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131 Cards in this Set
- Front
- Back
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most common cause of acute pancreatitis,
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Gallstone Pancreatitis
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most common cause of acute pancreatitis,
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Gallstone Pancreatitis
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most common cause of acute pancreatitis,
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Gallstone Pancreatitis
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can be identified in the stool of up to 94% of patients with acute gallstone pancreatitis
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Gallstones
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can be identified in the stool of up to 94% of patients with acute gallstone pancreatitis
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Gallstones
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can be identified in the stool of up to 94% of patients with acute gallstone pancreatitis
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Gallstones
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The bile reflux theory, first postulated by Lancereaux in 1899, suggests that
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as stones pass through the ampulla it is disrupted allowing reflux of bile, and other duodenal contents, into the pancreatic duct with subsequent intraglandular pancreatic enzyme activation.
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The bile reflux theory, first postulated by Lancereaux in 1899, suggests that
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as stones pass through the ampulla it is disrupted allowing reflux of bile, and other duodenal contents, into the pancreatic duct with subsequent intraglandular pancreatic enzyme activation.
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The bile reflux theory, first postulated by Lancereaux in 1899, suggests that
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as stones pass through the ampulla it is disrupted allowing reflux of bile, and other duodenal contents, into the pancreatic duct with subsequent intraglandular pancreatic enzyme activation.
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the common channel theory.
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is theory suggests that impaction of a stone at the ampulla of Vater leads to increased biliary pressures that exceed pancreatic duct pressure, with secondary reflux of bile into the pancreatic duct. This theory is weakened by the fact that some patients do not have common channels, and by studies that have shown sterile bile does not activate proteolytic enzymes. Nevertheless, infected bile is a potent stimulator of these enzymes due to the presence of bacterial amidase and the theory remains popular.
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the common channel theory.
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is theory suggests that impaction of a stone at the ampulla of Vater leads to increased biliary pressures that exceed pancreatic duct pressure, with secondary reflux of bile into the pancreatic duct. This theory is weakened by the fact that some patients do not have common channels, and by studies that have shown sterile bile does not activate proteolytic enzymes. Nevertheless, infected bile is a potent stimulator of these enzymes due to the presence of bacterial amidase and the theory remains popular.
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the common channel theory.
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is theory suggests that impaction of a stone at the ampulla of Vater leads to increased biliary pressures that exceed pancreatic duct pressure, with secondary reflux of bile into the pancreatic duct. This theory is weakened by the fact that some patients do not have common channels, and by studies that have shown sterile bile does not activate proteolytic enzymes. Nevertheless, infected bile is a potent stimulator of these enzymes due to the presence of bacterial amidase and the theory remains popular.
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lthough the diagnosis of acute gallstone pancreatitis is a clinical one, there are no signs or symptoms that are specific for the condition. A thorough history excluding other potential causes of pancreatitis is essential
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Alcohol, lipid levels, infectious agents, and medications should be considered.
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lthough the diagnosis of acute gallstone pancreatitis is a clinical one, there are no signs or symptoms that are specific for the condition. A thorough history excluding other potential causes of pancreatitis is essential
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Alcohol, lipid levels, infectious agents, and medications should be considered.
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lthough the diagnosis of acute gallstone pancreatitis is a clinical one, there are no signs or symptoms that are specific for the condition. A thorough history excluding other potential causes of pancreatitis is essential
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Alcohol, lipid levels, infectious agents, and medications should be considered.
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most sensitive at predicting GP are what labs
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arious studies have shown aspartate aminotransferase (AST), bilirubin, alkaline phosphatase, or γ-glutamyl transpeptidase (GGTP) to be most sensitive at predicting gallstone pancreatitis; however, there is no consensus and none of these parameters is specific.
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most sensitive at predicting GP are what labs
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arious studies have shown aspartate aminotransferase (AST), bilirubin, alkaline phosphatase, or γ-glutamyl transpeptidase (GGTP) to be most sensitive at predicting gallstone pancreatitis; however, there is no consensus and none of these parameters is specific.
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most sensitive at predicting GP are what labs
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arious studies have shown aspartate aminotransferase (AST), bilirubin, alkaline phosphatase, or γ-glutamyl transpeptidase (GGTP) to be most sensitive at predicting gallstone pancreatitis; however, there is no consensus and none of these parameters is specific.
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good at identifying gallstones, with 92% accuracy, and has the advantages of being widely available, inexpensive, and noninvasive.
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Abd US However, as 10% of the adult population have gallstones, this is not adequate for the diagnosis of gallstone pancreatitis.
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good at identifying gallstones, with 92% accuracy, and has the advantages of being widely available, inexpensive, and noninvasive.
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Abd US However, as 10% of the adult population have gallstones, this is not adequate for the diagnosis of gallstone pancreatitis.
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good at identifying gallstones, with 92% accuracy, and has the advantages of being widely available, inexpensive, and noninvasive.
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Abd US However, as 10% of the adult population have gallstones, this is not adequate for the diagnosis of gallstone pancreatitis.
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what are the other imagin abnormalities
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T is good at identifying cholelithiasis and can be used to measure common bile duct diameter. Additionally, helical CT cholangiography is an evolving technique that has sensitivities as high as 95% in diagnosing choledocholithiasis; however, the contrast agents required cause significant nausea, and the technique is not highly utilized.
