Gallbladder & Pancreatic Disorders Flashcards
define cholelithiasis
solid deposits w/in gallbladder (aka gallstones)
define choledocholithiasis
bild duct stones
cholelithiasis epidemiology
- women more than men
- incr. w/ age
- native + mexican americans
cholelithiasis etiology
- cholesterol more so than Ca composition
- causative = 4F’s (fat, fertile, female, forties)
- protective = low CHO/fat/fiber diet, caffeine, ASA, Mg
cholelithiasis S+S
- 75% asx
- RUQ pain
- epigastric pain that radiates to R shoulder
- n/v
- s/p fatty meal
biliary colic S+S
- episodic pain d/t gallstone w/o evidence of gallbladder wall inflammation
cholelithiasis work-up
- Labs (CBC, CMP w/ LFTs, UA, cardiac enzymes)
- abd XR to r/o other dz
- RUQ US
cholelithiasis tx
- asx = no tx req’d
- dietary modifications
- biliary collic = pain/nausea mgmt
- analgesics prn
- antiinflammatory (ketorolac i.e. Toradol)
- cholesterol stones = ursodeoxycholic acid
cholelithiasis f/u
refer to general surgeon for frequent events
cholelithiasis complications
- cholecystitis
- cholangitis
- pancreatitis
- gallbladder CA (rare)
define cholecystitis
acute or chronic inflammation of the gallbladder
cholecystitis etiology
- secondary to gallstone in cystic duct
- acalculous = secondary to other medical illness w/ gallstones
cholecystitis S+S
- RUQ and/or epigastric pain s/p fatty food
- n/v
- +/- fever
- Murphy’s Sign
define (+) murphys sign
inhibition of inspiration during palpation of RUQ
cholecystitis work-up
- CBC (WBC elevated)
- AST/ALT
- amylase/lipase
- US
- HIDA scan
- CT scan (2nd line to US or HIDA
cholecystitis tx
- analgesics/antiemetics
- abx
- surgical resection
cholecystitis complications
- abscess or gangrene
- choledocholithiasis/cholangitis
- perforations
- fistula to bowel
- pancreatitis
- CA
- chronic cholecystitis –> porcelain gallbladder
- emphysematous cholecystitis –> gas forming bacteria that requires emergent resection
define cholangitis
- common bile duct infection
cholangitis etiology
- choledocholithiasis
cholangitis S+S
- Charcot triad (RUQ pain, fever/chills, jaundice)
- Reynolds pentad (Charcot triad + AMS + hypotension)
- septic cholangitis
cholangitis work-up
- Labs (AST, WBC, bilirubin, ALT, amylase)
- US = CBD greater than 6mm
- MRCP
cholangitis tx
- ERCP = dx + tx w/ performing sphincterotomy + stone retrieval
- cholecystectomy
- abx
cholangitis complications
- sepsis
- stricture
- pancreatitis
- hemorrhage
define acute pancreatits
inflammation of the pancreas
acute pancreatitis etiology
- MC = stones
- ETOH
- hypercalcemia
- hyperlipidemia
- abd trauma
- rx
- vasculitis
- mumps, CMV
- peritoneal dialysis
- ERCP
- CA
acute pancreatitis S+S
- dull or boring epigastric pain
- pain may radiate to mid-back or shoulders
- s/p fatty meal or ETOH
- incr. w/ laying supine or walking
- n/v, anxiety
- TTP, distention, guarding, decr. bowel sounds
- fever
- jaundice
- tachycardia
acute pancreatitis work-up
- Labs (CBC, CMP, lipase more than amylase)
- EKG
- Ranson Criteria
- Abd XR = sentinel loop (LUQ air in sm. bowel) or colon cutoff (gas-filled transverse colon)
- CT, MRI better than US
acute pancreatitis tx
- bowel rest
- TPN
- fluids
- analgesics
- antiemetics
- ERCP
- ETOH
acute pancreatitis complications
- necrotizing pancreatitis (Turner’s + Cullens sign)
- hypovolemia/shock
- ileus
- abscess/psuedocyst
- chronic pancreatitis
define chronic pancreatitis
progressive damage d/t repetitive inflammation resulting in fibrosis, calcification, pancreatic ductal inflammation and/or pancreatic stone formation and eventual functional impairment
chronic pancreatitis etiology
- chronic ETOH
- incr. PTH ==> incr Ca
chronic pancreatitis S+S
- recurrent epigastric pain
- anorexia/wt loss
- n/v
- constipation
- flatulence
- steatorrhea
chronic pancreatitis work-up
- amylase/lipase
- secretin stimulation test
- fecal elastase test
- abd XR/US/CT
- ERCP/MRCP/endoscopic US
chronic pancreatitis tx
- avoid ETOH
- low-fat diet
- pain mgmt
- pancreatic enzyme supplement
chronic pancreatitis complications
- DM
- narcotic addiction
- pseudocyst/abscess
- pancreatic CA
define pancreatic pseudocyst
sterile localized fluid collection in/on pancreas surrounded by fibrosis/granulation tissue
- usually connected to pancreatic duct system + containing amylase or lipase
pancreatic pseudocyst etiology
- pancreatitis
- trauma
- ETOH
- biliary tract dz
- stones
pancreatic pseudocyst S+S
- asx
- epigastric pain
- n/v
- anorexia
- palpable mass
- sepsis/fever (if ruptured)
- pleural effusion
- peritonitis (if ruptured)
pancreatic pseudocyst work-up
- US
- CT
- MRI
- ERCP w/ fluid analysis
pancreatic pseudocyst tx
- supportive care if asx
- drainage
