Term
| a reservoir where undigested food is stored and digested by hydrochloric acid, pepsin, and gastric lipase |
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Definition
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Term
| neutralizes acid and initiates digestion, absorption of iron, calcium and folic acid |
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Definition
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Term
| secretes gastrin and is the mechanical grinding chamber that pulverizes food and slowly releases it through the pylorus into the duodenum. |
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Definition
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Term
| Responsible for most of the digestion and absorption of water and nutrients |
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Definition
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Term
| Completes digestion, takes up B12 and recovers bile salts |
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Definition
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Term
| Main function is to remove water from the stool |
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Definition
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Term
| Tupe of obstruction characterized by lesions, stones, FB that block the lumen |
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Definition
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Term
| Obstruction that narrow and obliterates the lumen, usually tumors or fibrotic strictures |
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Definition
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Term
| Obstruction that compresses and blocks the lumen |
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Definition
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Term
|
Definition
| segment of gut is twisted |
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Term
|
Definition
| Functional obstruction, a segment of gut losses its propulsive function |
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Term
|
Definition
| A disruption when an acute opening allows contents to spill into abd or thorax = peritonitis |
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Term
| Abnormal tubeike passage from one cavity to another, or from cavity to free surface |
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Definition
| Fistula - can be Congenital or acquired (tumors, Crohn's, truma, etc) |
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Term
| Ischemia of deeper myo layers causes ______, can lead to strictures with luminal narrowing & obstruction |
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Definition
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Term
| Can lead to a breach in the mucosa, may lead to fibrosis and scarring |
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Definition
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|
Term
| If 2 peritoneal structures rub together they can attach to one another, seal by fibrin and scar |
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Definition
| Adhesion (peritoneal scar) |
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Term
| True vs. False Diverticulum |
|
Definition
True - contains all layers of bowel wall
False - consists of mucosa & submucosa herniated through myo layer |
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Term
| 7 Common Mechanisms of GI disease |
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Definition
| Adhesion, Diverticula, Disruption, Fibrosis, Ischemia, Chronic Inflammation, Obstruction |
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Term
| Bright Red Blood per rectum |
|
Definition
| Hematochezia .. Distal colon |
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Term
|
Definition
| Black, tarry stool .. Cecum |
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|
Term
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Definition
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Term
| short-lived, acute painful peristalsis, usu due to acute gastroenteritis |
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Definition
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Term
| pain central and above umbilicus |
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Definition
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|
Term
| Pain low in abdomen below umbilicus, relieved by defecation |
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Definition
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Term
| Repeated painful peristalsis, sharp pain, doubles over, high pitched "tinkiling" bowel sounds, failure to pass gas/feces |
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Definition
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Term
| Localized pain, worse with movement or prodding |
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Definition
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Term
| Severe RUQ pain, radiates to back, pain in waves, last for hours, N/V, roam around to find comfortable position |
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Definition
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|
Term
| RUQ pain, radiates to shoulder, excessive belching, Nausea |
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Definition
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|
Term
