Gallbaldder Flashcards
stones present in GB
cholelithiasis
inflammation of GB, +/- stones (sludge)
cholecystitis
stone in CBD (common bile duct) causing pain, jaundice, pancreatitis
can be acute or chornic
Choledocholithiasis
stones or sludge in gallbladder that last for awhile
can have thickening of gallbladder wall and if it has calcium
chronic cholecystitis
what causes fatty food intolerance?
lack of bile salts
what causes episodic pain from the gallbaldder?
Intermittent obstruction
what causes pale feces?
lack of bile coloration
what causes pruritis from a gallbladder problem?
cholestasis, bile irritating skin
what is bile mostly made of?
Cholesterol from the liver
Of the 200-400 bilirubin produced each day, what happens to most of it?
fecal urobilinogen
some extreted in urine (urobilinogen)
some recycled
If urobilinogen is backing up in the systemic system, what might your urine look like?
Brown, like tea
with acute cholecystitis what will you have?
Fever Leukocytosis Alkaline phosphate elevate (from liver and bone) because GB is irritating liver may have N/V (ileus possible) pancreatitis, metabolic derangement's
What causes pancreatitis? from GB problem
If sludge, stone gets to distal end of bile duct and blocks the pancreatic duct.
Symptoms of pancreatitis
Band-like pain near umbilicus
Pancreas can hemorrhage
what is a metabolic derangement?
Electrolytes are way off
can become acidodic
blood sugar can shoot up due to lack of insulin
Big collections of air fluid levels can indicate what?
Ileus
Why are there not high pitched bowel sounds with an ileus
bowels aren’t moving
5 “F’s” for a GB problem
Fat Fertile Female Forty Fasting
What is the BEST test to find gallstones?
Ultrasound
shows stones, size, fluid, measurement of dilation
How long should they fast before a GB US?
4-6 hours
should be a lot of bile stored, helps you see it better
Imaging procedure used to diagnose problems in the liver, gallbladder and bile ducts.
a radioactive chemical or tracer is injected into a vein in your arm.
The tracer is handled by the liver like bile.
HIDA scan
What can the CT of GB show?
May show stones, but doesn’t necessarily give you information about inflammation
If a person is very obese, what diagnostic method doesn’t work as well?
Ultrasound
What is an ERCP
endoscopic retrograde cholangiopancreatography
diagnostic and therapeutic effect
Risk factors for gallstones
older, female pima indians, and native amercians obesity, rapid weight loss cirrhosis hemolytic anemia diabetes
What does a cholangiogram do?
Put catheter in liver, can drip dye in there
if there is an obstruction can put in a T tube so bile can be drained
look for stones that wandered further in the duct
If a diabetic has gallstones what should you do?
Plan a surgery to have it out before there is a problem
Is chemical gallstone dissolution helpful?
Not really, as soon as stop the drugs stones come back
Will there be an acoustic shadow with GI sludge?
no
what are most cases of pancreatitis due to?
alcoholism and biliary tract dz
what meds can cause pancreatitis?
hydrocholorthiazide
what can cause pancreatitis?
ulcer trauma tumor meds meatbolic disorders
most common people to have acute pancreatitis
male alcoholism
females with gallstone
What disease increases risk of acute pancreatitis?
AIDS
Drugs that can cause acute pancreatitis?
thiazides, diuretics, gluco-corticosteroids, azathioprine, sulfasalazine, herbal remedies
what are metabolic causes of acute pancreatitis?
hypercalcemia
hypertriglyceridemia
heredity
With pancreatitis what will there be an elevation of what levels?
Serum isoenzymes
What can you look for in the urine for acute pancreatitis?
Trypsinogen-2
what will you experience w/ acute pancreatitis?
Diabetic ketoacidosis enzymatic insufficiency calcium imbalance protein losses (ascities) hemorrhage and volume loss
What often sits in the pancreas with pancreatitis?
calcium
chronic pancreatitis causes
Recurrent chronic alcoholics biliary tract dz complications hypercalcemia, hyperlipidemia AIDS thiazides
signs of pancreatitis
Band-like epigastric pain
Fever, N/V, Ileus
what labs will be elevated with pancreatitis?
Serum amylase
Lipase
IS ERCP helpful with pancreatitis?
Can be, but may exacerbate symptoms
Usually do after NPO and in hospital for a few days
How do you treat pancreatitis?
eliminate irritants (EtOH, fat, meds) Hospitalize for IV hydration NPO and NG suction Antibiotics coverage for enterics pain management, nutrition
when do you start IV fluids and antibiotics with acute pancreatitis
When >30% of tissue is necrotic
who is esophageal cancer common in?
smokers
alcoholics
Lye ingestions
advanced GERD
most common type of esophageal cancer?
Epidermoid (squamous cell)
Symptoms of esophageal CA
Reflux Odynophagia Dysphagia Regurgitation Inaition (the "blahs")
How does esophageal cancer spread?
Mucosa to mediastinum/ tachae
Regional nodes with rapid spread
what blood type is more likely to get cancer?
Type A blood
who is gastric CA common in
non-white
low socioeconomic status
what is gastric cancer related to
environment
food prep
nitrates
Risk factos for gastric Ca
H. pylori
previous gastric surgery (Bilroth II)
achlorhydria (inadequate acid)
Most common cell type for gastric cancer?
adenocarcinomas
some signs of gastric cancer
Iron deficiency anemia
Heme + stool
ascites
L Supra-clavicular node enlargement
mainstay for diagnostic of gastric cancer?
endoscopy with biopsy and brushing
ways to prevent gastric cancer
stop smoking/ alcohol
management of GERD
manage H. pylori
reduce nitrates in food prep
who are colon and rectal carcinomas common in?
males
increases with age
Is there a genetic connection with colon and rectal cancer?
yes, autosomal dominant familial adenomatous
in the eastern world where are colorectal cancers more common?
right side of the colon
more colorectal cancers develop from what type polyps?
adenomatous polyps
what is the difference between synchronus and metachornus neoplasia?
synchronus came about at the same time, near eachother
metachronus is the opposite
a polyp size greater than what has a worse prognosis?
1.5 cm
where do most metastases from colorectal cancer go?
Liver due to portal circulation
Risks with pancreatic cancer?
High alcohol and smoking habits
male
DM, chronic pancreatitic
dry cleaning and gasoline chemicals (may)
Symptoms of pancreatic cancer?
unexplained pain weight loss jaundice depression DVT
How do you diagnose pancreatic cancer?
ultrasound and CT
percutaneous fine needle aspiration
endo retro cholangio pancreatography
What are some cancer serum markers for pancreatic cancer?
CA 19-9
CEA
15 % of the time with an unprovoked DVT what will a patient have?
An undiagnosed malignancy somewhere because malignancy makes the blood hyper-coaguable
what part of the pancreas is pancreatic cancer likely to occur?
Head
why might a person with pancreatic cancer have painless jaundice?
common bile duct obstruction
