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Biliary Tract Dz
Clinical Medicine I
| Question | Answer |
|---|---|
| Cholelithiasis | the presence of gallstones in the gallbladder |
| Cholecystitis | gallstone obstruction of the cystic duct, causing inflammation and infection |
| Choledocholithiasis | gallstones in commone bile duct |
| cholangitis | gallstone obstruction of biliary or hepatic ducts: inflammation and infection |
| Formation of a gallstone | cholesterol or calcium bilirubinate in bile above solubility |
| Risk Factors of Cholesteral gallstones | Female, European/NA ancestry, Age, Obesity, pregnancy, gallbladder stasis, drugs, heredity |
| RF pigment gallstones | associated w/ disorders of hemolysis (sickle cell, hereditary spherocytosis, beta-thalassmia |
| Cholelithiasis sxs | Biliary colic, RUQ, radiation to R scapular tip (Collins sign, post fatty meal, last 1-5 hrs, N/V, sporadic and unpredictable |
| Collins Sign | Pain radiating to R scapulalr tip |
| Cholelithiasis Signs | asymptomatic in PE |
| Causes of fever, tachy, hypotension, jaundice w/cholelithiasis | cholecystitis, cholangitis, pancreatitis, |
| Diagnosis of Cholethiasis | US is gold standard, |
| Tx of Cholelithiasis | Removal of gallbladder w/ complications and repeated episodes, Ursodiol |
| Ursodiol | Med to help dissolve gallstones |
| Complications of stones in gallbladder | Acute cholecystitis, chronic cholecystitis, gallbladder empyema, gallbladder cancer, gallstone ileus |
| Complications of stones in bile duct | ascending cholangitis, acute pancreatitis |
| Alarming sxs d/t cholelithiasis | epigastric pain>20 mins, N/V or fever with it, pain>1hr seek medical attention |
| Types of cholecytitis | acute calculous (90%) and Acute acalculous (10%) |
| Etiology of calculous cholecystis | Female, ethnic groups, obesity or rapid wt loss, drugs, pregnancy, increasing age (MC in Females) |
| Etiology of acalculous cholecytitis | critical illness, major surgery, sepsis, long-term parenteral nutrition, prolonged fasting (Biliary stasis)(Males) |
| Signs of cholecystitis | Fever, tachy, tenderness in RUQ w/guarding or rebound, jaundice, pain diffuse >6hrs |
| Lab tests for cholecystitis | Leukocytosis, ALT, AST, bilirubin, alk phose elevation, amylase/lipasse r/o pancreatitis, urinalysis r/o pylonephritis, pregnancy test |
| Gold standard to dx cholecystitis | Ultrasound, CT for extrabiliary disorders |
| Tx Cholecystitis | Initial: Bowel rest, IV hydration, IV abx, analgesia, Complicated: cholecystectomy |
| Criteria for uncomplicated cholecystitis | nl vitals, labs, US, underlying medical problems, proper at home care and analgesics |
| Complications of Cholecystitis | Usually rare, but w/ surgery, perforation/gangrene can occur |
| Lab Dx of Choledocholithiasis | Elevated AST, ALT, bili, alk phos, |
| Imaging Dx choledocholithiasis | EUS, MRCP |
| Tx | ERCP, endoscopic retrograde cholangiopancreatography |
| Etiology of Cholangitis | Choledocholithiasis, biliary tract manipulations/intervations, stents |
| Clinical Presentation of Cholangitis | Charcot's triad, mental confusion, bacteremia, septic shock |
| Dx Cholangitis | Leukocytosis, ^ bilirubin, alk phos leves, + blood cultures, Ultrasoud will confirm |
| Tx Cholangitis | Nonsuppurative: abx, Suppurative ~100% death unless obstruction is relieved and drained (ERCP) |
| Etiology of Gallbladder Cancer | Chronic inflammation, unusual: sclerosing cholangitis, ulcerative colitis, exposures and bacterial infections (62066yo)Females |
| Clinical presentations of gallbladder cancer | similar to biliary colic, abd pain, more diffuse, anorexia, wt loss |
| GB cancer signs | Jaundice, palpable GB (Courvoiser's sign) palbable nodes into umbilicus, Virchow node papable, palpable mass in digital rectal exam |
| Virchow node | left supraclavicular adenopathy |