| Severe pain just below shoulder blades, induced by eating or etoh, can be painless or initiates bad central back pain |
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Definition
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|
Term
|
Definition
| Difficulty in starting to swallow, assoc with drooling, aspiration pnemu. with liquid = neuro or myo problem |
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Term
|
Definition
| lump in throat, in highly anxious people, increased during stress, can't swallow Temporarily |
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|
Term
| Mouth filled with excess salivia, possibly syx of PUD |
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Definition
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|
Term
|
Definition
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|
Term
|
Definition
|
|
Term
|
Definition
| Feeling of rectal fullness, reflects rectal inflammation |
|
|
Term
|
Definition
| Anal itch, idiopathic or pinworm |
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|
Term
Flexible glass fibers carry image, has channels for insufflation, suction, instrument passage
Procedure of choice f/ dx of esophageal mucosal dz's, can see entire mucosa of esophagus |
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Definition
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|
Term
Visual inspection of lumen of esophagus, stomach, and duodenum. Used for dx of swallowing problems, bleeding, N/V, reflux, etc
Pt under conscious sedation, see all linings and can biopsy or cauterize |
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Definition
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Term
| Allows f/ visual inspection of stomach, duodenum, ducts of biliary tree and pancreas, dx for jaundice, upper abd pain , unexplained weight loss |
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Definition
| Endoscopic Retrograde Cholangiopancreatogrpahy ERCP |
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Term
| Visualize colon and distal ileum, dx of bowel changes, cancerm growths, bleeding. Can biopsy, cauterize and inject meds or dyes |
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Definition
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|
Term
| Visulaize distal colon and rectum |
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Definition
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|
Term
Rigid Endoscopes:
Anoscope
Proctoscope |
|
Definition
Anoscope - examine anal canal
Proctoscope - examine rectum |
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|
Term
CXR:
1. Wide mediastinum or air fluid level
2. pnemothorax/pneumomediastinum
3. free air under diaphragm |
|
Definition
1. obstructed esophagus
2. perforated esophagus
3. Perforated Bowel |
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|
Term
Abdominal x-ray:
Air-fluid levels indictate |
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Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
solid organs - liver, pancreas
Need creat. level for elderly, diabetics |
|
|
Term
|
Definition
intra-abdominal masses, details in soft tissues, lymph nodes, blood vessels and blood flow
Staging of abd tumors |
|
|
Term
Can determine if cystic duct is blocked by stone or inflammation
Isotope is picked up and excreted by liver
Normal: gallbladder fills w/radionucleotide
If cystic duct is blocked, gallbladder won't get any isotope
If common bile duct is not blocked- isotope goes into GI tract |
|
Definition
| HIDA Scan - Radionuclide Scan |
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Term
Causes the stomach to produce acid for digestion
Neccessary f/normal growth of stomach lining, s. intestine, and colon linings |
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Definition
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|
Term
| Causes the pancreas to send out digestive juices, stimulates stomach to produce pepsin, an enzyme that digests proteins & stimulates the liver to produce bile |
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Definition
|
|
Term
| Causes the pancreas to grow & produce enzymes, and causes gallbladder to empty |
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Definition
|
|
Term
Need bile for Absorption
Stored in Liver
Bone & Teeth Structure
Healthy Skin, mucous membranes
Vision in Dim light
Deficiencies |
|
Definition
Vitamin A
Reduced bone growth
Night Blidness
Keratomalacia - soft cornea
Depressed immunity
Drying, scaling skin, eye infection, blindness |
|
|
Term
Precursor in skin
Hormone in absorption of calcium & phosphorus
Mobilization & mineralization of bone |
|
Definition
Vitamin D
Rickets - soft bones, large joints, bow legs, spinal curve, lg skull, deformed chest
Osteomalacia
Renal Osteodystrophy |
|
|
Term
Prevents oxidation of Vit A in intestine
Protects cell membranes against oxidation
Protects RBCs
|
|
Definition
Vitamin E
Defieciency not common
Red cell hemolysis in infants |
|
|
Term
Forms prothrombin for normal blood clotting
Synethized in intestines |
|
Definition
Vitamin K
Prolonged clotting time
Hemorrhage, esp in infants & biliary tract dz |
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|
Term
Forms collagen
Keeps teeth firm in gums
Hormone synthesis
resistance to infection
Improve iron absorption
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|
Definition
Vitamin C
Scurvy: brusing, hemorrhage, bleeding gums, loose teeth
Poor wound healing
Poor bone, tooth development |
