UW Cholestasis and gallstone ileus Flashcards
what cells produce CCK?
produced by I cells
what intestines produce CCK?
duodenum and jejunum
what is trigger for CCK?
fat-protein-rich chyme enters the duodenum
CCK functions?3
increase pancreatic enzyme secretion (by acinar cells) and gallbladder contraction, and to decrease gastric emptying.
Cholestasis is defined as a decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts.
.
Intrahepatic causes of cholestasis?
Drug induced (erythromycin, contraceptives);
Primary biliary cholangitis
Cholestasis of pregnancy
Primary sclerosing cholangitis (may also be extraheptic)
Extrahepatic causes of cholestasis?
Choledocholithiasis Malignancy (pancreatic, gallbladder)
What cholestasis? Drug induced (erythromycin, contraceptives).
Intrahepatic
What cholestasis? Primary biliary cholangitis
Intrahepatic
What cholestasis? Cholestasis of pregnancy
Intrahepatic
What cholestasis? Primary sclerosing cholangitis (may also be extraheptic)
Intrahepatic
What cholestasis? Choledocholithiasis
Extrahepatic
What cholestasis? Malignancy (pancreatic, gallbladder)
Extrahepatic
Cholestasis can arise secondary to ….
Hepatocellular dysfunction or intrahepatic or extrahepatic biliary obstruction.
Both obstructive and nonobstructive cholestasis are characterized by?
deposition of bile pigment within the hepatic parenchyma, often with green-brown plugs in the dilated bile canaliculi.
When cholestasis is prolonged, what can expect?
When it is prolonged, the reduction in bile flow causes intestinal malabsorption of fats and fat-soluble vitamins (A, D, E, and K), which require bile salts for digestion.
Gallstone ileus epidemiology?
elderly women
Gallstone ileus. Size of stone?
typically >2.5 cm
Gallstone ileus. Gallstone cause formation of what?
cholecystoenteric fistula between the gallbladder and adjoining gut (most often the duodenum) due to pressure necrosis and erosion of these tissues.
Gallstone ileus. Cholecystoenteric fistula is formed between what structures?
between the gallbladder and adjoining gut (most often the duodenum) due to pressure necrosis and erosion of these tissues.
Gallstone ileus. Why occurs cholecystoenteric fistula?
due to pressure necrosis and erosion of these tissues.
Gallstone ileus. where stone is trapped?
in the ileum (ILEOCECAL VALVE), the narrowest portion of the intestine
Gallstone ileus. manifestation?
Abdominal pain/distension, nausea/vomiting, high-pitched (tinkling) bowel sounds, and tenderness to palpation.
Gallstone ileus. abdominal x ray?
may reveal dilated loops of bowel with air-fluid levels due to intestinal obstruction.
Gallstone ileus. What gas related finding could occur?
Communication between the intestine and gallbladder may also allow gas to enter the biliary tree (pneumobilia).