MRCP is an accurate and noninvasive modality, with a sensitivity and specificity for detecting choledocholithiasis of 81-100% and 92-100%, respectively. Although MRCP is expensive and may miss stones smaller than 5 mm, the technique is comparable to diagnostic ERCP and intraoperative cholangiography and has emerged as the noninvasive diagnostic modality of choice. EUS also has sensitivity and specificity of 88-97% and 96-100%, respectively; however, the technique is invasive and requires sedation. Thus, the role of EUS is not well established in most centers where MRCP is available. ERCP was historically the diagnostic procedure of choice with accuracy similar to MRCP; however, it is associated with complication rates as high as 15% that include cholangitis, pancreatitis, perforation, and bleeding. With improved accuracy and increased availability of less invasive modalities, ERCP is no longer considered to be a first-line diagnostic procedure |
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what are the other imagin abnormalities
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T is good at identifying cholelithiasis and can be used to measure common bile duct diameter. Additionally, helical CT cholangiography is an evolving technique that has sensitivities as high as 95% in diagnosing choledocholithiasis; however, the contrast agents required cause significant nausea, and the technique is not highly utilized.
MRCP is an accurate and noninvasive modality, with a sensitivity and specificity for detecting choledocholithiasis of 81-100% and 92-100%, respectively. Although MRCP is expensive and may miss stones smaller than 5 mm, the technique is comparable to diagnostic ERCP and intraoperative cholangiography and has emerged as the noninvasive diagnostic modality of choice. EUS also has sensitivity and specificity of 88-97% and 96-100%, respectively; however, the technique is invasive and requires sedation. Thus, the role of EUS is not well established in most centers where MRCP is available. ERCP was historically the diagnostic procedure of choice with accuracy similar to MRCP; however, it is associated with complication rates as high as 15% that include cholangitis, pancreatitis, perforation, and bleeding. With improved accuracy and increased availability of less invasive modalities, ERCP is no longer considered to be a first-line diagnostic procedure |
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what are the other imagin abnormalities
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T is good at identifying cholelithiasis and can be used to measure common bile duct diameter. Additionally, helical CT cholangiography is an evolving technique that has sensitivities as high as 95% in diagnosing choledocholithiasis; however, the contrast agents required cause significant nausea, and the technique is not highly utilized.
MRCP is an accurate and noninvasive modality, with a sensitivity and specificity for detecting choledocholithiasis of 81-100% and 92-100%, respectively. Although MRCP is expensive and may miss stones smaller than 5 mm, the technique is comparable to diagnostic ERCP and intraoperative cholangiography and has emerged as the noninvasive diagnostic modality of choice. EUS also has sensitivity and specificity of 88-97% and 96-100%, respectively; however, the technique is invasive and requires sedation. Thus, the role of EUS is not well established in most centers where MRCP is available. ERCP was historically the diagnostic procedure of choice with accuracy similar to MRCP; however, it is associated with complication rates as high as 15% that include cholangitis, pancreatitis, perforation, and bleeding. With improved accuracy and increased availability of less invasive modalities, ERCP is no longer considered to be a first-line diagnostic procedure |
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The management of acute gallstone pancreatitis has been controversial. but what is to be done
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Supportive care with aggressive intravenous hydration, nothing by mouth, and pain control is similar to the management of pancreatitis due to other etiologies; however, timing and method of common bile duct exploration for possible gallstone removal have been the focus of many studies. It is clear that ERCP is favored over surgery due to significantly better patient outcomes, with lower morbidity and mortality
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The management of acute gallstone pancreatitis has been controversial. but what is to be done
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Supportive care with aggressive intravenous hydration, nothing by mouth, and pain control is similar to the management of pancreatitis due to other etiologies; however, timing and method of common bile duct exploration for possible gallstone removal have been the focus of many studies. It is clear that ERCP is favored over surgery due to significantly better patient outcomes, with lower morbidity and mortality
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The management of acute gallstone pancreatitis has been controversial. but what is to be done
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Supportive care with aggressive intravenous hydration, nothing by mouth, and pain control is similar to the management of pancreatitis due to other etiologies; however, timing and method of common bile duct exploration for possible gallstone removal have been the focus of many studies. It is clear that ERCP is favored over surgery due to significantly better patient outcomes, with lower morbidity and mortality
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The management of acute gallstone pancreatitis has been controversial. but what is to be done
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Supportive care with aggressive intravenous hydration, nothing by mouth, and pain control is similar to the management of pancreatitis due to other etiologies; however, timing and method of common bile duct exploration for possible gallstone removal have been the focus of many studies. It is clear that ERCP is favored over surgery due to significantly better patient outcomes, with lower morbidity and mortality
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What appears to be consistent is that in patients with biliary pancreatitis and associated cholangitis what is indicated
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early drainage is indicated, typically within 48 hours of onset and after initial stabilization. Additionally, patients with clinical deterioration, as indicated by fever, increasing pain, and confusion, are likely to benefit from urgent ERCP. In patients without obstructive jaundice, early ERCP does not appear to be beneficial. Also, in patients with a mild course of biliary pancreatitis, up to 80% will have already passed the culprit stone and urgent ERCP is not recommended.
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What appears to be consistent is that in patients with biliary pancreatitis and associated cholangitis what is indicated
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early drainage is indicated, typically within 48 hours of onset and after initial stabilization. Additionally, patients with clinical deterioration, as indicated by fever, increasing pain, and confusion, are likely to benefit from urgent ERCP. In patients without obstructive jaundice, early ERCP does not appear to be beneficial. Also, in patients with a mild course of biliary pancreatitis, up to 80% will have already passed the culprit stone and urgent ERCP is not recommended.