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Term
Coenzyme for breakdown of glucose f/energy
Healthy nerves
Good digestion
Normal appetite
Good mental outlook |
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Definition
Vitamin B1 - Thiamin
Beriberi: fatigue, poor appetite, constipation, depression, neuropathy, angular stomatitis, polyneuritis, edema, heart failure, enlarged heart |
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|
Term
Coenzyme f/ protein & glucose metabolism
fatty acid synthesis
healthy skin
normal vision in bright light |
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Definition
Vitamin B2 - Riboflavin
Cheilosis, scaling skin
Burning, itching, sensitive eyes
Magenta tongue |
|
|
Term
Coenzyme f/ energy metabolism
Normal Digestion
Healthy Skin
Healthy nervous system
Tryptophan is a precursor |
|
Definition
Vitamin B3 - Niacin
(Nicotinic Acid, Niacinamide)
Pellagra: dermatitis, angular stomatitis, diarrhea, depression, disorientation, delerium |
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|
Term
Component of coenzyme A
Syn of sterols, fatty acids, heme |
|
Definition
Vitamin B5 - Pyridoxine
Cheilosis
GI upset
weak gait
Irritabilty
Neuropathy - impaired vibratory sensation
convulsions |
|
|
Term
Forms mature RBC
Synthesis of RNA, DNA
Requires intrinsic factor f/stomach to absorb |
|
Definition
Vitamin B12
Pernicious Anemia: lack of intrinsic factor or after gastrectomy
Macrocytic anemia
neurologic degeneration
pallor |
|
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Term
Maturation of RBC
Syntheis of RNA, DNA |
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Definition
Folic Acid
Macrocytic anemia in pregnancy, sprue, pallor, neural tube defects |
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|
Term
Component of coenzyme in metabolism
Some synthesis in intestine
Avidin, in raw egg white, interferes w/ absorption |
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Definition
Biotin
Occurs only w/ lg amount of ingested raw egg whites
Dermatitis
Loss of hair |
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Term
99% in bones & teeth
Nervous stimulation, myo contraction
blood clotting
activated pancreatic lipase
|
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Definition
Calcium
Fragile bones, osteoporosis
Hypertension |
|
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Term
80-90% in bones and teeth
Acid Balance
Transports fats
Enzymes f/ energy metabolism, protein synthesis
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Definition
Phosphorus
Excess: renal disease |
|
|
Term
60% in bones & teeth
Transmits nerve impulses
Myo Contraction
Enzymes f/ energy metabolism
Acid favors absorption |
|
Definition
Magnesium
Dietary dificiency unlikely - occurs in alcoholism, renal failure |
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Term
Extracellular fluid
Water balance
Acid-Base Balance
Nervous Stimulation
Myo Contraction
|
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Definition
Sodium
Def. raree occurs with excessive perspiration |
|
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Term
Intracellular fluid
Protein & glycogen synthesis
Water balance
Transmits nerve impulse
Myo Contraction
|
|
Definition
Potassium
Starvation
Diuretic therapy
hypertension |
|
|
Term
Mostly in hemoglobin
Myo Myoglobin
Oxidizing enzymes f/release of energy
|
|
Definition
Iron
Anemia, Cheliosis, Palloe
Excess: hepatotoxcity, death, altered LOC, N/V/D |
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|
Term
Forms thyroxine for energy metabolism
Chiefly in thyroid gland |
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Definition
|
|
Term
Prevents tooth decay
Storage in bones and teeth |
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Definition
Flouride
Excess: tooth mottling |
|
|
Term
Enzymes f/ transfer of carbon dioxide
Taste, protein synthesis
Necessary f/ the formation of insulin by the pancreas |
|
Definition
ZINC
Growth retardation, Altered taste, Depressed immunity
Acrodermatitis Enteropathica: autosomal recessive condition= eczema eruptions, alopecia, glossitis, diarrhea
GI conditions may lead to zinc def. |
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Term
Utilization of iron f/hemoglobin formation
Pigment formation
Myelin sheath of nerves
in form of ceruloplasmin in blood
Abnormal storage in Wilsons dz.
Need f/ insulin formation in pancreas |
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Definition
Copper
Rare deficiency.. increased zinc will decrease copper |
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|
Term
Most common anatomic abnormality of esophagus.. 2 parts
Infants present w/excess salivia, choke and cough when fed, cyanosis/pneumoia can occur from feedings |
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Definition
| Congenital trachoesophageal fistulas & esophageal atresia |
|
|
Term
Muscle configuration of the esophagus
upper, middle and lower |
|
Definition
upper 1/3 skeletal
middle 1/3 skeletal & smooth
lower 1/3 smooth |
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|
Term
Provides info on esophagus anatomy and function
Obtained while pt is swallowing |
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Definition
| Barium Esophagram or Swallow |
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|
Term
Usually a complication of esophageal or bronchogenic carcinoma, formed when tumor invades adjacent structure and undergoes necrosis.
