Gallbladder And Pancreas Flashcards
Asymptomatic gallstones do not require treatment except if?
Large stones > 3cm
What is the gold standard test for acute cholecystitis
HIDA- if positive the gallbladder wont be visualized
In Advance liver failure HIDA scan will be false positive because liver is not functioning so the gall bladder is not visualized
What is Mirizzi’s syndrome
Present with Dilated common hepatic duct and Jaundice
This is a complication of cholecystitis due to impacted stone in the cystic duct/gall bladder neck —-> the stone compresses the hepatic duct—> this results in obstruction and jaundice
Ultrasound shows gallstone and dilated common hepatic duct
Treatment is surgical cholecystectomy
What is a choledochoduodenal fistula AKA Cholecystoenteric fistula?
Erosions of gallstones through the gallbladder wall, so the gallstone erodes through the wall into the duodenum, from there the stone can travel down and cause obstruction at the terminal ileum and ileocecal valve
High mortality requiring urgent cholecystectomy or urgent cholecytostomy
What is chronic a calculus cholecystopathy (AKA Gallbladder dyskinesia) and how is it Dx and treated?
There is decrease gallbladder emptying leading to gallbladder dyskinesia, this causes RUQ pain
Patient have symptoms of biliary coli with NL U/S we can Dx with Radionucleotide scintigraphy with the CCK-stimulated gallbladder ejection fraction (+ is <35%)
Treatment is cholecystectomy
What does U/S shows in Acute Acalculous cholecystitis
Large, tense, static gallbladder without stones with evidence of poor emptying
What is choledocholithiasis and what is its most feared complications
Stone in the CBD
cholangitis
What is charcot’s Triad for Cholangitis?
RUQ pain
Fever
Jaundice
Raynaud’s
+ Hypotension, AMS
How do we workup a gallbladder polyp
On u/S gallbladder polyps do not move whereas stone do.
Gallbladder polyps more than 10 mm are more likely malignant and are usually adenocarcinoma.
Findings of a gallbladder polyp warrants cholecystectomy
what is cholangiocarcinoma?
How does patient present?
this is a bile duct cancer. When it is located near the porta hepatic it is called Klatskin tumors
Patient typically present with obstructive jaundice
Courvoisier sign: Distended palpable gallbladder
How does Adenocarcinoma of the Ampulla of Vater present?
What kind of patients do we typically see this in?
The ampulla of Vater is in the duodenum, this cancer because it is located in the duodenum can present with a UGIB (Melaka, iron def anemia).
Also because its in the ampulla it can cause obstructive jaundice
Typically seen in patients with :
- FAP, especially Gardener syndrome
- Peutz-Jeghers
According to the revised Atlanta classification of pancreatitis what are the 2 types?
What are the 2 phases of acute pancreatitis?
How is severity classified?
- Interstitial edematous pancreatitis (MC)
- Necrotizing pancreatitis
2 Phases
Early <1 week
Late phase after 1 week
Severity:
Mild=no organ dysfunction (Hypotension not responding to fluid, AKI, Respiratory Failure)
Moderate=Transient organ failure that resolves in <48 hours
Severe= Organ failure >48 hours
What are the local complications of acute pancreatitis?
- Interstitial edematous pancreatitis:
<4 weeks=Acute peripancreatic collection
>4 weeks=Pseudocyst - Necrotizing pancreatitis
<4 weeks=Acute necrotic collection
>4 weeks=Walled of necrosis
Which scoring system is used to predict mortality in acute pancreatitis?
BISAP score
BUN >24 Impaired mental ion SIRS Age >60 Pleural effusion
Patients with Gallstone pancreatitis undergoing cholecystectomy should also undergo what additional test and why?
They should undergo Lap chole with Intraoperative cholangiogram
The cholangiogram is done to see if there is any filling defects in the CBD for retained stone; if + then the patient will also need to undergo ERCP with stone extraction
