L73 Flashcards
(33 cards)
What is cholelithiasis?
Gall stones
2 types of gall stones
Cholesterol - yellow
Pigment - black or brown
How do cholesterol gall stones form
Bile normally = cholesterol + bile salts + phospholipids Stones: ↑cholesterol or ↓phospholipids // bile salts
5 things that ↑risk gall stones
- Obesity (high cholesterol states/food intake)
- Oral contraceptives - ↑E -> ↓GB fxn -> cholesterol hypersaturation
- Diabetes
- Crohn’s disease
What does black pigment stones mean?
Black = ↑unconj bilirubin
B/c anything that causes hemolysis:
- ↑bilirubin -> deconj
What does brown pigment stones mean?
Infection - bacterial cause
Can occur outside the GB in abnormal bile ducts (dilated b/c liver flukes)
Do you treat asymptomatic gall stones? Exceptions?
NO Except: - Diabetics - Sickle cell anemia - Calcified GB wall
What is the main symptom of gall stones? (aka when not asymptomatic)
Biliary colic = severe + steady R/LUQ pain b/c stone is obstructing cystic duct
- Might radiate to R shoulder or chest
- Esp @ night
- If you have symptomatic stones -> higher chance of recurrence of stones AND/or complications
- THIS is why you treat symptomatic stones
5 complications of symptomatic gall stones
- Cholecystitis
- Common duct obstruction/cholangitis
- Acute pancreatitis
- GB cancer
- Gallstone ileus = stone so big that the enlarged GB causes SI obstruction
If a pt has symptoms from any GB disease, what should you make sure they do not do?
NO eating
Food in gut stimulated GB contraction
What is acute cholecystitis?
Inflam of GB wall
Most likely due to stones in GB neck or cystic duct -> infection up the back up behind
Acute cholecystitis presentation
RUQ pain Murphy's sign = pain + inspiration arrest w/ deep breath N+V Fever Leukocytosis Jaundice
What is choledocholithiasis? 2 types
Stone in common bile duct
Choledocholithiasis cholangitis
vs pancreatitis
Symptoms + labs for choledocholithiasis
Fever
Jaundice
↑Alk phos
Maybe normal liver profile or ↑AST/ALT
What is choledocholithiasis cholangitis?
Stone in common bile duct -> bile becomes infected Charcot's triad: 1. RUQ pain 2. Jaundice 3. Fever \+ Abnormal LFTs \+ Hypotension \+ Mental confusion \+ Leukocytosis
What is choledocholithiasis pancreatitis?
Stone in common bile duct also blocks the pancreatic duct
Bile refluxing behind stone causes acinar cell damage -> enzyme release from pancreas
↑ALT + alk phos
Labs return to normal after stone passes
4 ways to treat cholelithiasis
- Surgery to remove stones
- Oral bile salts dissolve the stones, but won’t solve recurrent stones
- Contact dissolution
- Extracorporial lithotripsy = sound waves break stones
What is the surgery to remove gall stones for cholelithiasis?
Laprascopic cholecystectomy
B/c higher up in the tree - won’t reach w/ ERCP
Preferred way to treat choledocholithiasis
Endoscopic retrograde chol-angio-pancreatography = ERCP
Easier + less risky
What is primary sclerosing cholangitis? Cause?
Bile ducts in + out of liver -> inflam destruction
Strictures
Biliary tree infection
Presentation of acute pancreatitis
Ab pain - radiates to back
↑amylase + lipase in serum
Lipase = fat necrosis
2 main causes of acute pancreatitis
Alcohol
Gall stones
- Idopathic is probably due to undetectably small stones
Other: trauma, drug induced
Can you die from acute pancreatitis
YEP
IF severe and has begun to necrose surrounding organs
Treat acute pancreatitis
Remove the stone Supportive: - NPO - IV fluid replacement - Pain relief ↓inflammation