Presents: aspiration of food/saliva when pt swallows, lead to severe fatal pneumonia
Dx. barium swallow |
|
Definition
| Acquired Tracheoesophageal Fistula |
|
|
Term
| What you are trying to see in endoscopy of sliding hiatal hernia |
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Definition
| Z line, squamocolumnar junction, and gastric folds above the diaphragm |
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|
Term
| Three locations of Esophageal diverticulas |
|
Definition
Zenckers - Just above UES
Mid-Esophageal - level of aortic arch
Epiphrenic - distal, just above LES |
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Term
Posterior outpouching of mucosa/submucosa just above UES, food may collect in pouch. Regurgitation or aspiration of undigested food
CP: dyshagia, bad breath, regurgitation when bends over, older, syx for a while
DX: barium swallow |
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Definition
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Term
Thin esophageal ring at GE junction, central core is vascular fibrous tissue
CP: dysphagia to solids, episodically, may get food bolus stuck
DX: barium swallow
TX: bougienage to dilate ring |
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Definition
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|
Term
Mucosal folds protrude into lumen, covered w/sqamous epithelium, protrudes f/anterior wall into cervical esophagus
CP:intermittent dysphagia to solids |
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Definition
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|
Term
| Classically symptomatic webs in iron-deficient middle-aged women |
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Definition
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|
Term
| Most common cause of esophageal obstruction in adults |
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Definition
| Food .. after removed should be evaluated f/rings & strictures |
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Term
Autoimmune d/o depostis collagen in skin & viscera. Diffuse and Limited forms.
Atrophy & fibrous replacement of smooth myo in the distal esophagus results in weakness of contraction in the lower 2/3 of the esophagus & incompetence of teh LES |
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Definition
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|
Term
| CREST syndrome associated with what disorder? |
|
Definition
Scleroderma
C calcinosis
R raynaud's phenomenon
E esophageal dysmotility
S sclerodactyly
T telangiectasias |
|
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Term
CP: dysphagia to solids, pyrosis, regurgitation, develops severe GERD
Dx: barium swallow shows dilation & loss of peristaltic contractions in middle & distal portions of esophagus with loss of LES tone |
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Definition
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|
Term
| Loss of peristalsis in distal esophagus, failure of LES to relax, dilation of the esophagus, normal peristalis is lost, food accumulate in the esophagus, distending and dilating it |
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Definition
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|
Term
| From Chaga's Dz in South America b/c neurotoxin destroys nerve endings in the myenteric plexus of the distal esophagus |
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Definition
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|
Term
CP: dyspagia to solids & liquids, evolves slowly, regurgitation of undigested food, GERD, retrosternal chest pain f/esophageal spasms, weight loss, hiccups
Dx: barium swallow shows BIRD's BEAK narrowing at LES level, massive dilated esophagus. Esophageal manometry is definitive study |
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Definition
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|
Term
Identifies d/o of esophageal motility, probe into stomach measures pressures
Provides assessment of lower & upper esophageal sphicters and intergrity of esophageal peristalsis |
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Definition
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|
Term
| 3 basic treatments for achalasia |
|
Definition
1. smooth myo relaxants
2. Botox into LES
3. Pneumatic dilation of LES, or surgical myotomy (myo fibers of LES are cut) |
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|
Term
