genetics- CT disorders
  • physical inactivity
57
Q

sx of diverticulitis

A
  • LLQ abdomina pain- constant
  • n/v/f
  • change in bowel habits- usu constipation
  • tender palpable mass- due to stool build up
58
Q

dx of diverticulitis

A
  • CT with IV contrast *

- cbc with diff, bmp, urinalysis

59
Q

medical management of diverticulitis

A
  • cipro + flagyl**
  • augmentin
  • ertapenem or zosyn IV
  • 2nd or 3rd gen ceph + flagyl
  • analgesia and antiemetics
  • NPO -> clear diet -> normal diet
60
Q

surgical options for diverticulitis

A
  • one stage procedure: colon resection with primary anastomosis
  • two stage procedure: colonic resection and end stage colostomy, primary anastamosis with diverting ileostomy
61
Q

follow up for diverticulitis

A
  • colonoscopy 6 weeks after dx
  • dietary modifications- high fiber/ long term fiber supplementation
  • avoid seeds, nuts, corn possibly
62
Q

what is the most common cause of overt lower GI bleed

A
  • diverticular bleed
  • usually spontaneously stop
  • mostly due to right colonic diverticula
63
Q

si/sx of diverticular bleed

A
  • PAINLESS hematochezia, maroon colored stool
  • bloating, cramping, urge to defecate
  • if a lot of blood loss may be hemodynamically unstable
64
Q

dx of diverticular bleed

A
  • colonoscopy
  • nuclear scintigraphy- tagged RBC scan
  • angiography
65
Q

management of diverticular bleeds

A
  • IVFs, NS, blood transfusion PRN
  • +/- NGT to r/o upper GI
  • surgical intervention not commonly needed
66
Q

surgical options for diverticular bleeds

A
  • 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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