Disorders of the Gallbladder

Question 1

Cholecytitis

Answer 1

Inflammation of the gallbladder

*Acute vs. Chronic

Question 2

Cholecytitis clinical manifestation

Answer 2

Fever, leukocytosis, rebound tenderness, and abdominal muscle guarding

Question 3

Cholecytitis treatment

Answer 3

Pain control
Replacement of fluids and electrolytes
Fasting
Antibiotic administration
Perforated gallbladder: Immediate cholecystectomy

Question 4

Cholelithiasis (gallstone formation)

Answer 4

Cholesterol stone formation in bile that is supersaturated with cholesterol
Enzyme defect: Increased cholesterol synthesis
Decreased secretion of bile acids to emulsify fats
Decreased resorption of bile salts from the ileum
Gallbladder smooth muscle hypomotility, stasis
Genetic predisposition
Combination of any or all of the above

Question 5

Cholelithiasis: pigmented stones

Answer 5

• *Black pigmented stones: Are formed in a sterile environment and are primarily composed of calcium bilirubinate polymer from hyperbilirubinbilia.
• *Brown stones: Are associated with bacterial infection of the bile ducts with formation of stone that is composed of calcium soaps, unconjugated bilirubin, cholesterol, fatty acids, and mucin

Question 6

Cholelithiasis clinical manifestations

Answer 6

Epigastric and right hypochondrium pain
Intolerance to fatty foods
Biliary colic: Lodging of stones in the cystic or common duct
Jaundice: Stone in the common bile duct
Abdominal tenderness and fever: Cholecystitis

Question 7

Cholelithiasis treatment

Answer 7

Laparoscopic cholecystectomy: Preferred treatment
Transluminal endoscopic surgery: Rapidly advancing
Endoscopic retrograde cholangiopancreatography & sphincterotomy with stone retrieval
Large stones: Lithotripsy
Alternative treatment: Drugs that dissolve smaller stones such as bile acid chenodeoxycholic acid (CDCA) and ursodeoxycholic acid

Question 8

Pancreatitis (disorder of the Pancreas)

Answer 8

• *Inflammation of the pancreas
• Associated with several clinical disorders (alcohol intake and cholelithiasis)
• Is caused by injury or damage to pancreatic cells and ducts, causing a leakage of pancreatic enzymes into the pancreatic tissue.
• These enzymes cause autodigestion of pancreatic tissue and leak into the bloodstream to cause injury to blood vessels and other organs

Question 9

Acute Pancreatitis, clinical manifestations, evaluation

Answer 9

*Resolves spontaneously
- Clinical manifestations
Epigastric or midabdominal pain; nausea & vomiting
Fever and leukocytosis
- Evaluation
Elevated serum lipase: Primary diagnostic marker

Question 10

Acute Pancreatitis treatment

Answer 10

Narcotic pain medication
Nasogastric suctioning
IV fluids

Question 11

Chronic pancreatitis

Answer 11

Repeated exacerbations of acute pancreatitis can lead to chronic changes.
Destroys acinar cells and the islets of Langerhans.
Pancreatic parenchyma is destroyed and replaced by fibrous tissues, strictures, calcification, ductal obstruction, and pancreatic cysts.
Chronic alcohol abuse: Is the most common cause.
Is a risk factor for pancreatic cancer.

Question 12

Chronic Pancreatitis, clinical manifestation & treatment

Answer 12

Clinical manifestations
Continuous or intermittent abdominal pain
Treatment
Corticosteroidal agents: For autoimmune pancreatitis
Cessation of alcohol use and smoking
Analgesics, endoscopic therapy, and surgical drainage of cysts or partial resection of the pancreas