Frequent, abnormal, non-propulsive esophageal contractions, can be simultaneous, repetitive, prolonged or of very high amplitude
Normal peristalsis is present some of the time |
|
Definition
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|
Term
CP: Chest pain, dysphagia, may mimic MI made worse by drinking cold liquids, or stress, intermittent dysphagia equal f/solids & iquids
Dx: "corkscrew esophagus" on barium study
Can try to treat syx w/ smooth myo relaxants |
|
Definition
|
|
Term
Dysphagia characterized by poor coordination of skeletal myo in orophrynx , UES, and proximal esophagus
Pt often regurgitate or aspirate when swallowing. Liquids are esp hard - may come out of nose or triggers coughing |
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Definition
Dysphagia associated with Neuromuscular disorders .. CVA, Parkinson's, Myasthenia Gravis, Botulism, Muscular dystrophy, Plymyositis
"oropharyngeal dysphagia" |
|
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Term
| Used for orpharynegeal dsyphagia, performed by speech pathologist/radiologist, swallows food covered in barium - allows observation of bolus progression throughout swallowing |
|
Definition
| Video Fluoroscopic Swallowing Study (modified barium swallow) |
|
|
Term
| Pyrosis, pain in epigastric area, dysphagia, chronic cough, atypical chest pain, worse after fatty meals, hoarseness, nocturanl aspiration, exacerberate asthma |
|
Definition
|
|
Term
| What's 24 hour pH monitoring, what's it used for? |
|
Definition
Continuous readings of esophageal pH over 24 hours can be recorded by computer to determine freq. of reflux events & effectiveness of peristaltic acid clearance
pH less than 4 = GERD dx |
|
|
Term
| Small amounts of fluid are infused through a probe to reproduce chest pain and discomfort, hydrochloric acid and salt water are used |
|
Definition
| Bernstein Test (acid perfusion test) |
|
|
Term
| General measures to treat GERD |
|
Definition
| Elevate head of bed, avoid tight clothes, lose wight, smaller meals, avoid ETOH, tobacco, don't lye down after eating |
|
|
Term
| Ingestion of fat, pregnancy, Scleroderma, CREST, nitrates, NSAIDs, Cofee, Alcohol, Chocolate, |
|
Definition
| All are factors in reducing LES tone and promotion of reflux |
|
|
Term
| What's the Nissen Fundoplication |
|
Definition
It's where the gastric fundus is wrapped around the esophagus to try and restore LES competence
Surgical therapy for GERD |
|
|
Term
| Describe Barett's Esophagus |
|
Definition
| From chronic reflux, replaces native sqamous epithelium w/ metaplastic columnar epithelium, can result in dysplasia, assoc w/ adenocarcinoma, have to treat acid in esophagus .. PPI |
|
|
Term
| Ingestion of caustic agents, patchy from orophrynx to stomach, can lead to ulceration, necrosis, and perforation, healing may lead to strictures and fibrosis, increases risk of sqamous cell carcinoma |
|
Definition
|
|
Term
From direct prolonged contact of NSAID's KCL pills, Iron, Vit. C, certain Abx, etc...
Can lead to stricture, hemorrhage, performation, chesta pain, dysphagia, etc. |
|
Definition
| Medication Induced Ulcers/Esophagitis |
|
|
Term
| Occurs in immunosuppressed pts. Present w/ dysphagia, odynophagia, sometimes chest pain |
|
Definition
|
|
Term
Immunosupressed, on systemic Abx, uncontrolled diabetes, radiation pt. may have this..
Dx: endoscopy shows diffuse linear plaques adherent to mucosa. Branching pseudohyphae microscopically |
|
Definition
Candidal Esophagitis
Thrush present in only 75% of pts |
|
|
Term
Causes multiple small, deep ulcerations
Dx: Endoscopy shows ulcerations, biopsy for culture for def. dx |
|
Definition
Herpes Simplex 1 Viral Esophagitis
Tx: Acyclovir |
|
|
Term
Causes one to several large, shallow, superficial ulcerations
Dx: endo will show ulcerations, need biopsy for def. dx |
|
Definition
Cytolegalovirus Viral Esophagitis
Tx. Ganciclovir |
|
|
Term
| What's Radiation Esophagitis |
|
Definition
Dysphagia & odynophagia may develop after radiation therapy for treatment of thoraic cancers.
May eventually cause scarring & stricture formation
Tx. viscous lidocaine, dilation of strictures |
|
|
Term
Pressure in portal vein rises (portal hypertension) and blood is redirected to the distal esophagus causing dilation of submucosal veins.
In 50% of pt's with cirrhosis
CP: profuse hemorrhage from upper GI
Dx: upper endoscopy |
|
Definition
Esophageal Varicies
mortality rate after acute variceal bleed 30% |
|
|
Term
Injection of a scleroing agent or applying bands during endoscopy
