Week 7 - Disorders of the Biliary Tract Flashcards
list 3 disorders of the biliary tract
- cholelithiasis
- cholecystitis
- gallbladder cancer
what is cholelithiasis
gall stones
what causes cholelithiasis
- occurs when solutes in the bile become so concentrated that they no long stay in the solution
= form stone
what are the 2 types of gallstones
- cholestrol stones within or without calcium
- bilirubin stones
what are the 2 categories of risk factors for gallstones
- altered bile composition
- impaired gallbladder mobility
list 5 risk factors for cholestrol stones
- dietary cholestrol
- obesity
- oral contraceptives
- DM
- dyslipidemia
4 Fs
- Fat
- Fertile (previous pregnancies, oral contra)
- Female
- Forty
how are oral contraceptives a risk factor for gall stones
- contain estrogen which increases the risk of gallstones
- also alters the character of bile
how is obesity a risk factor for gall stones
- linked to high lvls of cholestrol
how does DM increase the risk of gallstones
- can cause hyperlipidemia = more cholestrol in bile = greater risk of precipitation
list 2 risk factors for bilirubin stones
- hemolytic anemias
- parasitic infection (ex. malaria)
is there a greater risk factor of gallstones in men or women? why?
- women r/t estrogen
peak incidence occurs in women at what age? men?
- women = 50
- men = 60
describe the effect of pregnancy on gallstones
- prior pregnancies increasesd the risk r/t estrogen
how does rapid weight loss effect gallstones?
- increases the risk
- causes increased disposal of cholestrol in the bile
what can gallstones cause
- obstruction of the cystic & common bile duct
what is cholecystitis
- inflammation of the gall bladder
what are symptoms of gallstones like
- most are asymptomatic
- but if it causes cholecystitis or cholangitis, it become symptomatic
what is the most common clinical presentation of cholelithiasis
- cholecystitis
how do gallstones cause cholecystitis
- when the gallstones cause obstruction
cholecystitis can be…
- acute or chronic
- or an acute episode during chronic disease
what type of jaundice can gallstones cause
- obstructive jaundice
what is cholangitis
- inflammation of the common bile duct
what other disorders can gallstones cause (5)
- cholecystitis
- cholangitis
- peritonitis (thru causing cholecystitis)
- obstructive jaundice
- pancreatitis
how can cholecystitis cause peritonitis
- the inflamed gallbladder can become infected, necrotic, and rupture
how can gallstones cause pancreatitis
- if the stone becomes obstructive and fail to clear the sphincter of Odi & block the pancreatic duct
what determines the symptoms of gallstone
if the gallstones are:
- stationary or mobile
- obstructing or not
what are manifestations of gallstones (5)
- biliary colic
- tachycardia
- diaphoresis
- prostration
- symtpoms of obstructive jaundice if it causes obstruction
what is biliary colic
- way to describe a “gall bladder attack”
- pain that occurs when a stone is lodged in a duct, causing painful spasms
- different for everyone
what causes tachycardia & diaphoresis during gallstones
- the pain
what is prostration
- weakness
what causes exacerbations of biliary colic
- after high-fat meals
- laying down
describe biliary colic; where does it occur? what does it feel like? does it radiate?
- different for everyone
- severe upper right quadrant, epigastric, or lower back pain
- radiates to the R shoulder
- can be cramping, dull, sharp
how do symptoms of gallstones change if they cause obstruction?
- get symptoms related to bile blockage
what are the manifestations of obstrcuted bile flow
- obstructive jaundice (and all of its symptoms)
- intolerance of fatty foods
what are the symptoms of obstructive jaundice (6)
- dark amber urine
- no urobilinogen in the urine
- clay or pale colored stools
- pruritis
- bleeding tendencies (due to vitamin K deficiency)
- steatorrhea
what symptoms occur due to intolerance of fatty foods
- nausea
- sensation of fullness
- anorexia
what are symptoms of cholecystitis (8)
- pain
- fever
- leukocytosis
- NV
- restlessness
- diaphoresis
- abdominal rigidity
- jaundice (bc often caused by obstruction)
what is the pain like during cholecystitis
- vary from indigestion to mod to sever pain
- pain in the RUQ
how is symptomatic cholelithiasis treated?
- cholecystectomy (removal of the gall bladder) = treatment of choice if symptomatic
- extracorporeal shock wave lithotripsy
- ERCP (clears stones)
