Disorders of the Gall Bladder and Pancreas

Question 1

What is cholelithiasis?

Answer 1

Gall stones.

Question 2

Bile stones are a result of precipitation of which three bile substances?

Answer 2

Cholesterol, calcium, bilirubin.

Question 3

What are five risk factors for cholelithiasis?

Answer 3

Female, multiparity, oral contraceptives, obesity, and genetics.

Question 4

What are four causes of cholelithiasis?

Answer 4

Abnormal composition of bile. Stasis of bile. Inflammation of gallbladder. Malabsorption disorders.

Question 5

What is biliary colic?

Answer 5

It is pain due to a gallstone lodged in the cystic duct or the common bile duct, or traveling though ducts resulting in spasm.

Question 6

What are the symptoms of biliary colic?

Answer 6

An abrupt onset. Persistent upper right quadrant/epigastric pain. Pain referred to back, right shoulder, midscapula. Bilirubinemia. Nausea.

Question 7

What is acute cholecystitis?

Answer 7

Inflammation of the gallbladder.

Question 8

What are the two types of acute cholecystitis?

Answer 8

Acute calculous cholecystitis and Acalous cholecystitis.

Question 9

What is the cause of acute calculous cholecystitis?

Answer 9

Impacted stones in the cystic duct. Lipases are released and bile salts damage the epithelium.

Question 10

What is the cause of acalculous cholecystitis?

Answer 10

It is due to ischemia, edema, bile stasis, or obstruction. It can progress to gangrene and perforation. It may lead to sepsis. It can be caused by sepsis, burns, trauma, infection, DM, multisystem organ failure.

Question 11

What are the manifestations of acute cholecystitis?

Answer 11

Acute onset, persistent upper right quadrant/epigastric pain, mild fever, anorexia, nausea, vomiting. Vomiting brings relief if “calculous”.

Question 12

What is acute pancreatitis?

Answer 12

Reversible inflammation due to premature activation of pancreatic enzymes resulting in auto-digestion. (Trypsin, which activates all the other enzymes).

Question 13

What are the causes of acute pancreatitis?

Answer 13

Gallstones and alcohol abuse are the leading causes. Other causes include hyperlipidemia, hypercalcemia, viral infections, trauma, medications (thiazide diuretics).

Question 14

What are the pancreatic enzymes?

Answer 14

Trypsin, Chymotrypsin, Carboxypolypeptidase, Ribonuclease, Deoxyribonuclease, Amylase, Lipase.

Question 15

What are the GI manifestations of pancreatitis?

Answer 15

Sudden onset upper left quadrant/epigastric/periumbilical pain, radiating to back, chest, flank. Abdominal distention/tenderness. Nausea, vomiting. Hypoactive bowel sounds. Steatorrhea (fatty stool).

Question 16

What are the CNS manifestations of pancreatitis?

Answer 16

Fever, thirst, agitation, confusion.

Question 17

What are the CVS manifestations of pancreatitis?

Answer 17

Tachycardia, hpyotension, massive fluid loss.

Question 18

What are the respiratory manifestations of pancreatitis?

Answer 18

Tachypnea, hypoxia, dyspnea.

Question 19

What is the renal manifestation of pancreatitis?

Answer 19

Oligurea.

Question 20

What are the integumentary manifestations of pancreatitis?

Answer 20

Cullen’s sign, Turner’s sign, jaundice, cool/clammy skin.

Question 21

What is Cullen’s sign?

Answer 21

Grey/blue discoloration of periumbilical region from intraperitoneal hemorrhage.

Question 22

What is Turner’s sign?

Answer 22

Grey/blue discoloration of flanks from pancreatic enzyme leakage into the peritoneal cavity/tissue.

Question 23

What are some diagnostic signs of pancreatitis?

Answer 23

Elevated serum trypsin, amylase, lipase, elastase. Elevated blood glucose. Hypocalcemia. Elevated serum bilirubin.

Question 24

Why does pancreatitis cause elevated blood glucose?

Answer 24

Pancreas secretes insulin, which lowers blood glucose. Pancreatitis causes impaired carbohydrate metabolism.

Question 25

Why does pancreatitis cause hypocalcemia?

Answer 25

Fat necrosis releases fat that combines with calcium, lowering serum calcium levels.

Question 26

Why does pancreatitis cause elevated serum bilirubin?

Answer 26

It can cause hepatobiliary obstriction. Bile contains bilirubin. If this is not being released properly then there will be increased bilirubin in the blood.

Question 27

What are some complications of pancreatitis?

Answer 27

Sepsis can occur quite easily because organs in the abdomen are very vascular. Acute respiratory distress syndrome. Acute tubular necrosis. MSOF.

Question 28

What are some complications of chronic pancreatitis?

Answer 28

Progressive permanent destruction of exocrine pancreas. Same complications as acute pancreatitis.

Question 29

Which cells does pancreatic cancer usually affect?

Answer 29

Adenocarcinoma of ductal epithelium.

Question 30

What is the survival rate of pancreatic cancer?

Answer 30

5 year survival rate of 4-5% (4th leading death d/t cancer).

Question 31

What are the risk factors for pancreatic cancer?

Answer 31

Age, smoking, diabetes mellitus, chronic pancreatitis, genetics.

Question 32

What are the manifestations of pancreatic cancer?

Answer 32

Jaundice. Pruritus. Weight loss. Dull epigastric pain, radiating to back. This is relieved by sitting forward, and worsened by supine position and eating.

Question 33

What is a complication of pancreatic cancer?

Answer 33

Thrombophlebitis. This happens because damaged pancreatic tissue sends off clots.

Question 34

What is the treatment for pancreatic cancer?

Answer 34

Surgery called the Whipple Procedure. This is resection of proximal pancreas, duodenum, distal portion of stomach, distal segment of common bile duct (sometimes gallbladder). Anastamosis of pancreatic & common bile duct and stomach to jejunum.

Question 35

What is the result of the Whipple Procedure? (Surgery for pancreatic cancer)

Answer 35

Results in insulin-dependent diabetes.