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Exam 3 > Diseases Of The Biliary Tree And Pancreas > Flashcards

Diseases Of The Biliary Tree And Pancreas Flashcards

1
Q

Cholecystitis definition

A

inflammation of the gallbladder, usually associated with gallstones

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2
Q

cholangitis definition

A

acute bacterial infection of biliary tree ususally secondary to obstruction by stones that leads to inflammation of bile ducts

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3
Q

Cholelithiasis defined

A

abnormal presence of stones in the gallbladder

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4
Q

Choledocholithiasis defined

A

gallstones lodged in the common bile duct

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5
Q

what is biliary pancreatitits?

A

gallstone lodged in the pancreatic duct

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6
Q

What population commonly gets cholecystitis?

A

Female
Fat
Fertile
Forties

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7
Q

Gold standard for detecting cholecystitis

A

ultrasound shows fluid, inflammation, acoustic shadows, positive murphys sign

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8
Q

When should you do a HIDA scan?

A

done when US is inconclusive and evaluates GB function as radio-nucleotides are taken up by hepatocytes but there is no filling of GB with radioactive bile

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9
Q

80% of patients with cholelithiasis present as

A

asymptomatic

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10
Q

most common type of gallstone

A

cholesterol stones (too much cholesterol, not enough bile salts)

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11
Q

What is on your differential diagnosis for GB pain?

A 
angina
pneumonia
kidney stone
peptic ulcers
esophagitis
spasm
gastric cancer
aneurysm
intestinal ischemia
obstruction
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12
Q

Clinical presentation of choledocholithiasis

A

jaunice
liver damage
negative murphys sign

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13
Q

Lab values in choledocholithiasis

A

early increase in AST/ALT

then alk phos, t. bili, and d. bili will elevate

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14
Q

If the ampulla of vater is blocked by a gallstone, what will your lab values look like?

A

elevated amylase and lipase

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15
Q

Choledocholithiasis treatment

A

ERCP for obstruction

cholecystectomy to precent future issue

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16
Q

chronic obstruction lab values

A

high alk phos

ast and alt will taper off

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17
Q

What are 3 common causes of cholangitis?

A

gram negative enteric bugs:
e coli
enterobacter
psuedomonas

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18
Q

Charcot’s Triad

A

for cholangitis

  1. RUQ pain
  2. jaundice
  3. fever and chills
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19
Q

Reynold’s pentad

A 
for cholangitis
1. RUQ pain, 2. jaundice, 3. fever chills from before
ADD
4. shock
5. altered mental status
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20
Q

Lab values in cholangitis

A

leukocytosis

LFTs: high bilirubin and alk phos

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21
Q

Cholangitis treatment

A

ICU admission w broad spectrum abx
ERCP for obstruction
cholecystectomy

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22
Q

How do you decompress the biliary tree?

A

stent placement

23
Q

Risk factors for pancreatic cancer

A 
Diet: animal fat, nitrosamines
Cigarettes
Hereditary
Peutz-Jeghers
chronic pancreatitis
DM
24
Q

most common location for pancreatic cancer

A

head of the pancreas, adenocarcinoma

25
Q

Clinical presentation of head of pancreas cancer

A

jaundice, gastric outlet obstruction

26
Q

What is a Virchow’s node?

A

left supraclavicular

27
Q

what is a trousseau’s sign?

A

migratory thrombophlebitis

28
Q

Courvoiser’s Law

A

jaundice + palpable GB = CANCER, not stone

29
Q

What are indications for whipple or distal pancreatectomy?

A

small, no mets, no vessels

30
Q

Common causes of ACUTE pancreatitis

A

alcohol, gallstones, idiopathic, trauma

31
Q

Common causes of CHRONIC pancreatitis

A 
alcohol #1
Cystic fibrosis
altered enzyme activitiy (trypsinogen)
metabolic (high TG)
cigarettes
32
Q

Pathophysiology of acute pancreatitis

A

insult to pancreas leads to zymogen activation, generation of inflammatory mediators, and ischemia. so you get a systemic inflammatory response that can lead to multi organ failure necrosis and apoptosis

33
Q

An increase in what lab value is the best mortality predictor in acute pancreatitis?

A

BUN

34
Q

Common lab findings in diagnosing acute pancreatitis

A 
elevated lipase (3x) and amylase, low Ca2+
high pancreatic specific amylase
35
Q

pancreatic spot on CT not taking up contrast is bad, this indicates

A

necrosis

36
Q

What is the prognostic indication criteria for pancreatitis called?

A

Ranson’s

37
Q

Treatment for acute pancreatitis

A 
supportive care (fluid recusitation, monitor vitals, urine output, BUN, Cr, HCT, LFTs, CRP)
meperidine for pain
abx to prevent cholangitis
***urgent ERCP if there is a stone ONLY
nutrition (TPN until safe to eat)
38
Q

Why is enteral feeding used in pancreatitis?

A

we get less pancreatic stimulation
less chance of infection
shorter hospital stays

39
Q

In the ER, what is the most important thing you can do for a patient presenting with acute pancreatitis?

A

early fluid recusitation

40
Q

epigastric pain, radiating to the back combined with steatorrhea— what is this?

A

chronic pancreatitis

41
Q

why is there steatorrhea in chronic pancreatitis?

A

absence of lipase

42
Q

The chain of lakes on CT scan is indicative of what?

A

pancreatitis calcification (chronic)

43
Q

Patient presents with colicky RUQ pain, radiating to shoulder
worse will ingestion of fatty foods

A

cholelithiasis

44
Q

When is cholecystostomy used?

A

when patient is not surgical candidate OR used in meantime to drain fluid and decrease GB inflammation while waiting for surgery to be done

45
Q

Choledocholithiasis is commonly paired with what two diseases?

A

pancreatitis

hepatitis

46
Q

Abx regemin for GB diseases

A

cipro + MTZ

amp-genta + MTZ

47
Q

ERCP should only be done when gallstones ARE suspected due to this complication

A

pancreatitis

48
Q

US and MRCP are not good for diagnosing pancreatitis but they are good for determining which etiologies?

A

ES- stones

MRCP- stricture, malignancy

49
Q

Late complications of pancreatitis

A

abscess - drain it

pseudocyst- watch wait, drain, bx for cancer

50
Q

what causes biliary colic?

A

CCK after eating fatty meal triggers gallbladder contraction and pushes stone into cystic duct

51
Q

tell me about carcinoid tumors

A

they produce serotonin and substance P from enterochromaffin cells

52
Q

cutaneous flushing and R heart valve lesions are in the clinical presentation of

A

carcinoid tumors

53
Q

Urein 5-HIAA detects

A

serotonin metabolite for carcinoid tumors

54
Q

Carcinoid tumor treatment

A

remove tumor and give octerotide

Exam 3 (18 decks)

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