Ch 59 Diseases of Gallbladder and pancreas Flashcards
20% of women > 40 years of age have gall stones. most gallstones contain cholesterol, and its oversecretion into bile is thought to be a major factor in pathogensis of stones. biliary sludge, which may increase during pregnancy, is an important precursor to gall stone formation and develops in approximately 30% of pregnant women.
after 1st trimester, both gallbladder volume during fasting and residual volume after contracting in response to a meal are twice as great as in the nonpregnant state. incomplete emptying may result in retention of cholesterol crystals, a prerequisite for cholesterol gallstones.
1:1,000 develops cholecystitis
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acute cholecystitis develops when there is obstruction of the cystic duct.
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ultrasonography can be used to visualize stones as small as 2mm. ultrasonic examination confirms gall stones in up to 90% of patients
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cholecystecomy is not indicated for silent stones during pregnancy
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as in nonpregnant patients, acute pancreatitis is characterized by mild to incapacitating epigastric pain, nausea and vomiting, and abdominal distension. patients are usually in distress and have low grade fever, tachycardia, hypotension and abdominal tenderness. up to 10% have associated pulmonary findings which can progress to acute respiratory distress syndrome. serum AMYLASE levels are 3 times the normal upper values are confirmatory
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management of acute pancreatitis:
acute pancreatitis self limited, inflammation generally subsides within 3-7 days. in pregnant women with persistent / severe biliary pancreatitis, ERCP with stone removal and papillotomy have been used successfully
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cholecystectomy should be considered in all cases of biliary pancreatitis after the inflammation subsides, as recurrent pancreatitis is common in women who do not have their gallbladders removed.
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