GI disease: lecture by B Witteman

Question 1

How long does food stay in the
A) stomach
B) SI
C) LI

Answer 1

A) 1-1.5 hrs
B) 2-4 hrs
B) 1 day

Question 2

Mrs Verloop: 47 y/o woman

• acute attacks of pain in right upper abdomen, irradiates to the shoulder
• Relation fatty meals
• Dark urine + discolored stools
  -1.68, 80 kg

Explain these symptoms + most possible outcome

Answer 2

• right upper abdomen complaints: irritation diaphragm, also here is the gall bladder
• relation fatty meals: gallbladder-related
• Discolored stools and urine: if you wait long enough, she will turn yellow. Has to do with transport bile liver to intestines

Bile stone: females more common. Especially the 5F’s : Female, forty, fat, fair, fertile

Question 3

Diclofenac is given to this patient. What does it do?

Answer 3

• Not only painkiller, but spasms will be gone. Stone can then move on in some cases.

Question 4

After diclofenac, fever and chills start to arise after new attack. Colicky pain irradiating to the back: severe nausea and vomiting.
Explain the symptoms + what now?

Answer 4

 Chills: temperature is going up very quickly. Bacteria in blood.
 Irradiating pain in the back: pancreas. Is at your spine

Lab examination is needed: blood tests and ultrasound.

Question 5

Lab examination:
- leucocytes: 23 000 (normal <10 000)
- Lipase 34 000 (normal <500)
- Elevated liver enzymes

US: cholelithiasis (=galsteen) + distended bile duct.
What is the diagnosis?

Answer 5

Obstruction of the pancreatic duct: ampulla of Vater (where bile duct and pancreas duct come together)

Question 6

What is so dangerous about an obstruction in the pancreatic duct?

Answer 6

pancreatic juices will leak into parenchyma of pancreas. This means: pancreas will be digested, very serious!!!

Question 7

What is the difference between cholecystolithiasis and choledocholithiasis?

Answer 7

CYSTO = gallstones in gall bladder
DOCHO = gallstones in gall bladder duct

Question 8

Can gallstones be inherited?

Answer 8

Cholesterol in bile is elevated in some families. Crystals can form, which can form stones.

Question 9

How are gallstones treated? What is often advised?

Answer 9

Inject dye, see on x-ray. Bile duct is dilated. When you see stones, sphincter and papilla can be opened: can pull out the stone.
Remove gallbladder: is often advised, because most patients will get recurring stones.

Question 10

What can happen with patients when, after 6 weeks, they are still very full after eating after they had problems with their pancreas?

Answer 10

Fluid collection in pancreatic zone: due to leakage of enzymal parenchyma, dissolve parenchyma, results in fluid. Can be infected due to bacteria -> abcess -> very severe complication. Drain it with endoscope!

Question 11

Mrs Verloop is now 60 years old. She is having a high blood glucose. What is a logical explanation, considering she had problems with her pancreas?

Answer 11

 Problems in the pancreas were in the tail. Islands of langehands are situated here, which make insulin. Therefore, she could get diabetes.
> there is also no glucagon
> enzyme production deficit
Digestion is not good: diarrhoea, lose fat, malabsorption vitamins

Question 12

What is a treatment for diabetes bc of islands of langerhands were destroyed?

Answer 12

Swallow pills with pancreas enzymes from pigs