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What appears to be consistent is that in patients with biliary pancreatitis and associated cholangitis what is indicated
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early drainage is indicated, typically within 48 hours of onset and after initial stabilization. Additionally, patients with clinical deterioration, as indicated by fever, increasing pain, and confusion, are likely to benefit from urgent ERCP. In patients without obstructive jaundice, early ERCP does not appear to be beneficial. Also, in patients with a mild course of biliary pancreatitis, up to 80% will have already passed the culprit stone and urgent ERCP is not recommended.
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lthough endoscopic sphincterotomy has been shown to be protective regarding future episodes what is the preffered standard of care
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cholecystectomy is the standard of care. More than 25% of patients who do not undergo cholecystectomy will have a recurrent episode, or related biliary complication, in the following 6 weeks. Early cholecystectomy is safe, and the preferred timing is upon resolution of pancreatitis and prior to hospital discharge.
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lthough endoscopic sphincterotomy has been shown to be protective regarding future episodes what is the preffered standard of care
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cholecystectomy is the standard of care. More than 25% of patients who do not undergo cholecystectomy will have a recurrent episode, or related biliary complication, in the following 6 weeks. Early cholecystectomy is safe, and the preferred timing is upon resolution of pancreatitis and prior to hospital discharge.
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lthough endoscopic sphincterotomy has been shown to be protective regarding future episodes what is the preffered standard of care
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cholecystectomy is the standard of care. More than 25% of patients who do not undergo cholecystectomy will have a recurrent episode, or related biliary complication, in the following 6 weeks. Early cholecystectomy is safe, and the preferred timing is upon resolution of pancreatitis and prior to hospital discharge.
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Biliary colic results from
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obstruction of the cystic duct or common bile duct by a stone that, by distention of the viscus, causes visceral pain that usually is a severe, steady ache or fullness in the epigastrium or right upper quadrant of the abdomen, frequently radiating to the interscapular area, right scapula, or shoulder.
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Biliary colic results from
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obstruction of the cystic duct or common bile duct by a stone that, by distention of the viscus, causes visceral pain that usually is a severe, steady ache or fullness in the epigastrium or right upper quadrant of the abdomen, frequently radiating to the interscapular area, right scapula, or shoulder.
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Biliary colic results from
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obstruction of the cystic duct or common bile duct by a stone that, by distention of the viscus, causes visceral pain that usually is a severe, steady ache or fullness in the epigastrium or right upper quadrant of the abdomen, frequently radiating to the interscapular area, right scapula, or shoulder.
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-Ultrasonography of the right upper quadrant is the method of choice for the diagnosis of gallbladder stones (see Figure 9-35). Its sensitivity is greater than
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95% for the detection of gallstones 1.5 mm or more in diameter.
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-Ultrasonography of the right upper quadrant is the method of choice for the diagnosis of gallbladder stones (see Figure 9-35). Its sensitivity is greater than
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95% for the detection of gallstones 1.5 mm or more in diameter.
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-Ultrasonography of the right upper quadrant is the method of choice for the diagnosis of gallbladder stones (see Figure 9-35). Its sensitivity is greater than
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95% for the detection of gallstones 1.5 mm or more in diameter.
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Its sensitivity is greater than 95% for the detection of gallstones 1.5 mm or more in diameter. Complete imaging of the gallbladder in various planes and in at least two positions of the patient is mandatory. The characteristic finding is
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The characteristic finding is a mobile echogenic focus with an acoustic shadow within the gallbladder lumen that moves in a gravity-dependent fashion with the patient's position. The gravity-dependent mobility of the echogenic foci allows differentiation from gallbladder polyps or carcinoma.
Ultrasonography also offers information about the size of the gallbladder, the presence of a thickened gallbladder wall, and pericholecystic fluid (signs of acute cholecystitis). Ultrasonography has high sensitivity (94%) and specificity (78%) for the diagnosis of acute cholecystitis. Complications such as perforation into the abdominal cavity can be detected or excluded. Bile duct dilation may point toward bile duct obstruction. For the detection of bile duct stones, however, ultrasonography offers only low to moderate sensitivity (see below). |
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Its sensitivity is greater than 95% for the detection of gallstones 1.5 mm or more in diameter. Complete imaging of the gallbladder in various planes and in at least two positions of the patient is mandatory. The characteristic finding is
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The characteristic finding is a mobile echogenic focus with an acoustic shadow within the gallbladder lumen that moves in a gravity-dependent fashion with the patient's position. The gravity-dependent mobility of the echogenic foci allows differentiation from gallbladder polyps or carcinoma.
Ultrasonography also offers information about the size of the gallbladder, the presence of a thickened gallbladder wall, and pericholecystic fluid (signs of acute cholecystitis). Ultrasonography has high sensitivity (94%) and specificity (78%) for the diagnosis of acute cholecystitis. Complications such as perforation into the abdominal cavity can be detected or excluded. Bile duct dilation may point toward bile duct obstruction. For the detection of bile duct stones, however, ultrasonography offers only low to moderate sensitivity (see below). |
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Its sensitivity is greater than 95% for the detection of gallstones 1.5 mm or more in diameter. Complete imaging of the gallbladder in various planes and in at least two positions of the patient is mandatory. The characteristic finding is
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The characteristic finding is a mobile echogenic focus with an acoustic shadow within the gallbladder lumen that moves in a gravity-dependent fashion with the patient's position. The gravity-dependent mobility of the echogenic foci allows differentiation from gallbladder polyps or carcinoma.
