Gallstones and Pancreatitis Flashcards
What are the 4 things bile id composed of?
- bile acids and salts
- cholesterol
- phospholipids
- bilirubin
What is cholelithiasis?
Gallstones
What are the 2 types of gallstones?
- cholesterol stones (most common)
Yellow, form due to solubility issues…high concentration of bile acids = better cholesterol solubility = lower stone formation - mixed, with bilirubin pigments
black, grey
What are the factors associated with cholesterol stones?
- female
- genetics
- drugs
- long term TPN
- diabetes
- obesity
- weight reduction
What are the factors associated with bilirubin stones?
- chronic hemolysis
- TPN
- thalassemia
- cirrhosis
- age
What is cholecystitis?
inflammation of the gallbladder
What are the 4 causes of gallstones?
- too much absorption of water from bile
- too much absorption of bile acids from bile
- too much cholesterol in bile
- inflammation of epithelium
What is choledochilithiasis?
Stones that block the gallbladder outlet
What are the symptoms of acute cholecystitis?
- fever
- pain upon coughing
- tender over gallbladder area
What is the common biochemistry?
- infection: CBC
- jaundice or obstruction: bilirubin
- inflammation: CRP or ESR
- general health: electrolytes, glucose, CBC
What is the main complication of cholelithiasis and what are the symptoms?
choledochilithiasis
- dark urine
- clay colored stool
- severe upright quadrant pain
- jaundice
- pancreatitis
What are the complications of cholecystitis?
- secondary to obstruction, infection and ischemia
- perforation of gallbladder, peritonitis
- perforation into another organ
- fistula to duodenum, colon
- infection through ducts to liver, abscesses
What are the indications for low fat diets?
- fat malabsorption and maldigestion
- cholecystitis
- pancreatitis
How do you determine fluid needs?
1ml/kcal
How much % energy should come from fat and how many g of fat is in 25g of meat?
30%
25g meat = 2g fat
What are the 5 treatments possible?
- surgery (cholecystectomy): low fat diet first, then return to healthy normal diet
- medications for small stones and functioning gallbladder (ex: chenodiol and ursodiol - bile acids which help dissolve the stone)
- ultrasound (lithotripsy)
- laparascopic cholecystectomy
- percutaneous cholecystostomy drainage of gallbladder
- biliary stents to clear ducts (ERCP)
What are the guidelines for the morning of the surgery?
Do not eat any food
Drink 1 CHO drink (50g) QUICKLY (in 5min)
What are the alternative medicines for gallstones (2)?
- peppermint (dissolves gallstones)
- tumeric (improves liver function)
What is the enzyme responsible for the autodigestion of the pancreas?
trypsinogen
Chyme stimulates intestinal production of what 2 molecules?
secretin and CCK
What is pancreatitis characterized as (3 things)?
- edema
- cellular exudate
- fat necrosis
What are some of the symptoms of pancreatitis?
- autodigestion, necrosis, hemorrhage of pancreatic tissue
- upper abdominal pain radiating to back
- nausea, vomiting, abdominal distention, steatorrhea
- hypotension and dehydration
What are the 3 main causes of acute pancreatitis?
- biliary tract disease/cholelithiasis
- alcoholism
- idiopathic
What are the symptoms of acute pancreatitis?
- abdominal pain, nausea, vomiting
- SIRS, shock, fever, edema
- high blood levels of pancreatic enzymes
- high liver enzymes
- low blood calcium
- high TG