| Sister Mary Joseph nodes | Palpable nodules buldging into the umbilicus |
| Courvoisier's Sign | Palpable gallbladder |
| Dx of GB cancer | CA 19-9 may be elevated, anemia, ^alk phos, bilirubin, US and CT to identify masses |
| Tx of GB cancer | Complete resection, adjuvant radiation and chemo, survival 10-20% 5yr survival, advanced 2-4months |
| Patho of acute pancreatitis | Injury to pancreas causes an inflammatory response, ^pancreatic vascular permeablity=hemorrhage, edema, eventually necrosis |
| Etiology of acute pancreatitis | Gallstones, alcohol, post ERCP, hypertriglyceridemia, drug-related, apolipoprotein CII deficiency |
| causes in M/F | Males: usually alcohol (39yo), Females: biliary tract related (69yo) |
| Sxs acute pancreatitis | abd pain, steady and boring, usually >1day, epigastric and periumbilical regions, radiate to back, bhest, flanks N/V/D |
| When is pain worse for acute pancreatitis | in supine position |
| Signs of acute pancreatitis | Fever, tachy, hypotension, abd tenderness, guarding, distention, hypoactive bowel sounds |
| Signs of necrotizing pancreatitis | Cullen's sign & turner's sign |
| Cullens sign | bluish discoloration around the umbilicus |
| Turner sign | bursing of the flanks |
| Dx labs of acute pancreatitis | ^amylase or lipase-more specefic to pancrease) Leukocytosis, Hemoconcentration (>44)& azotemia (>22) |
| Suggests gallstone pancreatitis | ^AST, ALT, alk phos, total biliary rased |
| Dx of choice of acute pancreatitis | CT, US only to detect gallstones |
| Dx requires 2/3 for Acute pancreatitis | -typical abd pain, -^amalase/lipase -radiology findings |
| Ransons Criteria | If score >= 3 severe pancreatitis is likely |
| Tx acute pancreatitis | bowel rest, NPO, IV fluids, oral intake once pain-free, no N/V nl bowel sounds and hungry (cholecystectomy if appropriate) |
| Complications of acute pancreatitis | acute fluid collection, pseudocyst, pancreatic necrosis, intra-abdominal infections |
| Fluid encolsed by granulation tissue (develops 4-6 weeks) | pseudocyst |
| Chronic inflammatory proccess that leads to IRREVERSIBLE fibrosis, w/ calcification | Chronic Pancreatitis |
| Etiology of chronic pancreatitis | alcohol and CF in kids (25% idiopathic) |
| What can happens w/ Chronic pancreatitis? | obstruction, toxinn or toxic metabolites, oxidative stress, necrosis-fibrosis, ischemia, autoimmune? |
| Epidemiology chronic panreatitis | 3X higher in African americans, alchol-induced dx~46yo |
| Sxs of chronic pancreatitis | abd pain varying location,severity, frequency, maldigestion, |
| Signs of chronic pancreatitis | mild tenderness, inconsistent w/ sevarity of pain the pt reports |
| Dx C. pancreatitis | secretin stimulation test* ^amylase/lipase, blood glucose, bilirubin and alk phose |
| Tx of C. pancreatitis | Cessation of alcohol consumption, pancreatic enzymes, acid supression, analgesics, Maybe surgical intervention |
| Complications of chronic pancreatitis | pseudocyts, obstruction, narcotic addiction, impared glucose tolerence, GI bleeding, jaunidce, 10%^ pancreatic cancer, cholangitis/bliary cirrhosis |
| 4th leading cause of cancer death | Pancreatic Cancer |
| Etiology of pancreatic cancer | Smoking, Obesity and dietary factors, DM, Chronic pancreatitis, Genetic features |
| Sxs pancreatic cancer | gradual onset, anorexia, malaise, nausea, fatigue, wt loss, mid-epigastric pain, jaundice w/ pruritis of head of pancreatis, depression, DM recent diagnosis |
| Signs of Pancreatic Cancer | Jaundice/cachexia, Courvoiser's sign, signs of metastases, miratory thrombophlebitis |
| Dx Pancreatic Cancer | CT: if doubt, EUS, CA 19-9 low sensitivity and specificty |
| Tx Pancreatic cancer | Surgery resection, chemo or chemo/rad |
| Median survival of pt's | 4-6m very deadly, w/ chemo about 9m, metastasis ~6m |
Created by:
becker15
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