Pancrease/Gallbladder/Liver 1 Flashcards
Types of Necrosis in Acute Pancreatitis
Liquifactive Fat necrosis (saponification)
Activation of what enzyme leads to acute pancreatitis?
Trypsin
Most common causes of Acute Pancreatitis
Alcohol and Gallstones
Alcohol causes contraction of the sphincter of oddi, causing inhibition of pancreatic drainage.
Gallstones does the same thing.
Laboratory elevation in Acute Pancreatitis?
Elevation of serum lipase and amylase.
Hypocalcemia due to saponification using up calcium deposits in the fat.
In chronic pancreatitis, you’re not producing amylase and lipase anymore.
Complications of Acute Pancreatitis
Shock
Pancreatic Pseudocyst
Pancreatic abscess
DIC and ARDS
Most common cause of Chronic Pancreatitis in adults and children
Adults: Alcohol, and recurrent acute pancreatitis
Children: cystic fibrosis
Which vitamins have difficulty being absorbed in Chronic Pancreatitis
A E D K fat soluble vitamins
Findings for pancreatic carcinoma at HEAD of the pancreas
Obstructive Jaundice (causing leakage of conjugated bilirubin into the blood) Pale stools (because bile is not reaching duodenum, which gives stools its color) palpable gall bladder
A thin elderly person with type 2 diabetes could be indicative of what?
Pancreatic Carcinoma.
Because most type 2 diabetics are middle aged and overweight
Tumor marker for pancreatic carcinoma
CA 19-9
Treatment for Pancreatic Carcinoma
Whipple Procedure
Head of pancreas
Duodenum
Gall bladder
What is cholelithiasis? Two types
Gallbladder stones
Cholesterol
or
Bilirubin
Why does Cholestyramine cause cholelithiasis?
Cholestyramine, a lipid lowering agent, binds bile acids and prevents it’s reabsorption in the ilieum. Phospholipids and bile acids help solubilize cholesterol, so it’s lack leads to cholesterol stones.
Why are females are higher risk for cholelithiasis?
Estrogen, increase activity of HMGCoA reductase leading to increased cholesterol synthesis.
Also increases lipoprotein receptors on hepatocytes thus increasing cholesterol reuptake.
Why does Crohn’s disease increase risk for gall stones?
Bile acid is taken up in the terminal ilium.
Why does extravascular hemolysis cause gall stones? What type of gall stones?
Extravascular hemolysis is breakdown of blood by splenic macrophages. Hemoglobin broken down into heme and globin. Heme is broken down into Iron and Protoporforin. Protoporforin is converted into unconjugated bilirubin. Once the liver conjugates it, the extra bilirubin is thrown into bile, causing saturation, and thus risk for BILIRUBIN GALLSTONE.
Why does bacterial infection cause gall stones? What type of stones? What type of bacteria?
Bacteria cause deconjugation, leading to precipitation of bilirubin.
E. Coli
Acute Cholecystitis is
Inflammation of gall bladder wall due to stone in the cystic duct causing ischemia and bacterial growth
Presentation of Cholecystitis
RUQ pain radiating to scapula***
Fever, elevated WBC
Nausea, vomiting
Increased serum Alkaline Phosphatase
Chronic Cholecystitis cause
Chemical irritation
Usually from longstanding cholelithiasis
What is a porcelain gallbladder?
Calcification from Chronic Cholecystitis
Ascending Cholangitis is…
caused by…
Bacterial infection of bile ducts
Enteric gram-negative bacteria
Gallbladder carcinoma is what type of cancer?
Risk factor
Adenocarcinoma, from the glandular epithelium of the gallbladder wall
Gall stones (cholecystitis in elderly woman) Especially with porcelain gallbladder
