GI: Pancreas, Liver, Gallbladder Flashcards
1
Q
- Developmental malformation in which the Pancreas forms a Ring around the Duodenum
- Risk of Duodenal obstruction
- Embryology tie-in w/ Head of Pancreas
A
Annular Pancreas
2
Q
- Inflammation and Hemorrhage of the Pancreas
- Autodigestion of Pancreatic Parenchyma by Enzymes
- Trypsin activates other Pancreatic enzymes
- Liquefactive Hemorrhagic Necrosis and Fat Necrosis
- A/w Alcohol (Sphincter of Oddi) and Gallstones
- Trauma, Hypercalemia, Hyperlipidemia, Drugs, Scorpion Stings, Mumps, Rupture of a Posterior Duodenal Ulcer (Head of Pancreas sits posterior)
- Pain radiates to the Back a ‘Boring’
- Nausea and Vomiting
- Periumbilical and Flank Hemorrhage (Periumbilical soft tissue and Retroperitoneum)
- Elevated Serum Lipase and Amylase
- Phospholipase –> ARDS
- Hypocalcemia w/ Saponification of Fat Necrosis
A
Acute Pancreatitis
3
Q
- Fibrosis of Pancreatic Parenchyma
- 2nd to Recurrent Acute Pancreatitis
-
Alcohol (Adults) and Cystic fibrosis (Children);
Most –> Idiopathic - Epigastric abdominal pain –> Radiates to the Back
- Pancreatic insufficiency –> Results in Malabsorption w/ Steatorrhea and Fat-soluble Vit. Def. (ADEK)
- Amylase and Lipase are not useful Serologic markers –> Destroyed
- Dystrophic Calcification of Pancreatic Parenchyma on Imaging
- ‘Chain of Lakes’ pattern due to dilation of Pancreatic Ducts
- 2nd to Diabetes Mellitus –> Late complication due to Destruction of Islets
- Increased risk Pancreatic Carcinoma (Adenocarcinoma of Pancreatic ducts)
A
Chronic Pancreatitis
4
Q
- Adenocarcinoma arising from the Pancreatic Ducts
- Elderly (avg. 70 y.o.), < 5% 5-year survival
- Smoking and Chronic Pancreatitis
- Epigastric Abdominal pain and Weight loss
- Obstructive Jaundice w/ Pale stools and Palpable gallbladder, a/w Tumors that arise in the Head of the Pancreas
- 2nd Diabetes Mellitus; a/w Tumors in Body or Tail of Pancreas
- Pancreatitis
- Migratory thrombophlebitis (Trousseau sign); Swelling, Erythema, Tenderness in extremities (10%)
- Serum Tumor marker CA 19-9
- Surgical en bloc of Head and Neck, proximal Dudenum, and Gallbladder –> Whipple procedure
- -> 1 yr. survival < 10%
A
Pancreatic Carcinoma
5
Q
- Failure to form or early Destruction of Exrahepatic Biliary Tree –> No lumen
- Leads to Biliary Obstruction w/in first 2 months of life
- Jaundice and progresses to Cirrhosis –> Pale stool
A
Biliary Atresia
6
Q
- Solid, Round stones in Gallbladder
- Precipitation of Cholesterol or Bilirubin in Bile
- Supersaturation of Cholesterol or Bilirubin
- Decreased Phospholipids (Solubilize cholesterol)(lecithin) or Bile acids
- Stasis
- RUQ pain, Nausea, Vomiting, Low-grade Fever, Leukocytosis
- Gangrene of the Gallbladder, Peforation, Fistula, Bowel obstruction, etc…
- Clofibrate – Lipid lowering agent used to control High Cholesterol
A
Cholelithiasis (Gallstones)
7
Q
- Radiolucent (10% are opaque), Cholesterol monohydrate
- Age (40s), Estrogen (Female gender, Obesity, Multiple pregnancies, Oral contraceptives, Hormone replacement therapy
- Fat, Female, Forty, Fertile, and Fucks (5 –F’s)
- Clofibrate – lipid lowering agent used to control for High Cholesterol (Hmg)
- Native American Pima and Navajo Indian ethnicity
- Crohn disease – dmg to terminal ilieum –> decreased Bile reuptake –> increased cholesterol precipitation
- Cirrhosis – decreased productionof Bile salts
A
Cholesterol Stones
8
Q
- Black pigmented Stones composed of Calcium salts and Unconjugated Bilirubin (UCB)
- Radiopaque
