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46 Cards in this Set

  • Front
  • Back
What is Hartmann's Pouch?
• a small pouch at the neck of the gallbladder
• location of most of the pathology
What is bile composed of?
• electrolytes
• protein
• bile salts
• cholesterol
• phospholipids
• bile pigment
What are causes of bile acid insufficiency?
• liver disease with decreased production of bile acids
• obstruction of the duct
• bacterial overgrowth (treated with tetracycline)
• disorders of the terminal ileum which decrease the absorption of bile salts
What is the most common type of gallstone?
Cholesterol (80%)
What is the most common cause of cholecystitis?
Cholelithiasis (85%-90% of cases)
What is the most sensitive, specific, noninvasive, and inexpensive test for the detection of gallstones?
When is a CT scan superior to ultrasound for detecting gallstones?
when the stone is in the distal common bile duct due toduodenum bowel gas cover
What are complications of cholelithiasis?
• acute cholecystitis
• cholangitis
• colic
• fistulization
• gallstone ileus
• perforation
Name and describe the 2 types of acute cholecystitis?
• Acute calculus cholecystitis: inflammation of gallbladder in association with stones
• Acute Acalculus cholecystitis: acute inflammation w/out the presense of stones; high incidence of gangrene, necrosis, perforation & high mortality rate
Where can pain from cholecystits radiate?
shoulder, back, tip of right scapula, or flank
What is the most sensitive and specific test for cholecystitis?
HIDA scan (does not detect gallstones but identifies an obstructed GB or biliary diskinesia)
What are the most common organisms found in biliary tract pathology?
• E. Coli
• Klebsiella species
• Streptococcus
What are complications of cholecystectomy?
• Common bile duct damage
• diarrhea
What are symptoms that can be caused by choledocholithiasis?
• Biliary Colic
• Cholangitis
• Hemobilia (fever, pain, blood in the intrahepatic system)
• Intermittent jaundice
• Obstructive jaundice
• Pancreatitis
What is Charcot's Triad and what condition is it seen in?
• seen in cholangitis (inflammation of the common bile duct)
• RUQ pain, jaundice, fever
What is the Choangitis pneumonic?
• Charcot's triad / Conjugated bilirubin increase
• Hepatic abscesses / Hepatic (intra/extra) bile ducts
• Obstruction
• Leukocytosis
• Alkaline phosphatase increase
• Neoplasms
• Gallstones
• Inflammatory bowel disease
• Transaminase increase
• Infection
• Sclerosing
What are characteristics of chronic cholecystitis?
• associated with gallstones 95% of the time
• fever is unusual
• pain after eating
• bloating, belching, and flatus
• Murphy's sign absent
• Labs are normal, but HIDA scan is positive
What is a Courvoisier's sign?
palpable gallbladder
What is Sclerosing cholangitis?
• an autoimmune inflammation of the bile ducts
• a rare complication of ulcerative colitis
What hormones are produced in the pancreas?
• insulin
• glucagon
• gastrin
• somatastatin
What enzymes are produced in the pancreas?
• amylase (digests carbohydrates)
• lipase (digests fats)
• trypsinogen (digests protein)
Why is trypsinogen convert to its active form trypsin in the duodenum?
to avoid autodigestion of the pancreas
What two hormones stimulate pancreatic secretion?
• Secretin: produced in the duodenum and stimulates the pancreas to produce bicarb & chlolride
• CCK: stimulates pancreas to produce amylase, lipase, & trypsin
What is pancreatitis?
an inflammatory process in which pancreatic enzymes autodigest the gland
What are the most common causes of pancreatitis?
Alcohol & gallstones (most common causes: 80-90%)
What are other causes of pancreatitis?
Pneumonic: I GET SMASHED
• Idiopathic
• Gallstones
• Ethanol
• Trauma
• Steroids
• Mumps
• Autoimmune
• Scorpion stings (for people for Trinidad)
• Hyperlipidemia / Hypercalcemia
• Drugs (azathiprine & diuretics)
What are symptoms of acute pancreatitis?
• epigastric pain with radiation to back
• nausea / vomiting
• aggravated by eating
• feels better leaning forward
What are key signs of acute pancreatitis?
• bowel sounds are feeble or absent
• low BP, thready pulse, diaphoresis
• low grade fever, tachycardia, tachypnea
• pleural effusion or basal consolidation of lung
• possible positive peritoneal signs
What is a Cullen sign?
• seen in acute pancreatitis
• discoloration of the periumbilical area
What is a Grey turner sign?
• seen in acute pancreatitis
• flank discoloration
Which test is more specific for pancreatitis, amylase or lipase?
What is the Ranson's critera on admission?
Pneumonic: GA LAW
• Glucose > 200
• AST > 250
• LDH > 350
• Age > 55 y/o
• WBC > 16,000
What is Ranson's Criteria for the initial 48 hours?
Pneumonic: C & HOBBS
• Calcium < 8
• Hct drop > 10%
• Oxygen (PO2) < 60 mm
• BUN rise > 5
• Base deficit > 4
• Sequestration of fluid > 6L
How do you interpret the Ranson's criteria score?
• under 3: predicted mortality about 1%
• 3-4: predicted mortality of 15%
• 5-6: predicted mortality of 40%
• > 6: predicted mortality of 100%
What is the most reliable imaging study in the diagnosis of acute pancreatitis?
• CT scan
• can visualize size of pancreas, extent of necrosis, & fluid retention
What is the treatment for pancreatitis?
Pneumonic: MACHINES
• Monitor vital signs
• Analgesia / Antibiotics
• Calcium gluconate (if necessary)
• H2 blockers
• IV access / IV fluids
• Empty gastric contents
• Surgery if required
What is the definition of chronic pancreatitis?
episode of acute inflammation in a previously injured pancreas
What are causes of chronic pancreatitis?
• Alcoholic abuse (most common cause)
• Pancreas divisum: failure of the ventral & dorsal pancreatic ducts to fuse
• Trauma
What is the most common cause of chronic pancreatitis in children?
cystic fibrosis
What are key symptoms of chronic pancreatitis?
• Epigastric tenderness radiating to the back, lasting hours to day, precipitated by alcohol
• streatorrhea (when 90% of pancreas is destroyed)
• sugar & vitamin B12 malabsorption
• Diabetes mellitus
What is the most common pancreatic carcinoma?
• Ductal carcinoma (accounts for more than 90% of all pancreatic carcinomas)
• most are adenocarcinoma of ampulla area
What are endocrine causes of pancreatic carcinoma?
• insulinoma
• gastrinoma
• glucagonoma
• somatostatinoma
• VIPoma
2/3 of pancreatic carcinoma occur where?
the head of the pancreas
How does pancreatic carcinoma presention differ if it is located in the head or in the tail?
• head: painless, non-pruritic, & jaundice
• tail: painful
What are classic findings of pancreatic carcinoma?
• none in early stages
• jaundice & icterus if common duct is obstructed
• Courvoisier's sign (palpable gallbladder)
• ascites & peripheral edema
• Trousseau's sign (superficial thrombophlebitis)
What are the different stages of a pancreatic carcinoma?
• Stage I - confined to pancreas
• Stage II - involving only the neighboring structures
• Stage III - involving regional lymph nodes
• Stage IV - Metastatic to liver & distant spread