TIPS &
Somatostatin & Octreotide infusion
Are all TX for what? |
|
Definition
Esophageal Varices
The somatostatin infusion reduced portal pressure and can help provide acute control of bleedin in up to 80% of pts. |
|
|
Term
Brought on by prolonged and sever vominting, they are linear, longitudinal laceration of the mucosal in the GE junction
Can disrupt the submucosal artery = massive bleed, can be seen after an alcoholic binge
CP: upper GI bleed
Dx: Upper endoscopy
Tx: surgery if severe, inject epi during endoscopy, stop the vomiting |
|
Definition
|
|
Term
| Majority of esopheagel neoplasms are in what portion of the esophagus? |
|
Definition
50% are in the middle 1/3
35% in lower third
15% in upper 1/3 |
|
|
Term
| Alcohol, smoking are risks for this neoplasm most commonly in the proximal 2/3 of the esophagus |
|
Definition
|
|
Term
GERD and BE are predisposing factors along w/ obesity,& poor diet. Found in distal 1/3 of the esophagus
CP: progressive dysphagia, weight loss, hoarseness, eventual obstruction leading to aspiration pneumonia
Dx: barium esophagram shows apple-core lesion, Endoscopy best for confirmation |
|
Definition
| Adenocarcinoma of Esophagus |
|
|
Term
Located in cardia/antrum these cells secrete a bicarbonate-rich mucous that coats and lubricates the gastric surface
Protects the epithelium f/ acid and chemicals |
|
Definition
|
|
Term
Located in cardia/antrum
Principle hormone secreted is gastrin which is important in the control of acid secretion and gastric motility |
|
Definition
|
|
Term
Located in Fundus/Body
Synethizes and secretes pepsinogen, the inactive precursor to pepson |
|
Definition
|
|
Term
Located in Fundus/Body
Secretes HCl, secretes intrinsic factor, activates pepsinogen, express receptors for histamine, gastrin & ACh |
|
Definition
|
|
Term
| 2 phases of acid secretion |
|
Definition
|
|
Term
| What happens during the cephalic phase of acid secretion |
|
Definition
| sight, smell and taste of food causes Vagus nerve stimulation & secretion of HCl acid, pepsinogen, & instrinsic factor |
|
|
Term
| What happens during the gastric phase of acid secretion |
|
Definition
| Distention of the antrum by food stimulates the release of gastrin that activates the parietal cell |
|
|
Term
Hypertropy of the the circular myo of the pylorus, progressing to gastric obstruction
CP:Usu.in a 3-6 wk old infant, appears dehydrated, projectile, bile-free vomiting, hungry-vomiter, olive-like mass in RUQ felt after vomiting
Dx:Upper GI series see "String Sign"
What's the curative treatment? |
|
Definition
Infantile Hypertrophic Pyloric Stenosis
(IHPS)
Tx: surgical cutting of the pyloric musculature (Pyloromytomy) |
|
|
Term
A delay in gastric emptying (gastric stasis)due to lack of coordination of:
1.SNS and PSNS
2. neurons within the stomach & intest.
3. smooth myo of the gut
CP: nausea after meals, early satiety, vomiting, weight loss
Dx: gastric scintigraphy
Tx: drugs, diet modification, decompression |
|
Definition
Gastroparesis
Tx. drugs may improve stomach emptying |
|
|
Term
Patients ingest radiolabeled meal, egg sandwich, images taken over 2 hours
Gastric emptying should take place in 45-90 minutes for solids
Used in dx of? |
|
Definition
Gastric Scintigrpahy (gastric emptying scan)
dx for Gastroparesis |
|
|
Term
What's a Bezoar?
What's the difference btwn a Phytobezoar and a Trichobezoar? |
|
Definition
Concentration of ingested material forms in the lumen of the stomach
Phyto-plant material (gastroparesis)
Tricho-hair (young girls)
Associated w/ gastric ulcer/bleeding
death rate 20% |
|
|
Term
Medical condition characterized by indegestion w/ chronic or recurrent pain in the upper abd
Upper abd fullness & feeling full earlier that expected
Bloating, belching, heartburn
May be assoc w/ GERD, ulcers, or cancer |
|
Definition
|
|
Term
Inflammation of the gastric mucosa is?
3 categories... |
|
Definition
Gastritis
1. Erosive & Hemorrhagic
2. Nonerosive, nonspecific gastritis
3. specofoc types (distinct etiologies) |
|
|
Term
Most common cuses are drugs, NSAIDs, etoh, stress from medical trauma, portal hypertension
Syx:anorexia, dyspepsia, N/V
CP: mild upper GI bleed, |
|
Definition
|
|
Term
| Develops in 25% of NSAID users |
|
Definition
|
|
Term
| Accounts for 20% of upper GI bleeds in chronic alcoholics |
|
Definition
|
|
Term
| Stress-realted mucosal erosions & subepithelial hemorrhage develop within 72 hours of pts becoming critically ill |
|
Definition
|
|
Term
H. Pylori
Associated with?
