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
What diet do we give someone with acute pancreatitis?
Low fat high carb and high protein foods
Clear fluids to begin with
No alcohol
Frequent small meals
What are the 4 main causes of chronic pancreatitis?
- alcoholism
- cystic fibrosis
- chemical exposures
- recurrent acute
How does alcohol cause chronic pancreatitis?
It damages acinar cells, stimulates secretin with induction of spasms in ducts, precipitation of protein in ducts
What are the symptoms of chronic pancreatitis?
- abdominal pain
- malabsorption, steatorrhoea
- weight loss
- progression of high pancreatic enzymes followed by low concentrations
What is the diet for chronic pancreatitis?
Low fat, high protein
CHO depends on islet function
No alcohol
Fat-soluble vitamins and B12
What are the 3 common nutritional problems in acute severe pancreatitis?
- hyperglycemia and insulin resistance
- hyperTG
- electrolyte and micronutrient deficiencies
What is the nutrition support for acute pancreatitis?
EN: 25kcal/kg PRO 1.5g/kg HB x 1.39 With sepsis (HB x 1.39+1.15) Initiate within 48-72h admission Initiate at 25ml/h, advance to reach 25kcal/kg over 24-48h
PN - only 5 days after admission
PRO 1.2-1.5g/kg
Intralipid less than 15-30% of kcal - give when TG<4.52mmol/L
What is the nutrition support for chronic pancreatitis?
- don’t give extremely low fat…tolerance is the goal
- pancreatic enzymes have to be taken with food
- avoid alcohol, coffee, tea, spices
- treat with insulin if indicated
What are the pancreatic enzyme replacement doses?
500-2500 U lipase/kg/meal
<10,000 U lipase/kg/d
1000-4000 U lipase/1g dietary fat per day at meals and snacks
**swallow without crushing, they only work if the pH is high enough, so must give antacids
