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Julie W: Module 9 - GI > D/O of the Gallbladder & Exocrine Pancreas- Prof Wall & Porth, Chpt 30 > Flashcards

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
Q

Cholelithiasis

Diagnostics

When is the Transabdominal Ultrasound NOT a good test?

A
  • When the stones are in the COMMON BILE DUCT!
    • ​you just can’t spot them there!
26
Q

Cholelithiasis

Treatment Options

A
  • 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
Q

Cholecystitis

  • Acute:*
  • Etiology & Pathology*
A
  • Cystic duct BLOCKED!
    • Gallstones
    • Less common:
      • Sludge, infxn, cancer
  • Gallbladder blocked -> Distention/edema -> Ischemia-> RUQ Pain (esp. post-meal)
28
Q

Cholecystitis

Symptoms

A
  • RUQ & Epigastric pain
    • Radiation: Right Shoulder/Scapula
  • Nausea
  • Vomiting
  • Fever/Chills
29
Q

Cholecystitis

Signs

A
  • Tenderness
    • RUQ/Epigastrium
  • Murphy’s sign:
    • Tenderness & inspiration pause on RUQ palpation
  • Jaundice
    • (maybe)
30
Q

Cholecystitis

  • Diagnostic Options:*
  • 1.* Ultrasound
A
  • Ultrasound***
    • ​May show:
      • Gallstones
      • Thickened GB walls (>3mm)
      • Pericholecystic Fluid
      • Sonography Murphy’s Sign
31
Q

Cholecystitis

  • Diagnostic Options:*
    1. HIDA Scan*

“The best test…BUT usually not necessary!”

A
  • Nuclear Med Study
    • Hepatobiliary IminoDiacetic Acid Scan
    • Radioactive tracer injected
      • followed through liver to GB
32
Q

Cholecystitis

  • Diagnostic Options:*
  • 3.* Plain Radiographs
A
  • Not usually helpful
  • ~25% of stones = radioopaque
    • Calcium stones = radioopaque
33
Q

Cholecystitis

Lab Studies

A
  • 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
Q

Cholecystitis

Treatment

A
  • 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
Q

Choledocholithiasis

A

Stone in the Common Bile Duct

36
Q

Choledocholithiasis

Clinical Course

A
  • Asymptomatic (30-40%)
  • Biliary Colic (painful)
  • Jaundice, Pancreatitis, Colangitis
37
Q

Choledocholithiasis

Diagnosis & Treatment

A
  • MRCP
    • Diagnosis only
  • ERCP
    • Diagnosis & Treatment
  • HIDA Scan
38
Q

Acute Cholangitis

A

Infection & Inflammation of the Biliary Tract

Due to Obstruction, then Infection!

LIFE THREATENING!!! (Sepsis, Shock)

39
Q

Acute Cholangitis

Differential

A

Hard to differentiate from:

Cholecystitis

40
Q

Acute Cholangitis

Signs & Symptoms

Charcot’s Triad

A
  • Abdominal Pain
  • Jaundice
  • Fever
41
Q

Acute Cholangitis

Diagnosis

A
  • Labs:
    • CBC
      • see Leukocytosis
    • Hyperbilirubinemia
      • Elevated/increasing
    • Blood cultures x 2
42
Q

Acute Cholangitis

Treatment

A
  • Antibiotics
    • Gram negative anaerobes, eneterococci
    • Remove obstructions viaERCP
43
Q

Cholecystic Disorders

Just remember…

A
  • 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
Q

Pancreatitis

A

Inflammation of the Pancreas

Causes acinar cell injury

45
Q

Pancreatitis

Why Does this Occur?

A
  • 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

Julie W: Module 9 - GI (8 decks)

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