Gallbladder/Pancreatic Lecture Flashcards
Bile storage site
Concentrates bile
Contracts in response to cholecystokinin (CCK)
Filled when spincter or Oddi is closed
Gallbladder
Helps break up fats (for digestion in sm intestine, terminal ileum
and recycled to liver for re-excretion)
500-1500 mL secreted from liver each day!
Bile
Made up of:
- Bile salts (from cholesterol)
- Bilirubin (waste product from old worn out RBCs)
- Alkaline fluid
Bile
Cholecystic
Referring to gallbladder
Cholecystectomy
Removal of gallbladder
Cholecystalgia
Pain from gall bladder (aka biliary colic)
Acute cholecystitis
Inflammation (can be chronic)
What percentage of gallstones are cholesterol?
What percentage are calcium bilirubinate/ Ca salts?
Cholesterol 75%
Calcium 25%
“Pigmented” black/brown stones
Calcium bilirubiante stones
- Cholesterol supersaturation (bile gets supersaturated with cholesterol)
- Nucleation (Microscopic cholesterol comes together and crystallizes. Over time, additional layers of cholesterol added on)
- Gallbladder hypomotility (Slower emptying=more time for stone formation, ie pregnancy)
Causes of gallstones
Age (traditionally, over 40y/o)
Obesity (or rapid weight loss)
Sex: Female
Race (example: Native Americans)
(Female, Fat, Forty, Fair, and Fertile)
Risk factors for stones
Cholelithiasis
Stones in GB
Choledocholithiasis
Stone in bile duct
Oral contraceptives, Pregnancy, Diabetes/Insulin use, Hemolysis, Biliary parasites, Cirrhosis, Crohn’s, Hyperparathyroid Dz.
Contributing factors for gallstones
What % of ppl have gallstones and are asymptomatic
50-60% (most are never symptomatic)
Biliary colic (aching pain in the RUQ/epigastric)
Referred pain: to back, scapula, or R shoulder area
Symptoms of cholelithiasis
Best diagnostic (especially initial) for cholelithiasis
Ultrasound (95%)
Cystic ducts become blocked due to:
- gallstones
- sludge, infection cancer (less common)
Acute cholecystitis
Gallbladder blockage –> distention/edema –> ischemia
..this causes?
RUQ pain
RUQ and epigastric pain
R scapula/shoulder pain
N/V
Fever/Chills
Acute cholecystitis symptoms
Tenderness RUQ/epigastric area
+ Murphy’s sign
Possibe jaundice (late sign)
Acute cholestitits
Are plain radiographs good diagnostic images of gallstones?
NO..can only see about 25% (Ca containing stones are only about 25%)
Hepatobiliary IminoDiacetic Acid Scan
Radioactive tracer injected, followed thru liverGB
Best test, but usually not necessary
HIDA scan
..expensive! only use if odd presentation
CBC w/ diff:
Elevated WBC count (leukocytosis) 12-15k
Hepatic function tests:
LFT’s: elevated, sometimes
Alkaline phosphatase: usually elevated (at least a little)
Gamma-glutamyl transpeptidase (GGT): elevated
Bilirubin: elevated, especially in common duct stone
Amylase: elevated, sometimes
Labs in acute cholecystitis
Stone in common bile duct
- usually migrates from gallbladder
- less common: form in GBD
Choledocholithiasis
Can be asymptomatic (30-40%)
Biliary colic
Jaundice, pancreatitis, maybe cholangitis
ERCP (endoscopic retrograde cholangiopancreatography) can be used to DIAGNOSE and TREAT
Choledocholithiasis
Contraindication of ERCP?
Pancreatitis
ERCP is diagnosis and treatment ONLY if the stone is..
in common bile duct
(Choledocholithiasis)
Infection and inflammation of biliary tract
Due to obstruction, then infection
(retrograde infection: E.coli, Enterococcus, Klebsiella and Enterobactor)
Acute cholangitis