Chapter 37, Alternations in Function of the Gallbladder and Exocrine Pancreas
Which patients may be at risk for development of cholesterol gallstones?
High Spinal Cord Injuries, Receiving Total PArenteral Nutrition Had Rapid Weight Loss Pregnant women
Lipase preferred test for pancreatitis
Increase in amylase and lipase during first 12 hr(indictative) Elevated aminotransferases, alkaline phosphataseand bilirubin
Pancreatitis is associated with with quadrant of pain
LUQ and Epigastric Pain
Chronic Pancreatitis may lead to
Diabetes Mellitus
Which finding would indicate a critical complication of acute pancreatitis
Dropping blood pressure
Acute Pancreatitis Clinical manifestations
Steady, boring pain in epigastrium or LUQ• Increases in intensity• Severe tenderness on palpation• Radiates or penetrates to back• Nausea and vomiting Abdominal distention• Hypoactive bowel sounds Low-grade fever
Pancreatitis signs and symptoms
Steady, boring pain in epigastrium or LUQ• Increases in intensity• Severe tenderness on palpation• Radiates or penetrates to back• Nausea and vomiting Abdominal distention• Hypoactive bowel sounds Low-grade fever
Pancreatic cancer treatment
Surgery Chemotherapy
It is true that biliary cancer
Tends to be asymptomatic and progress insidiously
Chronic Pancreatitis is associated
with alcohol intake Can progress even if alcohol consumption is stopped
CT of abdomen for pancreatitis
• Gold standard: allows remarkable detail• Prognostic assessment: Ranson's criteria
Chronic Cholecystitis can lead to which problems
Biliary Sepsis, Calcified Gallbladder, Porcelain Gallbladder
chronic cholecystitis can lead to which problems
Biliary sepsis Calcified Gallbladder Cirrhosis
Acinar cell injury
Alcohol, drugs, ischemia, viruse
More than half of the initial cases of pancreatitis are associated with
Alcoholism
A biliary cause of acute pancreatitis is suggested by an elevation in which serum laboratory results
Alkaline Phosphatase
Chronic Pancreatitis clinical manifestations
Bouts of acute pancreatitis with progressive endocrine and exocrine pancreatic dysfunction • Diabetes: progressive loss of pancreatic islets • Malabsorption: fat and vitamins A, D, E, and K • Weight loss: poor intake related to pain Insidious onset of steady, boring epigastricpain radiating to back (first symptom Nausea After about 5 years of continual pain: decreasein symptoms (pain "burns out")
Which digestive enzymes are secreted from the intestinal mucosa during a meal?
Cholecystokinin, Secretin
Chronic Pancreatitis
Chronic inflammatory lesions in pancreas
Pseudocyst: collection of fluid within oradjacent to pancreas symptoms
Fever, tachycardia, abdominal mass, and tenderness• Management: endoscopic or surgical drainage
Defective intracellular transport
Metabolic Injury, Alcohol,
UNtreated acute cholecystitis may lead to gangrene of
the gallbladder wall.
Key ELement of pathogensis of chronic pacreatitis
Necrosis of exocrine parenchyma followed by fibrosis
3 pathways of pancreatitis
Obstruction of the pancreatic duct by a stone or other cause (usually unknown) Acinar cell injury Defective intracellular transport
Pancreatic cancer clincal manifestations
Pancreatic Head Tumors: Jaundice, Malabsorptions, and weight loss Pancreatic Tail: Ab pain and Nausea
Normal bile is composed of
water, electrolytes, and organic solutes.
Pathogenesis
Prescence of chronic inflammatory lesions in pancreas
Complications of chronic pancreatitis
Pseudocyst Pancreatic Ascites Obstruction of common bile duct: Surgical or endoscopic intervention Thrombosis of portal and splenic veins may lead to GI hemorrhage related to gastric varices Peptic Ulcer Disease
Acute Pancreatitis Complications
Pseudocyst: collection of fluid within oradjacent to pancreas
Narcotic administration should be administered carefully in patients with acute pancreatitis related to potential for
Sphincter of Oddi dysfunction
The definitive treatment for cholecystitis is
cholecystectomy
Most gallstones are composed of
cholesterol
Chronic pancreatitis may lead to
diabetes mellitus
Pancreatitis pathology
etiologic agent causes: -increase in pressure in the pancreatic ducts -allows pancreatic enzymes to escape from cells / ducts ---digest pancreas itself! ---digest surrounding adipose tissue this all leads to: -poor pancreatic function -necrosis and edema ---hemorrhaging ---perforation
A patient with pancreatitis may experience muscle cramps secondary to
hypocalcemia
Pancreatitis etiology
inflammation of the pancreas
Pancreatitis
inflammation of the pancreas Autodigestion of the pancreas from enzymeactivation
It is true that gall stones are
more common in women
Chronic Pancreatitis pathogensis leads to calcification
obstructed flow of pancreatic juices
the most challenging aspect of treatment for chronic pancreatitis is
pain control
Elevated Serum lipase and amylase levels are indicative of
pancreatitis
Elevated surum lipase and amylase levels are associated with
pancreatitis
Pancreatic ascites
persistent leak in pancreatic duct into pleural space and mediastinum Painless and massive• Detected by ultrasound or CT, fluid analysis obtainedby aspiration• Treatment: prolonged parenteral nutrition, stent
Patients with acute pancreatitis are generally made NPO and may require continuous gastric suctioning in order to
remove the usual stimuli for pancreatic secretion
The pain associated with chronic pancreatitis is generally described as
steady and boring in nature.