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P&T Block 3 Pulm & GI > L73 > Flashcards

L73 Flashcards

1
Q

What is cholelithiasis?

A

Gall stones

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2
Q

2 types of gall stones

A

Cholesterol - yellow

Pigment - black or brown

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3
Q

How do cholesterol gall stones form

A 
Bile normally = cholesterol + bile salts + phospholipids 
Stones:
↑cholesterol
or
↓phospholipids // bile salts
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4
Q

5 things that ↑risk gall stones

A
  1. Obesity (high cholesterol states/food intake)
  2. Oral contraceptives - ↑E -> ↓GB fxn -> cholesterol hypersaturation
  3. Diabetes
  4. Crohn’s disease
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5
Q

What does black pigment stones mean?

A

Black = ↑unconj bilirubin
B/c anything that causes hemolysis:
- ↑bilirubin -> deconj

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6
Q

What does brown pigment stones mean?

A

Infection - bacterial cause

Can occur outside the GB in abnormal bile ducts (dilated b/c liver flukes)

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7
Q

Do you treat asymptomatic gall stones? Exceptions?

A 
NO
Except:
- Diabetics
- Sickle cell anemia 
- Calcified GB wall
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8
Q

What is the main symptom of gall stones? (aka when not asymptomatic)

A

Biliary colic = severe + steady R/LUQ pain b/c stone is obstructing cystic duct

  • Might radiate to R shoulder or chest
  • Esp @ night
  • If you have symptomatic stones -> higher chance of recurrence of stones AND/or complications
  • THIS is why you treat symptomatic stones
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9
Q

5 complications of symptomatic gall stones

A
  1. Cholecystitis
  2. Common duct obstruction/cholangitis
  3. Acute pancreatitis
  4. GB cancer
  5. Gallstone ileus = stone so big that the enlarged GB causes SI obstruction
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10
Q

If a pt has symptoms from any GB disease, what should you make sure they do not do?

A

NO eating

Food in gut stimulated GB contraction

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11
Q

What is acute cholecystitis?

A

Inflam of GB wall

Most likely due to stones in GB neck or cystic duct -> infection up the back up behind

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12
Q

Acute cholecystitis presentation

A 
RUQ pain
Murphy's sign = pain + inspiration arrest w/ deep breath 
N+V
Fever
Leukocytosis 
Jaundice
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13
Q

What is choledocholithiasis? 2 types

A

Stone in common bile duct
Choledocholithiasis cholangitis
vs pancreatitis

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14
Q

Symptoms + labs for choledocholithiasis

A

Fever
Jaundice
↑Alk phos
Maybe normal liver profile or ↑AST/ALT

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15
Q

What is choledocholithiasis cholangitis?

A 
Stone in common bile duct -> bile becomes infected
Charcot's triad:
1. RUQ pain
2. Jaundice
3. Fever
\+ Abnormal LFTs 
\+ Hypotension 
\+ Mental confusion
\+ Leukocytosis
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16
Q

What is choledocholithiasis pancreatitis?

A

Stone in common bile duct also blocks the pancreatic duct
Bile refluxing behind stone causes acinar cell damage -> enzyme release from pancreas
↑ALT + alk phos
Labs return to normal after stone passes

17
Q

4 ways to treat cholelithiasis

A
  1. Surgery to remove stones
  2. Oral bile salts dissolve the stones, but won’t solve recurrent stones
  3. Contact dissolution
  4. Extracorporial lithotripsy = sound waves break stones
18
Q

What is the surgery to remove gall stones for cholelithiasis?

A

Laprascopic cholecystectomy

B/c higher up in the tree - won’t reach w/ ERCP

19
Q

Preferred way to treat choledocholithiasis

A

Endoscopic retrograde chol-angio-pancreatography = ERCP

Easier + less risky

20
Q

What is primary sclerosing cholangitis? Cause?

A

Bile ducts in + out of liver -> inflam destruction
Strictures
Biliary tree infection

21
Q

Presentation of acute pancreatitis

A

Ab pain - radiates to back
↑amylase + lipase in serum
Lipase = fat necrosis

22
Q

2 main causes of acute pancreatitis

A

Alcohol
Gall stones
- Idopathic is probably due to undetectably small stones
Other: trauma, drug induced

23
Q

Can you die from acute pancreatitis

A

YEP

IF severe and has begun to necrose surrounding organs

24
Q

Treat acute pancreatitis

A 
Remove the stone
Supportive:
- NPO
- IV fluid replacement 
- Pain relief 
↓inflammation
25
Q

Acute pancreatitis complications

A

Pseudocyst

26
Q

6 reasons you get chronic pancreatitis

A

ALL multiple bouts of acute:

  • *CF
  • Alcoholism
  • Hereditary
  • ↑TGs
  • Autoimmune
  • Fibrocalcific -> nutritional def in pts from India
27
Q

How does chronic pancreatitis differ in presentation from acute?

A 
Calcification in pancreas
Pancreatic INSUFF - no ↑enzymes
- Steatorrhea
- Diabetes 
T cell invasion
28
Q

What type of diabetes do you get from chronic pancreatitis?

A

Brittle - hard to control

29
Q

3 ways to dx chronic pancreatitis by structure

A
  1. ERCP
  2. CT // US
  3. Ab XR - calcification
30
Q

Best dx chronic pancreatitis by fxn

A

Secretin test - should stimulate the pancreas

31
Q

How does pancreatic cancer present if in the head?

A
  1. Jaundice due to biliary obstruction
  2. New onset diabetes // diabetes has become very hard to control
  3. Thrombosis (Trouseau’s syndrome = hypercoag state associated w/ cancer)
  4. Depression = paraneo
32
Q

How does pancreatic cancer present if in the body or tail?

A

Asymptomatic until PAIN

33
Q

What sign you see on ERCP for pancreatic cancer of the head?

A

Double duct sign

Tumor blocking both pancreatic and bile ducts

P&T Block 3 Pulm & GI (31 decks)

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