Ultrasonography also offers information about the size of the gallbladder, the presence of a thickened gallbladder wall, and pericholecystic fluid (signs of acute cholecystitis). Ultrasonography has high sensitivity (94%) and specificity (78%) for the diagnosis of acute cholecystitis. Complications such as perforation into the abdominal cavity can be detected or excluded. Bile duct dilation may point toward bile duct obstruction. For the detection of bile duct stones, however, ultrasonography offers only low to moderate sensitivity (see below). |
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Its sensitivity is greater than 95% for the detection of gallstones 1.5 mm or more in diameter. Complete imaging of the gallbladder in various planes and in at least two positions of the patient is mandatory. The characteristic finding is
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The characteristic finding is a mobile echogenic focus with an acoustic shadow within the gallbladder lumen that moves in a gravity-dependent fashion with the patient's position. The gravity-dependent mobility of the echogenic foci allows differentiation from gallbladder polyps or carcinoma.
Ultrasonography also offers information about the size of the gallbladder, the presence of a thickened gallbladder wall, and pericholecystic fluid (signs of acute cholecystitis). Ultrasonography has high sensitivity (94%) and specificity (78%) for the diagnosis of acute cholecystitis. Complications such as perforation into the abdominal cavity can be detected or excluded. Bile duct dilation may point toward bile duct obstruction. For the detection of bile duct stones, however, ultrasonography offers only low to moderate sensitivity (see below). |
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less sensitive and more expensive than ultrasound and requires exposure to radiation
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Computed tomography (CT)
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less sensitive and more expensive than ultrasound and requires exposure to radiation
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Computed tomography (CT)
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Magnetic resonance imaging (MRI) and cholangiopancreatography (MRCP)
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MRI is not recommended for screening for gallstones, but is useful for visualizing pancreatic ducts and bile ducts and has excellent sensitivity for bile duct or pancreatic duct dilations. Its sensitivity for detection of bile duct stones is approximately 85%. MRCP can be used as an alternative to ERCP to exclude bile duct stones in the preoperative screening of patients undergoing laparoscopic cholecystectomy if there is a low to intermediate level of suspicion for bile duct stones.
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Magnetic resonance imaging (MRI) and cholangiopancreatography (MRCP)
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MRI is not recommended for screening for gallstones, but is useful for visualizing pancreatic ducts and bile ducts and has excellent sensitivity for bile duct or pancreatic duct dilations. Its sensitivity for detection of bile duct stones is approximately 85%. MRCP can be used as an alternative to ERCP to exclude bile duct stones in the preoperative screening of patients undergoing laparoscopic cholecystectomy if there is a low to intermediate level of suspicion for bile duct stones.
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Magnetic resonance imaging (MRI) and cholangiopancreatography (MRCP)
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MRI is not recommended for screening for gallstones, but is useful for visualizing pancreatic ducts and bile ducts and has excellent sensitivity for bile duct or pancreatic duct dilations. Its sensitivity for detection of bile duct stones is approximately 85%. MRCP can be used as an alternative to ERCP to exclude bile duct stones in the preoperative screening of patients undergoing laparoscopic cholecystectomy if there is a low to intermediate level of suspicion for bile duct stones.
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This is the most sensitive method for the detection of ampullary stones.
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Endoscopic ultrasound
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This is the most sensitive method for the detection of ampullary stones.
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Endoscopic ultrasound
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This is the most sensitive method for the detection of ampullary stones.
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Endoscopic ultrasound
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The differential diagnosis of acute right upper quadrant abdominal pain should include
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duodenal ulcer disease, acute pancreatitis, appendicitis, duodenal obstruction, lower rib margin syndrome, right lower lobe pneumonia, mesenteric vascular ischemia, and gastroparesis. An ultrasound examination and, if necessary, a HIDA scan will help establish the diagnosis of acute cholecystitis.
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The differential diagnosis of acute right upper quadrant abdominal pain should include
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duodenal ulcer disease, acute pancreatitis, appendicitis, duodenal obstruction, lower rib margin syndrome, right lower lobe pneumonia, mesenteric vascular ischemia, and gastroparesis. An ultrasound examination and, if necessary, a HIDA scan will help establish the diagnosis of acute cholecystitis.
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The differential diagnosis of acute right upper quadrant abdominal pain should include
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duodenal ulcer disease, acute pancreatitis, appendicitis, duodenal obstruction, lower rib margin syndrome, right lower lobe pneumonia, mesenteric vascular ischemia, and gastroparesis. An ultrasound examination and, if necessary, a HIDA scan will help establish the diagnosis of acute cholecystitis.
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Acute cholecystitis is the most frequent complication of gallstone disease. In 90% of patients it is caused by a transient or permanent obstruction of the cystic duct by a stone. It represents an inflammatory response to mechanical, chemical, or bacterial causes. The increased intraluminal pressure and distention of the gallbladder result
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in ischemia of the mucosa and the wall of the gallbladder. Inflammatory agents, such as lysolecithin, and local tissue factors may be released. Bacterial inflammation playing a role in 50-85% of patients with acute cholecystitis and, in general, is a secondary event occurring late in the course. The organisms most frequently isolated by culture of gallbladder bile in these patients include Escherichia coli, Klebsiella species, Streptococcus species, and Clostridium species.
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Acute cholecystitis is the most frequent complication of gallstone disease. In 90% of patients it is caused by a transient or permanent obstruction of the cystic duct by a stone. It represents an inflammatory response to mechanical, chemical, or bacterial causes. The increased intraluminal pressure and distention of the gallbladder result
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in ischemia of the mucosa and the wall of the gallbladder. Inflammatory agents, such as lysolecithin, and local tissue factors may be released. Bacterial inflammation playing a role in 50-85% of patients with acute cholecystitis and, in general, is a secondary event occurring late in the course. The organisms most frequently isolated by culture of gallbladder bile in these patients include Escherichia coli, Klebsiella species, Streptococcus species, and Clostridium species.
