D/O of the Gallbladder & Exocrine Pancreas- Prof Wall & Porth, Chpt 30 Flashcards

1
Q

What does the so-called Hepatobiliary System consist of?

A
  • Gallbladder
  • Left & Right Hepatic Ducts
    • come together & form: Common Hepatic Duct
  • Cystic Duct
  • Bile Duct =’s CBD + CD
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2
Q

What forms the Hepatopancreatic Ampulla?

A
  • Bile Duct
  • Main Pancreatic Duct
    • Empty into the Duodenum
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3
Q

Can you palpate the Pancreas?

A
  • No!
    • Pretty much hiding (posterior region)
      • (big issue re: pancreatic CA)
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4
Q

What type of Organ is the Pancreas?

A
  • Endocrine & Exocrine Organ
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5
Q

What type of Organ is the Pancreas?

Exocrine Function

& Acinar Cells

A
  • Exocrine =
    • Acinar cells
      • Secrete Digestive Enzymes* into Microscopic Ducts
        • Empty into main pancreatic duct
    • *Digestive Enzymes:
      • Proteolytic (protein)
      • Amylase (carbs)
      • Lipase (fat)
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6
Q

What type of Organ is the Pancreas?

Exocrine Function

& Ductal Epithelial Cells

A
  • Secrete
    • Alkaline Solution
      • Water, Electrolytes, Sodium Bicarb
      • Increase pH in duodenum
      • Alkaline solution = majority of what pancreas secretes
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7
Q

What type of Organ is the Pancreas?

Endocrine Function

A
  • Secretion into bloodstream
  • Islets of Langerhans
    • B-Cells
      • Insulin syn/sec
    • A-Cells
      • Glucagon
    • D-Cells
      • Somatostatin
        • Inhinits GH & TSH secretion
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8
Q

Pancreas…

So… what does this organ do?

A
  • Secretes
    • aids in digestion, regulation of pH in intestines & blood sugar regulation

DO NOT MAKE THIS ORGAN ANGRY!!!! That would be bad.

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9
Q

Gallbladder

A

Bile Storage Site

  • Bile gets concentrated here
  • Filled when Sphinter of Oddi closed
  • Contracts to CKK
  • Induces drug tolerance to opiods!
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10
Q

Bile

A
  • Breaks up Fats for small intestine digestion
  • Secreted from Liver
  • Made from:
    • Bile salts
      • cholesterol
    • Bilirubin
      • Worn out WBCs
    • Alkaline Fluids
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11
Q

Cholecystic

A
  • Referring to the Gallbladder
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12
Q

Cholecystitis

A
  • Inflammation of Gallbladder
    • Chronic or Acute
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13
Q

Cholelithiasis

A
  • Stones in Gallbladder
    • aka: cholecystolithiasis
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14
Q

Choledocholithiasis

A
  • Stone in Bile Ducts
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15
Q

Cholecystectomy

A
  • Removal of Gallbladder
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16
Q

Cholecystalgia

A
  • Pain
    • aka: biliary colic
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17
Q

Cholelithiasis

Gallstones!

A
  • 10-15% adults get this
    • 500,000 cholecystectomies/year
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18
Q

Cholelithiasis

Composition

A
  • Cholesterol
    • Most common
    • 75% of stones
  • Calcium Bilirubinate/Ca Salts
    • 25% of stones
    • ‘pigmented’ black/brown
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19
Q

Cholelithiasis

Etiology & Pathophyz

A
  • Super Saturation of Cholesterol
    • Diet is so important to prevention!
  • Nucleation
    • Microscopic cholesterol comes together & crystallizes
    • Over time… more layers of cholesterol added
  • GB hypo-motility
    • Slower emptying = more time for stone formation
      • pregnancy…
20
Q

Cholelithiasis

  • The 5 F’s*
  • *Risk Factors**
A
  • Female
  • Forty
    • >40yo
  • Fat
    • Obesity, or rapid weight loss
  • Fair
    • White/pasty!
  • Fertile
21
Q

Cholelithiasis

Other Risk Factors

A
  • OCPs
  • Preggers
  • DM/Insulin Use
  • Hemolysis
  • Biliary Parasites
  • Cirrhosis
  • Crohn’s
  • Hyperparathyroid Dz
22
Q

Cholelithiasis

Symptoms/Presentations

A
  • Asymptomatic (50-60%)
  • Symptomatic (~40%)
    • ​Biliary Colic
      • Aching pain in RUH/Epigastric
    • Referred Pain
      • Back, Scapula, R. Shoulder
23
Q

Cholelithiasis

Symptoms/Presentations

Non-Specific Symptoms

A
  • Nausea
  • Vomiting
  • Fatty Food Intolerance
  • Dyspepsia
  • Heartburn
  • Bloating
  • Flatulance
  • Belching
24
Q