- A/w Chronic hemolytis anemias, Cirrhosis, Bacterial infection, and Parasites
- A/w Extravascular Hemolysis (Reticular endothelial
–> Splenic Macrophages –> Unconjugated bilirubin)(increased Bilirubin in bile) and Biliary tract infection
(E coli, Ascaris lumbricoides, and Clonorchis sinensis)
A
Bilirubin Stones
9
Q
- Common Roundworm that infects 25% of the Worlds population, especially in areas w/ Poor sanitation (Fecal-oral transmission)
- Infects the Biliary tract
- Increases risk for Gallstones
A
Ascaris lumbricoides
10
Q
- Endemic in China, Korea, and Vietnam (Chinese Liver flukes)
- Infects the Biliary tract
- Increases the risk of Gallstones
- Cholangitis
- Cholangiocarcinoma
A
Clonorchis sinensis
11
Q
- Waxing and Waning RUQ Pain
- Gallbladder contracting against a Stone lodged in the Cystic duct
- Symptoms relived when Stone passes
- Common Bile duct obstruction may result in
- *Acute Pancreatitis** or Obstructive Jaundice
A
Biliary Colic
12
Q
- Acute Inflammation of the Gallbladder wall
- -> squeezes blood vessels –> Ischemia
- Impacted stone in Cystic duct
- -> Dilation w/ Pressure ischemia
- Bacterial overgrowth (E coli)
- Inflammation and Bloating
- RUQ Pain –> Radiating to Right Scapula, Fever w/ increased WBC count, Nausea, Vomiting, and increased Serum Alkaline Phosphatase (Duct dmg)
- Risk of rupture if left untreated
A
Acute Cholecystitis
13
Q
- Chronic inflammation of Gallbladder
- Chemical irritation from Longstanding cholelithiasis w/ or w/out Superimposed bouts of Acute cholecystitis
- A/w Herniation of Gallbladder mucosa into Muscular Wall (Rokitansky-Aschoff sinuses)
- Vague RUQ Pain, Postprandyl pain
- Porcelain Gallbladder is a late complication – Shrunken, Hard Gallbladder due to Chronic Inflammation, Fibrosis, and Dystrophic Calcification
- Increased risk for Carcinoma
- Tx: Coholecystectomy, esp. w/ Porcelain Gallbladder
A
Chronic Cholecystitis
14
Q
- Bacterial infection of the Bile ducts
- A/w Ascending infection w/ Enteric Gram-Negative bacteria
- Presents as Sepsis (High Fever and Chills), Jaundice, and Abdominal Pain
- Increased incidence w/ Choledocholithiasis (stone in Biliary duct –> decreases flow washout)
- Triad: Epigastric / RUQ pain, Fever, and Jaundice
A
Ascending Cholangitis
15
Q
- Gallstone enters and Obstructs the Small Bowel
- Due to Cholecystitis w/ Fistula formation between the Gallbladder and Small Bowel
A
Gallstone Ileus
16
Q
- Adenocarcinoma arising from the Glandular epithelium that lines the Gallbladder-wall
- Gallstones are a Major risk factor, esp. w/ Porcelain Gallbladder
- Clonorchis sinensis (Liver Flukes)
- Cholecystitis in an Elderly Woman (40 – 70 y.o.)
- -> Gallbladder Carcinoma –> Poor prognosis
- Klatskin tumor - carcinoma of the Bifurcation of the Right and Left Hepatic Bile ducts
A
Gallbladder Carcinoma
17
Q
- Yellow discoloration of the Skin and Scleral Icterus
- Increased Serum Bilirubin > 2.5 mg/dL
- A/w Bilirubin metabolism disturbance
A
Jaundice
18
Q
- High lvls of UCB overwhelm the conjugating ability of the Liver
- Increased UCB (not water soluble)
- Dark urine due to increased urine Urobilinogen, increased Conjugated-UCB
- Increased Risk for Pigmented Bilirubin Gallstones
A
Extravascular Hemolysis
or
Ineffective Erythropoiesis
19
Q
- Newborn Liver has transiently low UGT activity (UGT1A1 activity, decreased excretion)
- Increased UCB –> Fat soluble –> Depositions in Basal Ganglia of the Brain (Kernicterus) –> Neurological deficits and Death
- Tx: Phototherapy (makes UCB water soluble) –> urinate out Bilirubin
A
Physiologic Jaundice of the Newborn