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Acute cholecystitis is the most frequent complication of gallstone disease. In 90% of patients it is caused by a transient or permanent obstruction of the cystic duct by a stone. It represents an inflammatory response to mechanical, chemical, or bacterial causes. The increased intraluminal pressure and distention of the gallbladder result
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in ischemia of the mucosa and the wall of the gallbladder. Inflammatory agents, such as lysolecithin, and local tissue factors may be released. Bacterial inflammation playing a role in 50-85% of patients with acute cholecystitis and, in general, is a secondary event occurring late in the course. The organisms most frequently isolated by culture of gallbladder bile in these patients include Escherichia coli, Klebsiella species, Streptococcus species, and Clostridium species.
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he organisms most frequently isolated by culture of gallbladder bile in these patients include
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Escherichia coli, Klebsiella species, Streptococcus species, and Clostridium species.
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he organisms most frequently isolated by culture of gallbladder bile in these patients include
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Escherichia coli, Klebsiella species, Streptococcus species, and Clostridium species.
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he organisms most frequently isolated by culture of gallbladder bile in these patients include
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Escherichia coli, Klebsiella species, Streptococcus species, and Clostridium species.
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Physical examination of patients with acute cholecystitis reveals right upper quadrant tenderness. Usually there is marked tenderness and inhibition of inspiration on deep palpation under the right subcostal margin (Murphy sign). An enlarged, tense gallbladder is palpable in about one third of patients, often associated with a
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stone in the neck of the gallbladder
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Physical examination of patients with acute cholecystitis reveals right upper quadrant tenderness. Usually there is marked tenderness and inhibition of inspiration on deep palpation under the right subcostal margin (Murphy sign). An enlarged, tense gallbladder is palpable in about one third of patients, often associated with a
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stone in the neck of the gallbladder
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Physical examination of patients with acute cholecystitis reveals right upper quadrant tenderness. Usually there is marked tenderness and inhibition of inspiration on deep palpation under the right subcostal margin (Murphy sign). An enlarged, tense gallbladder is palpable in about one third of patients, often associated with a
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stone in the neck of the gallbladder
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Physical examination of patients with acute cholecystitis reveals right upper quadrant tenderness. Usually there is marked tenderness and inhibition of inspiration on deep palpation under the right subcostal margin (Murphy sign). An enlarged, tense gallbladder is palpable in about one third of patients, often associated with a
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stone in the neck of the gallbladder
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Mirizzi syndrome is a rare complication in whic
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a gallstone becomes impacted in the neck of the gallbladder or cystic duct, causing compression of the common bile duct and obstructive jaundice.
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Mirizzi syndrome is a rare complication in whic
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a gallstone becomes impacted in the neck of the gallbladder or cystic duct, causing compression of the common bile duct and obstructive jaundice.
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Mirizzi syndrome is a rare complication in whic
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a gallstone becomes impacted in the neck of the gallbladder or cystic duct, causing compression of the common bile duct and obstructive jaundice.
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Most patients with common bile duct stones (choledocho) present with
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biliary pain accompanied by abnormal liver tests with or without jaundice. Major complications of choledocholithiasis are obstructive jaundice, cholangitis, pancreatitis, and secondary biliary cirrhosis.
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Most patients with common bile duct stones (choledocho) present with
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biliary pain accompanied by abnormal liver tests with or without jaundice. Major complications of choledocholithiasis are obstructive jaundice, cholangitis, pancreatitis, and secondary biliary cirrhosis.
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Most patients with common bile duct stones (choledocho) present with
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biliary pain accompanied by abnormal liver tests with or without jaundice. Major complications of choledocholithiasis are obstructive jaundice, cholangitis, pancreatitis, and secondary biliary cirrhosis.
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If direct proof or exclusion of bile duct stones by ultrasonography is not possible, clinical symptoms and signs of biliary obstruction guide the planning of further diagnostic measures. If there is high suspicion of the presence of a bile duct stone what is indicated
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endoscopic retrograde cholangiography (ERC) is indicated because it permits simultaneous therapeutic intervention (endoscopic papillotomy and stone extraction).
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If direct proof or exclusion of bile duct stones by ultrasonography is not possible, clinical symptoms and signs of biliary obstruction guide the planning of further diagnostic measures. If there is high suspicion of the presence of a bile duct stone what is indicated
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endoscopic retrograde cholangiography (ERC) is indicated because it permits simultaneous therapeutic intervention (endoscopic papillotomy and stone extraction).
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If direct proof or exclusion of bile duct stones by ultrasonography is not possible, clinical symptoms and signs of biliary obstruction guide the planning of further diagnostic measures. If there is high suspicion of the presence of a bile duct stone what is indicated
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endoscopic retrograde cholangiography (ERC) is indicated because it permits simultaneous therapeutic intervention (endoscopic papillotomy and stone extraction).
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The characteristic presentation of cholangitis involves
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biliary pain, jaundice, and spiking fevers with chills (the Charcot triad). Leukocytosis is typical, and blood cultures are positive in about 75% of patients.
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The characteristic presentation of cholangitis involves
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biliary pain, jaundice, and spiking fevers with chills (the Charcot triad). Leukocytosis is typical, and blood cultures are positive in about 75% of patients.
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The characteristic presentation of cholangitis involves
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biliary pain, jaundice, and spiking fevers with chills (the Charcot triad). Leukocytosis is typical, and blood cultures are positive in about 75% of patients.