4 Tests for it? |
|
Definition
Gram-Negative
Assoc with PUD, Gastric adenocarcinoma, MALT
1. serologic test (ELISA) antibodies
2. Fecal antigen test
3. Urea Breath/Blood Test
4. Endoscopy Biopsy |
|
|
Term
Autoimmune disorder, fundus has severe gland atrophy and there's intestinal metaplasia
Parietal cell antibodies in 90% of pts
Loss of intrinsic factor secretion, B12 malabsorption |
|
Definition
Pernicious Anemia Gastritis
Associated:
1. development of small, multinucleated, carcinoid tumors
2. adenocarcinoma increased 3x |
|
|
Term
Used to evaluate disorders assoc with malabsorption of B12, given radioactive & non-radioactive B12 and collect urinE
If the urine doesn't contain Radioactive B12 = impaired absorption of the vitamin
Then repeated w/ intrinsic factor if the radioactive B12 appears then then the pt has a lack of intrinsic factor |
|
Definition
|
|
Term
3 Major causes are
1. H.Pylori
2. NSAIDSs/ASA
3. Acid hypersecretory state (Zollinger-Ellison) |
|
Definition
|
|
Term
develops in pyloric channel, when more acid is secreted than can be neutralized, always benign, more common site
Pt reports relief of pain w/ food & antacids, nocturnal pain awakens pt. |
|
Definition
|
|
Term
Located in antrum, pt have least pain with fasting and onset of pian usu occurs shortly after eating
Vomiting and anorexia are worse for this less common etiology |
|
Definition
|
|
Term
| Gold Standard test for PUD |
|
Definition
Endoscopy
Can visualize H.pylori and exclude carcinoma
3-5% gastric ulcers are malignant |
|
|
Term
Gastric acid hypersecretion, diarrhea, PUD,
Most cases sporadic, 25% w/ multiple endocrine neoplasia (MEN 1)
Gastrin secreting neuroendocrine tumor
Dx: Elevated serum gastrin, gastric analysis, EGD
Tx: surgery |
|
Definition
Zollinger-Ellison Syndrome
Gastrinoma
Pancreas - 25%
Duodenal wall - 45%
Lymph Nodes - 5-15%
2/3 of gastromas are malignant |
|
|
Term
Benign Gastric Tumors
2 types... |
|
Definition
Gastric Polyps
Hyperplastic Polyps (fake polyp)
Very common, no malignancy, its just an overgrowth of gastric mucosa
Adenomatous Polyps
tubular ov villous, assoc w/ adenocarcinoma, malignant transformation is 3-4% |
|
|
Term
Most common cancer worldwide after lung. Several types
CP: pain, bloating, N/V, weight loss, upper GI bleed
Tobacco, H.Pylori and certain foods predispose |
|
Definition
|
|
Term
| Dietary fats, proteins, and carbs are hydrolyzed & solubilized by secreted digestive enzymes & bile |
|
Definition
Luminal Phase
Small Intestine |
|
|
Term
| Border membrane of intestinal epithelial tranport digested products f/ the lumen into the cells |
|
Definition
Mucosal Phase
Small Intestine |
|
|
Term
| Reassembled lipids & other key nutrients are transported via lymphatics & portal circulation f/ epithelial cells to other parts of the body |
|
Definition
Postabsorptive Phase
Small Intestine |
|
|
Term
Functional obstruction, failure of peristalsis , small bowel distended throughout its length, absorption of nutrients, electrolytes & fluids is impaired
Common post-op, trauma, sepsis
CP: unable to pass gas, decreased bowel sounds, distention |
|
Definition
|
|
Term
Mechanical blockage f/ structural abnormailty preveting progression of gut contents
CP:colicky abd pain, absolute constipation, distention, unable to pass gas |
|
Definition
|
|
Term
| On Abd x-ray you'll see "Sting of Beads" |
|
Definition
Small Bowel Obstruction
! Don't do barium swallow!
