Chapter 37: Alterations in Function of the Gallbladder and Exocrine Pancreas Flashcards Preview

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Flashcards in Chapter 37: Alterations in Function of the Gallbladder and Exocrine Pancreas Deck (14):


- Also called gallstones

- Etiology includes Native Americans > American Caucasians and Women > men (2:1)

- Adults May be asymptomatic and not need treatment

- Children Usually from an underlying condition and need gallbladder removed


Chronic Cholelithiasis


- Related to intermittent obstruction of cystic duct

- Precipitated by a meal (infrequent schedule)

- Persistent epigastric or right upper abdominal pain, often radiates to back

- Nausea, vomiting, sweating, flatus
Increases steadily for >15 minutes, lasts several hours, then slowly decreases

- Fatty food intolerance, belching, bloating, and epigastric burning

- Diagnosis: ultrasound

- Treatment includes Watchful waiting, Cholecystectomy (surgical removal of the gallbladder), Chemical dissolution of gallstones, and Lithotripsy (mechanical breaking up of gallstones within the gallbladder)



- Inflammation of the gallbladder wall

- Causes fibrosis and thickening

- Related to continued presence of gallstones

- 2 types (Acute, Chronic)


Etiology of Acute Cholecystitis

- Acute inflammation of the gallbladder wall

- Etiology includes:

- Cholelithiasis present in 90% of patients

- Obstruction of cystic duct present in almost all patients: related to stasis of bile

- Bacterial infection may be present


If Acute Cholecystitis is untreated

- If untreated, escalates; gangrene may occur

- Rupture

= Peritonitis

- Septic shock

- Localized abscess (empyema)

- Cholecystoenteric fistula (fistula between gallbladder and GI tract)


Clinical Manifestations and Diagnosis of Acute Cholecystitis

- Clinical manifestations include severe right upper abdominal pain: radiates to back; abdominal tenderness; fever; leukocytosis, mild elevations of bilirubin and serum transaminases

- Diagnosis is made through abdominal ultrasound (presence of stones, thickened gallbladder wall) and HIDA scan, CT, MRCA, and ERCP


Treatment of Acute Cholecystitis

- Laproscopic cholecystectomy: mainstay of therapy

- Antibiotics (if bacterial infection)

- Percutaneous catheter drainage or endoscopic drainage with stent placement (obstruction)

- Gangrene, empyema, or emphysematous changes: surgical emergencies

- Pain management

- Chemodissolution (nonsurgical): use of bile acids/organic solvents to dissolve gallstone

- Lithotripsy (nonsurgical): Breaking up of gallstones using shockwaves; Stones


Acalculous Cholecystitis

- Occurs in patients without preexisting gallstones

- Males >50 years

- Tends to occur in the setting of major surgery, critical illness, trauma, burn-related injury, or TPN

- Rapid development of gangrene, perforation, emphysematous cholecystitis, and empyema


Acute Pancreatitis

- Inflammation of the pancreas (Autodigestion of the pancreas from enzyme activation)

- Predisposing factors (Biliary tract disease, hypertriglyceridemia, ethanol-associated (66%))

- 3 pathways ( Obstruction of the pancreatic duct by a stone or other cause (usually unknown), Acinar cell injury, Defective intracellular transport)


Clinical Manifestations of Acute Panreatitis

- Steady, boring pain in epigastrium or LUQ

- Increases in intensity

- Severe tenderness on palpation

- Radiates or penetrates to back

- Nausea and vomiting

- Abdominal distention

- Hypoactive bowel sounds

- Low-grade fever


Diagnosis of Acute Pancreatits

- Laboratories use lipase preferred test (Increase in amylase and lipase during first 12 hr (indictative), Elevated aminotransferases, alkaline phosphatase and bilirubin)

- Abdominal X-Ray (Ileus pattern; “sentinel loop”: distended loop of small bowel in area of pancreas)

- Adominal Ultrasound

- CT of abdomen (GOLD STANDARD;:allows remarkable detail, Prognostic assessment: Ranson’s criteria)


Treatment for mild to moderate Acute Pancreatitis

- Reduce pancreatic secretions

- Conservative management

- Withhold oral feedings

- Nasogastric suction for adynamic ileus

- IV fluid replacement

- Analgesics


Treatment for Severe Acute Pancreatitis

- Usually in ICU

- Nutritional replacement: prevents tissue breakdown, may need TPN

- Calcium and magnesium administration

- Control of hyperglycemia (insulin)

- Prevent respiratory failure, acute renal failure, intraabdominal sepsis

- Mechanical ventilation and hemodialysis may be needed

- Bacterial infection: antibiotics and aspirate fluid cultured; usually indicates poor prognosis

- Surgical intervention (abscess or hemorrhage) (Necrosectomy: debridement of devitalized tissue) (Pancreatectomy: major pancreatic resection) (Drains usually present)


Complications of Severe Acute Pancreatitis

- Pseudocyst: collection of fluid within or adjacent to pancreas (Fever, tachycardia, abdominal mass, and tenderness; Management: endoscopic or surgical drainage)

- Pancreatic ascites: persistent leak in pancreatic duct into pleural space and mediastinum (Painless and massive, Detected by ultrasound or CT, fluid analysis obtained by aspiration, Treatment: prolonged parenteral nutrition, stent)