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The characteristic presentation of cholangitis involves
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biliary pain, jaundice, and spiking fevers with chills (the Charcot triad). Leukocytosis is typical, and blood cultures are positive in about 75% of patients.
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Preoperative diagnostic studies-Preoperative ultrasonography must be performed not only for diagnosis of gallbladder stones but also for detection of potential complications. Preoperative determination of liver enzymes (GGT, alkaline phosphatase, transaminases) and serum bilirubin is mandatory to assess the likelihood of simultaneous bile duct stones or preexisting liver disease. The likelihood of simultaneous bile duct stones is high if the
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diameter of the common bile duct is greater than 6-8 mm and GGT, alkaline phosphatase, or serum bilirubin value is elevated.
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Preoperative diagnostic studies-Preoperative ultrasonography must be performed not only for diagnosis of gallbladder stones but also for detection of potential complications. Preoperative determination of liver enzymes (GGT, alkaline phosphatase, transaminases) and serum bilirubin is mandatory to assess the likelihood of simultaneous bile duct stones or preexisting liver disease. The likelihood of simultaneous bile duct stones is high if the
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diameter of the common bile duct is greater than 6-8 mm and GGT, alkaline phosphatase, or serum bilirubin value is elevated.
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Preoperative diagnostic studies-Preoperative ultrasonography must be performed not only for diagnosis of gallbladder stones but also for detection of potential complications. Preoperative determination of liver enzymes (GGT, alkaline phosphatase, transaminases) and serum bilirubin is mandatory to assess the likelihood of simultaneous bile duct stones or preexisting liver disease. The likelihood of simultaneous bile duct stones is high if the
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diameter of the common bile duct is greater than 6-8 mm and GGT, alkaline phosphatase, or serum bilirubin value is elevated.
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autoantibodies against the ADAMTS-13 (A disintegrin and metalloproteinase with thrombospondin type 1 repeat, member 13) molecule, also known as the von Willebrand factor cleaving protease (vWFCP), leads to accumulation of ultra-large von Willebrand factor (vWF) multimers that bridge platelets and facilitate excessive platelet aggregatio
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idiopathic TTP
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autoantibodies against the ADAMTS-13 (A disintegrin and metalloproteinase with thrombospondin type 1 repeat, member 13) molecule, also known as the von Willebrand factor cleaving protease (vWFCP), leads to accumulation of ultra-large von Willebrand factor (vWF) multimers that bridge platelets and facilitate excessive platelet aggregatio
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idiopathic TTP
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autoantibodies against the ADAMTS-13 (A disintegrin and metalloproteinase with thrombospondin type 1 repeat, member 13) molecule, also known as the von Willebrand factor cleaving protease (vWFCP), leads to accumulation of ultra-large von Willebrand factor (vWF) multimers that bridge platelets and facilitate excessive platelet aggregatio
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idiopathic TTP
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Only approximately 25% of patients with TMA manifest all components of the so-called pentad of findings which is?
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microangiopathic hemolytic anemia, thrombocytopenia, fever, renal insufficiency, and neurologic system abnormalities)
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Only approximately 25% of patients with TMA manifest all components of the so-called pentad of findings which is?
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microangiopathic hemolytic anemia, thrombocytopenia, fever, renal insufficiency, and neurologic system abnormalities)
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Only approximately 25% of patients with TMA manifest all components of the so-called pentad of findings which is?
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microangiopathic hemolytic anemia, thrombocytopenia, fever, renal insufficiency, and neurologic system abnormalities)
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Only approximately 25% of patients with TMA manifest all components of the so-called pentad of findings which is?
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microangiopathic hemolytic anemia, thrombocytopenia, fever, renal insufficiency, and neurologic system abnormalities)
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Only approximately 25% of patients with TMA manifest all components of the so-called pentad of findings which is?
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microangiopathic hemolytic anemia, thrombocytopenia, fever, renal insufficiency, and neurologic system abnormalities)
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Laboratory features of TMA include those associated with microangiopathic hemolytic anemia
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anemia, elevated lactate dehydrogenase (LD), elevated indirect bilirubin, decreased haptoglobin, reticulocytosis, negative direct antiglobulin test, and schistocytes on the blood smear); thrombocytopenia; elevated creatinine; positive stool culture for E coli O157:H7 or assays for Shiga-like toxins (cases of HUS only); and reductions in vWFCP activity. Notably, routine coagulation studies are within the normal range in most patients with TMA.
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Laboratory features of TMA include those associated with microangiopathic hemolytic anemia
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anemia, elevated lactate dehydrogenase (LD), elevated indirect bilirubin, decreased haptoglobin, reticulocytosis, negative direct antiglobulin test, and schistocytes on the blood smear); thrombocytopenia; elevated creatinine; positive stool culture for E coli O157:H7 or assays for Shiga-like toxins (cases of HUS only); and reductions in vWFCP activity. Notably, routine coagulation studies are within the normal range in most patients with TMA.
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Laboratory features of TMA include those associated with microangiopathic hemolytic anemia
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anemia, elevated lactate dehydrogenase (LD), elevated indirect bilirubin, decreased haptoglobin, reticulocytosis, negative direct antiglobulin test, and schistocytes on the blood smear); thrombocytopenia; elevated creatinine; positive stool culture for E coli O157:H7 or assays for Shiga-like toxins (cases of HUS only); and reductions in vWFCP activity. Notably, routine coagulation studies are within the normal range in most patients with TMA.
