Biliary disease & pancreatitis Flashcards Preview

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Flashcards in Biliary disease & pancreatitis Deck (27):
1

epi of gall stones

- 10% of pop
- incidence up with age
- cholesterol in west, pigment in east
- genetics most important

2

4 predisposing factors

1. age
2. fam hx/ ethnicity
3. gender/hormones - F>M
4. obesity

3

reasons age implicated (3)

1. higher bilary chol
2. GB motility goes down
3. less sentive to CCK

4

reasons for females

- E makes gall bladder static
- pregnancy increases

5

2 reasons related to obesity

1. lipid metabolism means increased biliary chol. secretion
2. related to rapid weight loss

6

natura Hx of stones

20% will require surgery over 20 years
- only surg once Sx emerge

7

3 clinical syndromes related to stones

1. biliary colic
2. acute cholecystitis
3. chronic cholecstitis

8

def. biliary colic

CONSTANT RUQ pain due to cystic duct obst. and distension of the gall bladder
- sudden upset and lasting up to 24 hrs
- esp. after a big fatty meal

9

3 treatments

1. rehysdrate
2. analgesics
3. elective lap. cholecytectomy

10

path of acute cholecyctitis

1. duct obst.
2. GB ischemia and irritation
3. secondary infection

11

def, of cholecystitis

1. same Sx as acute cholic, but:
- pain >24hrs
- Sx of systemic infaction
- murphy sign
- palpable mass in 20%

12

DDx for gall pain

- ulcer
- appendidicits
- pancreatitis
- MI
- pneuminia

13

treat of acute chole

- IV fluids, anal, ABs
- 75% better without surgery
- ealry surg. can help prevent recurrence and complications

14

def. chronic chole

- chronic inflammation of gall bladder due to stones
- GB wall usually thickened
- GB may be small and contracted
- Sx usually long standing colic

15

diagnosis of gall stones

- may cause high LFTs and WBC
- ultrasound is main method
- ERCP
- MRCP

16

why US?

easy, cheap, reliable
- high accuracy
- reveals size and shape of stones

17

2 general complications of stones

1. related to bladder
2. related to duct

18

4 complications related to Bladder

1. acute cystitis
2. perf
3. gall stone illeus
4. GB carcinoma

19

4 complications related to duct

1. choledocholitiaitis (in CBD)
2. obs. jaundice
3. cholangitis
4. biliary pancreatitis

20

def. choledocholitiaitis

- in CBD (10-15% of cases)
- increases with age
- get out with ERCP

21

def. obs. jaundice

- may be first manifestation
-

22

def. cholangitis

- dev. in presence of bile obs. and infection
- obs>intraluminal pressure>reflux of bact to hepatic veins>systemic circ

23

def. charcots triad

fever, jaundice, RUQ pain

24

def. raynauds pentad

fever, jaundice, RUQ pain, hypotension, confusion = emergncy

25

mgmt of cholangitis

- fluids
- ABs for gr- and gr+ anarobes
- biliary decompression

26

def. biliary pancreatitis

transient blockage of ampulla of vader leads to pancreatitis

27

treatment of stones

- cholecystectomy
- laprascopic

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