Flashcards in Final Exam -- GI Disease IV (Biliary System and Pancreas) Deck (48):
The biliary system is a collection of vessels that direct the secretions from the liver, gallbladder, and pancreas into which part of the small intestine?
What is the function of bile?
Detoxification, cellular recycling, breakdown and absorption of fat soluble vitamins.
Cholelithiasis is another name for gallstones. 80% of gallstones are made of what?
Cholelithiasis is another name for gallstones. 20% of gallstones are made of what?
What are the risk factors for gallstones?
Pregnancy, diabetes, obesity, sickle cell disease, and cirrhosis.
Gallstones are mostly asymptomatic, although biliary colic sometimes happens. What is biliary colic?
Occurs typically after a fatty meal when the gall bladder contracts and a gallstone blocks the cystic duct. This causes an attack of upper right abdominal pain, N&V, and sometimes pain in the right shoulder/back.
Gallstones are diagnosed with transabdominal ultrasonography and can be treated with cholecystectomy (surgical removal of gall bladder), bile acid pill, or extracorporeal shock wave lithotripsy. What are some indications for cholecystectomy?
Large stones (more than 2.5 cm), hemolytic anemia, or organ transplant in an immune compromised patient.
___________ is when gallstones are lodged in the common bile duct and can be imaged with intraoperative cholangiography.
The symptoms of choledocholithiasis are similar to those of cholelithiasis, with the possible addition of?
Jaundice, dark urine, pale stools, rapid heartbeat and decreased BP.
Choledocholithiasis can be diagnosed with transabdominal ultrasound, CT, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), or endoscopic ultrasonography. Which of these imaging techniques includes the ability to perform surgical procedures as treatment for choledocholithiasis?
What are the treatment options for choledocholithiasis?
Lithotripsy, cholecystectomy, biliary stenting, ERCP.
What are the potential complications of choledocholithiasis?
Gallstone pancreatitis and acute cholangitis.
Acute cholangitis is a bacterial infection caused by an obstruction of the biliary tree, elevation of intraluminal pressure, and infection of bile. It is most commonly caused by a gallstone.
Charcot triad is a group of symptoms of acute cholangitis. Name the features of this triad.
Pain, fever/chills, and jaundice.
Reynold's pentad is a group of symptoms of acute cholangitis. Name the features of this pentad.
Charcot triad (pain, fever/chills, jaundice) plus altered mental status and hypotension.
Acute cholangitis is concerning due to the potential for sepsis. What are the treatment options for this condition?
Hospital admission, antibiotics, establish biliary drainage, and cholecystectomy.
Cholecystitis is inflammation of the gall bladder. True or false: it is more commonly due to tumors.
False; it is most commonly related to gallstones.
What are the symptoms of cholecystitis?
Severe pain in upper right abdomen, tenderness over abdomen, N&V, fever.
What techniques are used to diagnose cholecystitis?
Treatment for cholecystitis includes likely hospitalization, antibiotics and/or pain medication, possible cholecystectomy, and what else?
Fasting (to lessen contractions of the gallbladder)
______________________ is chronic inflammation, fibrosis, and stricturing of the biliary tree inside and/or outside of the liver.
Primary sclerosing cholangitis.
Primary sclerosing cholangitis is associated with what bowel condition?
Inflammatory Bowel Disease*
Though 50% of patients with primary sclerosing cholangitis are asymptomatic, symptoms can include what?
Fatigue, pruritis, jaundice, hepatomegaly, splenomegaly.
How would you diagnose primary sclerosing cholangitis?
ERCP, magnetic resonance cholangiography (MRC), percutaneous cholangiogram, possibly liver biopsy.
Since primary sclerosing cholangitis can cause cirrhosis, the median survival time of symptomatic patients is 10-18 years after initial diagnosis.
True or false: there is no proven treatment to slow the progression of primary sclerosing cholangitis, though you can do IV fluids and antibiotics for sepsis, and balloon dilation for short term relief. Liver transplant can be used if cirrhosis develops.
__________ cells have an exocrine function, and their enzymes drain into the duodenum.
____________ product hormones like insulin and glucagon, and release them into the blood stream.
Islets of Langerhans
In acute pancreatitis, pancreatic enzymes are inappropriately released, damaging pancreatic tissue. What are some causes of this condition?
Toxic exposure (such as with alcohol*) and pancreatic duct obstruction (such as from biliary tract disease*) are the two main causes.
What are the signs and symptoms of acute pancreatitis?
Acute, severe epigastric pain often radiating to the back, N&V, tenderness on palpation, obstructive jaundice, fever, tachypnea, hypoxemia, hypotension, panniculitis.
How is acute pancreatitis diagnosed?
2-3 times elevated serum lipase/amylase, and/or characteristic findings on imaging.
True or false: in most cases, acute pancreatitis is mild and does not require therapy.
List the treatment options for acute pancreatitis.
Pain control, IV fluids, ICU (if severe), pancreatic debridement (if necrosis), and treatment of the underlying cause.
Chronic pancreatitis is progressive inflammation of the pancreas that leads to ______________ (reversible/irreversible) structural damage.
What is the major cause of chronic pancreatitis? What are some other causes?
Alcohol abuse* is the main cause. Ductal obstruction, tropical location, systemic diseases, autoimmune diseases are some other causes.
What are the signs and symptoms of chronic pancreatitis?
Epigastric abdominal pain, jaundice, and inability to digest complex foods.
Inability to digest complex foods, such as can occur with chronic pancreatitis, occurs when what percentage of pancreatic function is lost?
More than 90%
What sort of imaging can be done for chronic pancreatitis?
X-ray, CT, and endoscopic untrasonography with or without fine needle aspiration.
What is the treatment for chronic pancreatitis?
Pain management, lifestyle changes (smaller meals, low-fat meals, no alcohol or tobacco), pancreatic lithotripsy, surgery.
True or false: 50% of patients with chronic pancreatitis die within 5 years.
False; 50% die within 10 years.
_______________ cancer is the 4th leading cause of cancer related deaths among men and women in the US.
What are the risk factors for pancreatic cancer?
Hereditary chronic pancreatitis, hereditary breast cancer, smoking, diabetes, pancreatic cysts, high BMI, low physical activity.
What are the signs and symptoms of pancreatic cancer?
Pain*, jaundice, weight loss, dark urine, pale stools, diarrhea, vomiting.
What imaging is used to screen individuals who are at high risk for pancreatic cancer?
CT, MRI, EUS (endoscopic ultrasound)
True or false: histologic confirmation is needed for diagnosis of pancreatic cancer.
True or false: the only treatment for pancreatic cancer is surgery, but the prognosis is low.
True. The 5-year survival is only 25-30%, and only 15-20% of patients are good candidates for surgery anyway.
Which of the pancreatic and biliary system conditions discussed in class are more common in males?
Primary sclerosing cholangitis, chronic pancreatitis, pancreatic cancer (just barely)