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Laboratory features of TMA include those associated with microangiopathic hemolytic anemia
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anemia, elevated lactate dehydrogenase (LD), elevated indirect bilirubin, decreased haptoglobin, reticulocytosis, negative direct antiglobulin test, and schistocytes on the blood smear); thrombocytopenia; elevated creatinine; positive stool culture for E coli O157:H7 or assays for Shiga-like toxins (cases of HUS only); and reductions in vWFCP activity. Notably, routine coagulation studies are within the normal range in most patients with TMA.
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Laboratory features of TMA include those associated with microangiopathic hemolytic anemia
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anemia, elevated lactate dehydrogenase (LD), elevated indirect bilirubin, decreased haptoglobin, reticulocytosis, negative direct antiglobulin test, and schistocytes on the blood smear); thrombocytopenia; elevated creatinine; positive stool culture for E coli O157:H7 or assays for Shiga-like toxins (cases of HUS only); and reductions in vWFCP activity. Notably, routine coagulation studies are within the normal range in most patients with TMA.
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Immediate administration of what is essential in TMA
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plasma exchange is essential in most cases due to the mortality rate of > 95% without treatment. With the exception of children or adults with endemic diarrhea-associated HUS, who generally recover with supportive care only, plasma exchange must be initiated as soon as the diagnosis of TMA is suspected. Plasma exchange usually is administered once daily until the platelet count and LD have returned to normal for at least 2 days
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Immediate administration of what is essential in TMA
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plasma exchange is essential in most cases due to the mortality rate of > 95% without treatment. With the exception of children or adults with endemic diarrhea-associated HUS, who generally recover with supportive care only, plasma exchange must be initiated as soon as the diagnosis of TMA is suspected. Plasma exchange usually is administered once daily until the platelet count and LD have returned to normal for at least 2 days
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Immediate administration of what is essential in TMA
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plasma exchange is essential in most cases due to the mortality rate of > 95% without treatment. With the exception of children or adults with endemic diarrhea-associated HUS, who generally recover with supportive care only, plasma exchange must be initiated as soon as the diagnosis of TMA is suspected. Plasma exchange usually is administered once daily until the platelet count and LD have returned to normal for at least 2 days
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Immediate administration of what is essential in TMA
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plasma exchange is essential in most cases due to the mortality rate of > 95% without treatment. With the exception of children or adults with endemic diarrhea-associated HUS, who generally recover with supportive care only, plasma exchange must be initiated as soon as the diagnosis of TMA is suspected. Plasma exchange usually is administered once daily until the platelet count and LD have returned to normal for at least 2 days
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Immediate administration of what is essential in TMA
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plasma exchange is essential in most cases due to the mortality rate of > 95% without treatment. With the exception of children or adults with endemic diarrhea-associated HUS, who generally recover with supportive care only, plasma exchange must be initiated as soon as the diagnosis of TMA is suspected. Plasma exchange usually is administered once daily until the platelet count and LD have returned to normal for at least 2 days
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are contraindicated in the treatment of TMAs due to reports of worsening thrombotic microangiopathy, possibly due to propagation of platelet-rich microthrombi
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Platelet transfusions
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are contraindicated in the treatment of TMAs due to reports of worsening thrombotic microangiopathy, possibly due to propagation of platelet-rich microthrombi
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Platelet transfusions
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are contraindicated in the treatment of TMAs due to reports of worsening thrombotic microangiopathy, possibly due to propagation of platelet-rich microthrombi
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Platelet transfusions
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are contraindicated in the treatment of TMAs due to reports of worsening thrombotic microangiopathy, possibly due to propagation of platelet-rich microthrombi
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Platelet transfusions
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Heparin-induced thrombocytopenia (HIT) is an acquired disorder that affects approximatel
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3% of patients who are exposed to unfractionated heparin and 0.6% of patients who are exposed to low molecular-weight heparin (LMWH).
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Heparin-induced thrombocytopenia (HIT) is an acquired disorder that affects approximatel
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3% of patients who are exposed to unfractionated heparin and 0.6% of patients who are exposed to low molecular-weight heparin (LMWH).
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Heparin-induced thrombocytopenia (HIT) is an acquired disorder that affects approximatel
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3% of patients who are exposed to unfractionated heparin and 0.6% of patients who are exposed to low molecular-weight heparin (LMWH).
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HIT results from
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The condition results from formation of IgG antibodies to heparin-platelet factor 4 (PF4) complexes; the antibodies then bind platelets, which activates them. Platelet activation leads to both thrombocytopenia and a pro-thrombotic state.
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HIT results from
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The condition results from formation of IgG antibodies to heparin-platelet factor 4 (PF4) complexes; the antibodies then bind platelets, which activates them. Platelet activation leads to both thrombocytopenia and a pro-thrombotic state.
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HIT results from
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The condition results from formation of IgG antibodies to heparin-platelet factor 4 (PF4) complexes; the antibodies then bind platelets, which activates them. Platelet activation leads to both thrombocytopenia and a pro-thrombotic state.
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Confirmation of the HIT diagnosis can be obtained through a
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positive PF4-heparin antibody enzyme-linked immunosorbent assay (ELISA) or functional assay (such as serotonin release assay), or both.
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Confirmation of the HIT diagnosis can be obtained through a
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positive PF4-heparin antibody enzyme-linked immunosorbent assay (ELISA) or functional assay (such as serotonin release assay), or both.
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Confirmation of the HIT diagnosis can be obtained through a
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positive PF4-heparin antibody enzyme-linked immunosorbent assay (ELISA) or functional assay (such as serotonin release assay), or both.
