Gallbladder and Pancreatic Disorders Flashcards
Define cholelithiasis
Gallstones
Define choledocholithiasis
Bile duct stones
Populations affected by cholelithiasis
- Native and Mexican Americans
- Fat Fertile Female Forties
Define biliary colic
Episodic pain attributed to gallstones WITHOUT evidence of cholecystitis
What confirms diagnosis of cholelithiasis?
RUQ ultrasound
Treatment of gallstones
- Asymp = no treatment (dietary modifications, pain management for biliary colic episodes)
- Elective surgery
Define cholecystitis
Acute or chronic inflammation of gallbladder
Causes of cholecystitis
- 90% d/t gallstones
- 10% acalculous
What is best for diagnosing cystic duct obstruction?
HIDA scan
Treatment of cholecystitis
- Analgesics/antiemetics
- IV abx
- Surgical resection or stent placement
Define porcelain gallbladder
- Calcified, non-functional
- Caused by chronic cholecystitis (persistent inflammatory state)
Define emphysematous cholecystitis and treatment
- Cholecystitits a/w gas-forming bacteria (clostridia, E. coli, Klebsiella)
- Requires emergent resection
Define cholangitis
Common bile duct infection secondary to choledocholithiasis (bile duct stones)
Define primary sclerosing cholangitis
Common bile duct infection a/w IBD (NOT STONE)
Presentation of cholangitis
- Charcot triad (RUQ pain, fever, jaundice)
- Reynolds pentad (Charcot + AMS and hypotension)
Describe MRCP vs. ERCP
- Both used to diagnose cholangitis
- ONLY ERCP can be used as treatment too (sphincterotomy and stone retrieval)
MC cause of acute pancreatitis
Stones
Presentation of acute pancreatitis
Constant “boring” epigastric pain (gets better with leaning forward)
How to assess severity of acute pancreatitis
Ranson criteria:
- WBC 16+
- Age 55+
- Glucose 200+
- AST 250+
- LDH 350+
What does x-ray show for acute pancreatitis?
- Sentinel loop (LUQ air filled small bowel)
- Colon cutoff sign (gas filled transverse colon)
Treatment of acute pancreatitis
Bowel rest!
Define necrotizing pancreatitis
- Complication of acute pancreatitis
- Tissue destruction and hemorrhage resulting in Turner’s sign (hematoma in flanks) and Cullen’s sign (periumbilical discoloration)
MC cause of chronic pancreatitis
Chronic ETOH
How to diagnose chronic pancreatitis?
- Secretin stimulation test (pancreatic secretions are diminished)
- Fecal elastase test
- Xray, US, CT
Treatment of chronic pancreatitis
- ETOH avoidance, low fat diet
- Pain management with non opioids preffered
- Pancreatic enzyme supplement
Complication of chronic pancreatitis
Development of DM (80% within 25 yrs)
Definition of pancreatic pseudocyst
- Sterile, localized fluid collection in or on pancreas
- Surrounded by fibrous or granulation tissue
- Usually contains amylase or lipase
Who gets pancreatic pseudocysts?
- 20-40% chronic pancreatitis
- 10-25% acute pancreatitis
Treatment of pancreatic pseudocysts
- Supportive if asymptomatic
- Drainage if persistent symptoms, infection, hemorrhage, etc.