Cholelithiasis

Diagnostics

A
  • ULTRASOUND!!!!!!!
    • RUQ Transabdominal
    • >95% sen/spec
25
**Cholelithiasis** *Diagnostics* **When is the Transabdominal Ultrasound NOT a good test?**
* When the stones are in the **COMMON BILE DUCT!** * **​**you just can't spot them there!
26
**Cholelithiasis** *Treatment Options*
* Cholecystectomy - Take it out! * Leave it in? * Sure - Unless @ risk for complications * Diabetes, Sickle Cell, & those @ risk for GB cancer * Other Options: * Dissolve Cholesterol Stones * PO Ursodeoycholic Acid, or Chenodeoxycholic Acid
27
**Cholecystitis** * Acute:* * Etiology & Pathology*
* Cystic duct BLOCKED! * Gallstones * Less common: * Sludge, infxn, cancer * Gallbladder blocked -\> Distention/edema -\> Ischemia-\> RUQ Pain (esp. post-meal)
28
**Cholecystitis** *Symptoms*
* RUQ & Epigastric pain * Radiation: Right Shoulder/Scapula * Nausea * Vomiting * Fever/Chills
29
**Cholecystitis** *Signs*
* Tenderness * RUQ/Epigastrium * Murphy's sign: * Tenderness & inspiration pause on RUQ palpation * Jaundice * (maybe)
30
**Cholecystitis** * Diagnostic Options:* * 1.* Ultrasound
* **Ultrasound\*\*\*** * **​**May show: * Gallstones * Thickened GB walls (\>3mm) * Pericholecystic Fluid * Sonography Murphy's Sign
31
**Cholecystitis** * Diagnostic Options:* * 2. HIDA Scan* **"The best test...BUT usually not necessary!"**
* Nuclear Med Study * Hepatobiliary IminoDiacetic Acid Scan * Radioactive tracer injected * followed through liver to GB
32
**Cholecystitis** * Diagnostic Options:* * 3.* Plain Radiographs
* Not usually helpful * ~25% of stones = radioopaque * Calcium stones = radioopaque
33
**Cholecystitis** *Lab Studies*
* CBC w/ diff * elevated WBC (12-15K) * Hepatic Function Tests * LFTs: * *sometimes* Elevated * If REALLY elevated.. think, Liver! * Alkaline Phosphatase * Elevated * GGT * Elevated * Bilirubin * Elevated, esp in common duct stone * Amylase * Elevated (sometimes)
34
**Cholecystitis** *Treatment*
* **Main Treatment =** * **​Take it out!!!** * **​_Cholecystectomy_** * Leave it in? * Maybe - if mild or unclear dx * Drain it * Cholecystostomy & Percutaneous Drainage * Abx * If fever +/- Leukocytosis
35
**Choledocholithiasis**
Stone in the Common Bile Duct
36
**Choledocholithiasis** *Clinical Course*
* Asymptomatic (30-40%) * Biliary Colic (painful) * Jaundice, Pancreatitis, Colangitis
37
**Choledocholithiasis** *Diagnosis & Treatment*
* _MRCP_ * Diagnosis only * _ERCP_ * Diagnosis & Treatment * _HIDA Scan_
38
**Acute Cholangitis**
Infection & Inflammation of the Biliary Tract *Due to Obstruction, then Infection!* LIFE THREATENING!!! (Sepsis, Shock)
39
**Acute Cholangitis** *Differential*
Hard to differentiate from: _Cholecystitis_
40
**Acute Cholangitis** *Signs & Symptoms* Charcot's Triad
* Abdominal Pain * Jaundice * Fever
41
**Acute Cholangitis** *Diagnosis*
* Labs: * CBC * see Leukocytosis * Hyperbilirubinemia * Elevated/increasing * Blood cultures x 2
42
**Acute Cholangitis** *Treatment*
* Antibiotics * Gram negative anaerobes, eneterococci * Remove obstructions viaERCP
43
**Cholecystic Disorders** Just remember...
* If it hurts... Take it out * GB: Cholecystectomy * CBD: ERCP * If its infected... Antibiotic it * Cholecystitis or Cholangitis * If its blocked... Unblock it * GB: - ectomy * Choledocholithiasis: ERCP
44
**Pancreatitis**
Inflammation of the Pancreas *Causes acinar cell injury*
45
**Pancreatitis** *Why Does this Occur?*
* Theories: * Obstruction of Pancreatic duct * Stones cause this * Pancrea divisum (developmental d/o) * Inactive proenzymes activated too early (while in pancreas) * Fat necrosis * Pancreas starts to "Digest" itself