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Biliary Disorders

QuestionAnswer
Cholelithiasis Gallstones in gallbladder. Mostly cholesterol/bilirubin. Can be asymptomatic.
Cholecystitis Inflammation of gallbladder, often from stones obstructing cystic/common bile duct.
Cholecystitis Sx RUQ pain radiating to shoulder, N/V, fever, +Murphy's sign, jaundice, clay stools.
Cholecystitis Risk 4 F's: Female, Forty, Fertile, Fat. Also obesity, pregnancy, rapid weight loss, DM.
Murphy's Sign Pain on inspiration during palpation of RUQ. Indicates acute cholecystitis.
Biliary Labs ↑WBC, ↑Alk Phos, ↑AST, ↑Bilirubin, ↑Amylase/Lipase if pancreatic involvement.
Cholecystectomy Gallbladder removal. Laparoscopic (preferred) or open. Post-op: low-fat diet, monitor for bile leak.
Acute Pancreatitis Inflammation from autodigestion by pancreatic enzymes. Severe epigastric pain radiating to back.
Pancreatitis Causes Gallstones (most common), alcohol, trauma, ERCP, drugs, hypertriglyceridemia.
Pancreatitis Sx Epigastric/LUQ pain worse supine, relieved fetal position. N/V, fever, jaundice, Cullen/Turner signs.
Cullen Sign Periumbilical ecchymosis. Indicates retroperitoneal bleeding in severe pancreatitis.
Grey Turner Sign Flank ecchymosis. Indicates retroperitoneal bleeding in severe pancreatitis.
Pancreatitis Labs ↑Lipase (most specific), ↑Amylase, ↑Glucose, ↓Ca++, ↑WBC. Hypocalcemia from saponification.
Pancreatitis Care NPO, bowel rest, IV fluids, pain control (morphine/Dilaudid), NG tube, jejunal feeding, monitor resp status.
Chronic Pancreatitis Progressive, destructive inflammation/fibrosis. From chronic alcohol use. Leads to insufficiency.
Chronic Pancreatitis Sx Constant gnawing abdominal pain, steatorrhea, weight loss, jaundice, diabetes (endocrine failure).
Pancreatic Enzymes Exocrine: Amylase (carbs), Lipase (fats), Trypsin/Elastase (proteins). Autodigestion causes damage.
Endocrine Pancreas Produces insulin (beta cells), glucagon (alpha cells), somatostatin. Regulates blood glucose.
Pancreatitis Complications Pseudocyst, necrosis, infection, ARDS, DIC, MODS, chronic pancreatitis, diabetes.
Created by: Wasurenboh
 

 



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