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Management of HIT (Table 14-6) involves the immediate discontinuation of all forms of heparin. If thrombosis has not already been detected
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duplex Doppler ultrasound of the lower extremities should be performed to rule out subclinical deep venous thrombosis. Despite thrombocytopenia, platelet transfusions are rarely necessary
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Management of HIT (Table 14-6) involves the immediate discontinuation of all forms of heparin. If thrombosis has not already been detected
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duplex Doppler ultrasound of the lower extremities should be performed to rule out subclinical deep venous thrombosis. Despite thrombocytopenia, platelet transfusions are rarely necessary
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Management of HIT (Table 14-6) involves the immediate discontinuation of all forms of heparin. If thrombosis has not already been detected
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duplex Doppler ultrasound of the lower extremities should be performed to rule out subclinical deep venous thrombosis. Despite thrombocytopenia, platelet transfusions are rarely necessary
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Due to the substantial frequency of thrombosis among HIT patients, an alternative anticoagulant, typically a
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direct thrombin inhibitor (DTI) such as argatroban or lepirudin should be administered immediately
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Due to the substantial frequency of thrombosis among HIT patients, an alternative anticoagulant, typically a
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direct thrombin inhibitor (DTI) such as argatroban or lepirudin should be administered immediately
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Due to the substantial frequency of thrombosis among HIT patients, an alternative anticoagulant, typically a
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direct thrombin inhibitor (DTI) such as argatroban or lepirudin should be administered immediately
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Due to the substantial frequency of thrombosis among HIT patients, an alternative anticoagulant, typically a
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direct thrombin inhibitor (DTI) such as argatroban or lepirudin should be administered immediately
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The DTI should be continued in HIT until the platelet count has recovered to at least
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The DTI should be continued until the platelet count has recovered to at least 100,000/mcL, at which point treatment with a vitamin K antagonist (warfarin) may be initiated. The DTI should be continued until therapeutic anticoagulation with the vitamin K antagonist has been demonstrated by virtue of an international normalized ratio (INR) of 2.0-3.0 (requires temporary discontinuation of argatroban, if it is being used, as it also prolongs the INR).
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The DTI should be continued in HIT until the platelet count has recovered to at least
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The DTI should be continued until the platelet count has recovered to at least 100,000/mcL, at which point treatment with a vitamin K antagonist (warfarin) may be initiated. The DTI should be continued until therapeutic anticoagulation with the vitamin K antagonist has been demonstrated by virtue of an international normalized ratio (INR) of 2.0-3.0 (requires temporary discontinuation of argatroban, if it is being used, as it also prolongs the INR).
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The DTI should be continued in HIT until the platelet count has recovered to at least
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The DTI should be continued until the platelet count has recovered to at least 100,000/mcL, at which point treatment with a vitamin K antagonist (warfarin) may be initiated. The DTI should be continued until therapeutic anticoagulation with the vitamin K antagonist has been demonstrated by virtue of an international normalized ratio (INR) of 2.0-3.0 (requires temporary discontinuation of argatroban, if it is being used, as it also prolongs the INR).
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purpura fulminans
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leeding in DIC usually occurs at multiple sites, such as intravenous catheters or incisions, and may be widespread
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purpura fulminans
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leeding in DIC usually occurs at multiple sites, such as intravenous catheters or incisions, and may be widespread
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purpura fulminans
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leeding in DIC usually occurs at multiple sites, such as intravenous catheters or incisions, and may be widespread
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In Fresh frozen plasma should be given only to patients with
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prolonged aPTT and PT and significant bleeding; 4 units typically are administered at a time, and the posttransfusion platelet count should be documented. Cryoprecipitate may be given for bleeding and fibrinogen levels < 80-100 mg/dL. The PT, aPTT, fibrinogen, and platelet count should be monitored at least every 6 hours in acutely ill patients with DIC.
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In Fresh frozen plasma should be given only to patients with
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prolonged aPTT and PT and significant bleeding; 4 units typically are administered at a time, and the posttransfusion platelet count should be documented. Cryoprecipitate may be given for bleeding and fibrinogen levels < 80-100 mg/dL. The PT, aPTT, fibrinogen, and platelet count should be monitored at least every 6 hours in acutely ill patients with DIC.
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In Fresh frozen plasma should be given only to patients with
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prolonged aPTT and PT and significant bleeding; 4 units typically are administered at a time, and the posttransfusion platelet count should be documented. Cryoprecipitate may be given for bleeding and fibrinogen levels < 80-100 mg/dL. The PT, aPTT, fibrinogen, and platelet count should be monitored at least every 6 hours in acutely ill patients with DIC.
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In Fresh frozen plasma should be given only to patients with
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prolonged aPTT and PT and significant bleeding; 4 units typically are administered at a time, and the posttransfusion platelet count should be documented. Cryoprecipitate may be given for bleeding and fibrinogen levels < 80-100 mg/dL. The PT, aPTT, fibrinogen, and platelet count should be monitored at least every 6 hours in acutely ill patients with DIC.
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In Fresh frozen plasma should be given only to patients with
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prolonged aPTT and PT and significant bleeding; 4 units typically are administered at a time, and the posttransfusion platelet count should be documented. Cryoprecipitate may be given for bleeding and fibrinogen levels < 80-100 mg/dL. The PT, aPTT, fibrinogen, and platelet count should be monitored at least every 6 hours in acutely ill patients with DIC.
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In Fresh frozen plasma should be given only to patients with
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prolonged aPTT and PT and significant bleeding; 4 units typically are administered at a time, and the posttransfusion platelet count should be documented. Cryoprecipitate may be given for bleeding and fibrinogen levels < 80-100 mg/dL. The PT, aPTT, fibrinogen, and platelet count should be monitored at least every 6 hours in acutely ill patients with DIC.
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