Biliary system and pancreas Flashcards
Draw out the biliary tree and label the bits as you go
Just do it!
What are components of bile?
Bile acids, cholesterol, bilirubin
Phosphatidyl choline, xenobiotics
Purposes of bile?
Recycle cellular garbage
Break down and absorb fats and fat soluble vitamins
What’s another name for cholelithiasis?
Gall stones
Epidemiology of gall stones?
Ladies over 40
Especially if pregnant, overweight, DMI, sickle cell, cirrhosis
Symptoms of cholelithiasis?
Asymptomatic
Biliary colic
How would you diagnose cholelithiasis?
Ultrasound
Would you ever do a gall bladder transplant?
Only if you were immunocompromised
When would you do a cholecystectomy
If gall stone >2.5cm or you had hemolytic anemia
How would you treat uncomplicated cases of cholelithiasis?
Lithotripsy or bile acid tabs
What is choledocholithiasis
Gall stone lodged in common bile duct
Symptoms of choledocholithiasis?
Symptoms of cholelithiasis + jaundice, high bp and increased heart rate
How would you diagnose choledocholithasis?
ERCP (can cause pancreatitis)
MRCP
Ultrasound or CT
Endoscopic Ultrasound
How would you treat choledocholithasis?
ERCP
Biliary stent
lithotripsy or cholecystectomy
What are complications that can occur with choledocholithiasis?
Pancreatitis and acute cholangitis
What happens with acute cholangitis?
Obstruction of biliary tree causes backflow. High pressure and infected bile results
Symptoms of acute cholangitis?
Charcot triad: Jaundice, pain, fever/chills
Reynold’s traid: Charcot’s + change in mentation and hypOtension
Biliary colic
How would you diagnose acute cholangitis?
ERCP and CBC
Blood culture
CT/MRI
How would you treat acute cholangitis?
Antibiotics, drain biliary tree, hospitalize and cholecystectomy
What is cholecystitis?
Inflam of gall bladder usually caused by gallstone. Can also be tumor or other diseases
What happens to the gallbladder with cholecystitis?
Loses elasticity, doesn’t release juices as well, can rupture
Symptoms of cholecystitis?
Abdominal dysfunction stuff
Pain, nausea and vomitting, and fever
How would you diagnose cholecystitis?
Ultrasound or CT
How would you treat cholecystitis?
Cholecystectomy, pain meds and antibiotics
Fasting to relieve pain
What happens with primary sclerosing cholangitis?
Chronic cholangitis leading to chronic inflammation and fibrosing of biliary tree
What other disease is primary sclerosing cholangitis associated with?
IBD, namely ulcerative colitis
Symptoms of primary sclerosing cholangitis?
Hepatomegaly, splenomegaly, jaundice
can be asymptomatic too
Epidemiology of primary sclerosing cholangitis?
50yo males
How would you diagnose primary sclerosing cholangitis?
ERCP
MRC
Percutaneous cholangiogram
Prognosis for primary sclerosing cholangitis?
Poor prognosis
Sclerosis leads to cirrhosis
How do you treat primary sclerosing cholangitis?
Temporary balloon stent
IV fluids and antibiotics
Liver transplant if cirrhosis
What is the purpose of the pancreas?
Exocrine: Digestive enzymes from acinar cells
What can cause acute pancreatitis?
Alcohol, genetics, obstruction of biliary tree
Vascular injury, infection
What is acute pancreatitis?
Injury leading to inflam of pancreas. Enzymes inappropriate released and causes more damage
What’s the pathophysiology of pancreatitis?
Obstruction
Acinar cell damage
Acinar transport damage
How do you diagnose acute pancreatitis?
Ultrasound/CT/MRI
Symptoms of acute pancreatitis?
Hypoxia, Tachypnea, hypOtension
Abdomen problem stuff: pain, N/V and fever
How do you treat acute pancreatitis?
Most are mild and require no treatment
Pain medications, IV fluids
Debride of pancreatic necrosis
What’s chronic pancreatitis caused by?
Autoimmune, herditary, obstruction of duct #1 cause is alcohol Also idiopathic
What systems are obstructed with chronic pancreatitis?
Endocrine and exocrine systems of pancreas
Who typically has chronic pancreatitis?
Middle aged males
Symptoms of chronic pancreatitis?
Abdomen pain
Jaundice and inability to digest complex foods
How would you image for chronic pancreatitis?
Xray/CT/Endoscopic ultrasound with or without biopsy
How would you treat chronic pancreatitis?
Treat complications and pain
Treat pain and give IV fluids
Small low fat meals
Stop tobacco and alcohol
Prognosis of chronic pancreatitis?
Poor. 50% survive 10 years
Who is at risk for pancreatic cancer?
Middle aged males
What are risk factors for pancreatic cancer?
FHx, Chronic pancreatitis or pancreatic cysts
Breast cancer, overweight/DM, smoke
Symptoms of pancreatic cancer?
Pain, jaundice, weightloss
Diarrhea and vomitting
How do you diagnose pancreatic cancer?
Histology and imaging
How do you treat for pancreatic cancer?
Can’t
Can try to resect, but just give palliative care
Prognosis for pancreatic?
Poor. 25% survive another 5 years
True or false: Both acute and chronic pancreatitis are irreversible
False. Acute pancreatitis IS reversible whereas chronic is not
