Gallbladder & Pancreatic Disorders

Question 1

define cholelithiasis

Answer 1

solid deposits w/in gallbladder (aka gallstones)

Question 2

define choledocholithiasis

Answer 2

bild duct stones

Question 3

cholelithiasis epidemiology

Answer 3

• women more than men
• incr. w/ age
• native + mexican americans

Question 4

cholelithiasis etiology

Answer 4

• cholesterol more so than Ca composition
• causative = 4F’s (fat, fertile, female, forties)
• protective = low CHO/fat/fiber diet, caffeine, ASA, Mg

Question 5

cholelithiasis S+S

Answer 5

• 75% asx
• RUQ pain
• epigastric pain that radiates to R shoulder
• n/v
• s/p fatty meal

Question 6

biliary colic S+S

Answer 6

• episodic pain d/t gallstone w/o evidence of gallbladder wall inflammation

Question 7

cholelithiasis work-up

Answer 7

• Labs (CBC, CMP w/ LFTs, UA, cardiac enzymes)
• abd XR to r/o other dz
• RUQ US

Question 8

cholelithiasis tx

Answer 8

• asx = no tx req’d
• dietary modifications
• biliary collic = pain/nausea mgmt
• analgesics prn
• antiinflammatory (ketorolac i.e. Toradol)
• cholesterol stones = ursodeoxycholic acid

Question 9

cholelithiasis f/u

Answer 9

refer to general surgeon for frequent events

Question 10

cholelithiasis complications

Answer 10

• cholecystitis
• cholangitis
• pancreatitis
• gallbladder CA (rare)

Question 11

define cholecystitis

Answer 11

acute or chronic inflammation of the gallbladder

Question 12

cholecystitis etiology

Answer 12

• secondary to gallstone in cystic duct

- acalculous = secondary to other medical illness w/ gallstones

Question 13

cholecystitis S+S

Answer 13

• RUQ and/or epigastric pain s/p fatty food
• n/v
• +/- fever
• Murphy’s Sign

Question 14

define (+) murphys sign

Answer 14

inhibition of inspiration during palpation of RUQ

Question 15

cholecystitis work-up

Answer 15

• CBC (WBC elevated)
• AST/ALT
• amylase/lipase
• US
• HIDA scan
• CT scan (2nd line to US or HIDA

Question 16

cholecystitis tx

Answer 16

• analgesics/antiemetics
• abx
• surgical resection

Question 17

cholecystitis complications

Answer 17

• abscess or gangrene
• choledocholithiasis/cholangitis
• perforations
• fistula to bowel
• pancreatitis
• CA
• chronic cholecystitis –> porcelain gallbladder
• emphysematous cholecystitis –> gas forming bacteria that requires emergent resection

Question 18

define cholangitis

Answer 18

• common bile duct infection

Question 19

cholangitis etiology

Answer 19

• choledocholithiasis

Question 20

cholangitis S+S

Answer 20

• Charcot triad (RUQ pain, fever/chills, jaundice)
• Reynolds pentad (Charcot triad + AMS + hypotension)
• septic cholangitis

Question 21

cholangitis work-up

Answer 21

• Labs (AST, WBC, bilirubin, ALT, amylase)
• US = CBD greater than 6mm
• MRCP

Question 22

cholangitis tx

Answer 22

• ERCP = dx + tx w/ performing sphincterotomy + stone retrieval
• cholecystectomy
• abx

Question 23

cholangitis complications

Answer 23

• sepsis
• stricture
• pancreatitis
• hemorrhage

Question 24

define acute pancreatits

Answer 24

inflammation of the pancreas

Question 25

acute pancreatitis etiology

Answer 25

• MC = stones
• ETOH
• hypercalcemia
• hyperlipidemia
• abd trauma
• rx
• vasculitis
• mumps, CMV
• peritoneal dialysis
• ERCP
• CA

Question 26

acute pancreatitis S+S

Answer 26

• dull or boring epigastric pain
• pain may radiate to mid-back or shoulders
• s/p fatty meal or ETOH
• incr. w/ laying supine or walking
• n/v, anxiety
• TTP, distention, guarding, decr. bowel sounds
• fever
• jaundice
• tachycardia

Question 27

acute pancreatitis work-up

Answer 27

• Labs (CBC, CMP, lipase more than amylase)
• EKG
• Ranson Criteria
• Abd XR = sentinel loop (LUQ air in sm. bowel) or colon cutoff (gas-filled transverse colon)
• CT, MRI better than US

Question 28

acute pancreatitis tx

Answer 28

• bowel rest
• TPN
• fluids
• analgesics
• antiemetics
• ERCP
• ETOH

Question 29

acute pancreatitis complications

Answer 29

• necrotizing pancreatitis (Turner’s + Cullens sign)
• hypovolemia/shock
• ileus
• abscess/psuedocyst
• chronic pancreatitis

Question 30

define chronic pancreatitis

Answer 30

progressive damage d/t repetitive inflammation resulting in fibrosis, calcification, pancreatic ductal inflammation and/or pancreatic stone formation and eventual functional impairment

Question 31

chronic pancreatitis etiology

Answer 31

• chronic ETOH

- incr. PTH ==> incr Ca

Question 32

chronic pancreatitis S+S

Answer 32

• recurrent epigastric pain
• anorexia/wt loss
• n/v
• constipation
• flatulence
• steatorrhea

Question 33

chronic pancreatitis work-up

Answer 33

• amylase/lipase
• secretin stimulation test
• fecal elastase test
• abd XR/US/CT
• ERCP/MRCP/endoscopic US

Question 34

chronic pancreatitis tx

Answer 34

• avoid ETOH
• low-fat diet
• pain mgmt
• pancreatic enzyme supplement

Question 35

chronic pancreatitis complications

Answer 35

• DM
• narcotic addiction
• pseudocyst/abscess
• pancreatic CA

Question 36

define pancreatic pseudocyst

Answer 36

sterile localized fluid collection in/on pancreas surrounded by fibrosis/granulation tissue
- usually connected to pancreatic duct system + containing amylase or lipase

Question 37

pancreatic pseudocyst etiology

Answer 37

• pancreatitis
• trauma
• ETOH
• biliary tract dz
• stones

Question 38

pancreatic pseudocyst S+S

Answer 38

• asx
• epigastric pain
• n/v
• anorexia
• palpable mass
• sepsis/fever (if ruptured)
• pleural effusion
• peritonitis (if ruptured)

Question 39

pancreatic pseudocyst work-up

Answer 39

• US
• CT
• MRI
• ERCP w/ fluid analysis

Question 40

pancreatic pseudocyst tx

Answer 40

• supportive care if asx

- drainage