Complications: strangulation w/ischemia, peritonitis, irreducible hernia |
|
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Term
Can be found in small intestine and colon, see passage of Red Current Jelly Stool
May see Target sign on X-ray
Contrast Enema definite dx
Tx: Surgery
Most common abd. surgery in childhood |
|
Definition
|
|
Term
| Impaired absorption of dietary constituetns |
|
Definition
|
|
Term
| Syx: Diarrhea, Steatorrhea resulting in defieciency of fat soluble vitamins and calcium, weakness, weight loss, anemia, edema |
|
Definition
|
|
Term
Allergic, toxic rx to gliadin component of gluten. Causes damage to mucosa of proximal sml bowel, causing malabsorption, predisposing to neoplasm
See Dermatitis Herpetiformis skin rash
Iron Deficiency Anemia
Antibodies: IgA, IgE, Transglutaminase
Increased Fecal Fat
See blunting of villi in jejunum(atrophy) Crypt hyperplaia & lengthening, flattening of mucosal surface, chronic inflammatory rx in lamina propria |
|
Definition
Celiac Sprue
Need to watch for lymphoma |
|
|
Term
Functional Disorder where gut is overly sensitive to stimuli, crampy pain, altered bowel habits
Rome III Dx Criteria
Feeling on incomplete emptying, urgency |
|
Definition
| IBS .. Irritable Bowel Syndrome |
|
|
Term
|
Definition
IBS-D . Diarrhea prominent
IBS-C . constipation
IBS-M . mixed diarrhea/constipation
IBS-A . alternating d/c |
|
|
Term
|
Definition
Fiber . for IBS-C
Antispasmotics . inhibit myo contraction
Seratonin. inhibits colonic motility
Antidepressents . chronic pain |
|
|
Term
| Determines plasma oncotic pressure, maintains plasma volume, carrier for bili, f.a, and some drugs |
|
Definition
|
|
Term
Hepatocellula dz is assoc w/ decreased serum concentration of _____
results in prolonged prothrombin time |
|
Definition
|
|
Term
| Protease inhibitor that inactivates harmful proteases involved in inflammation, coagulation, and other processes |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
Enlargement of the liver
Can be from Focal Lesions:tumors, cysts, abcesses, or nodules
Diffuse enlargement: generalized enlargement infiltrative either cellular of non cellular
cellular:cancers, infectious dz
Noncellular: venous congestion w/ dilation of sinusoids, amyloidosis |
|
Definition
|
|
Term
| Intracellular Liver Enzymes - 3 |
|
Definition
|
|
Term
|
Definition
| Alcoholic Cirrhosis, liver congestion, metastatic tumor of liver |
|
|
Term
|
Definition
| Acute Hep, Viral Hep, infectious mono w/ hep. |
|
|
Term
| Help to dx biliary obstruction, released into circulation when biliary ducts are obstructed at ANY level |
|
Definition
Alk Phos
Gamma-glutamyltransferase (GGT)
5'-Nucleotide |
|
|
Term
Alkaline Phosphate (ALP)
ALP1 origin?
ALP2 origin? |
|
Definition
|
|
Term
| Lipophilic toxin, can diffuse into brain causing seizures & mental retardation, It's bound to albumin, will not be in Urine, Taken up by hepatocytes |
|
Definition
|
|
Term
| secreted into bile, travels to intestine, in gut its degraded by bacteria into sterocobilin,It's water soluble and can be in urine, high amounts = tea colored urine |
|
Definition
|
|
Term
| May develop when there is 1. too much bili production 2. too little conjugation 3. reduced hepatic uptake |
|
Definition
| Unconjugated Hyperbilirubinemia |
|
|
Term
Occurs b/c glucoronate activity is low at birth, can result in brain injury
Phototherapy makes unconjugated bili more water soluble so it can be excreted |
|
Definition
| Physiologic Jaundice of the Newborn |
|
|
Term
| Most common congenital hyperbilirubinemia. Mild defect of conjugation, partial deficiency of glucuronyl transferase. Not tx req. |
|
Definition
|
|
Term
| Manifestation of liver or biliary tract dz. Ability of hepatocytes to excrete conjugated bili is impaired. |
|
Definition
| Conjugated Hyperbilirubinemia |
|
|
Term
Cuases impaired excretion of conjugated bili
Can be congenital
Dubin-Johnson Syndrome
Rotor's Syndrome |
|
Definition
|
|
Term
|
Definition
1. Intrahepatic Causes: Viral hep, cirrhosis, druf toxicity
2. Extrhepatic causes: gallstones, carcinoma, cholangitis (infection) |
|
|
Term
Genetic Disorder, Deficiency of copper-binding protein, ceruoplasmin. Copper is unable to be excreted by liver into bile. Increase in copper = necrosis of hepatocytes
CP: may look like hep. Kayser-Fleischer rings in eyes(brown rings) |
|
Definition
|
|
Term
|
Definition
|
|
Term
Common genetic disorder, excess absorption of iron from the gut, causing excess deposition of iron in tissues including the liver. Symptomatic later in life, Females even later
CP: skin bronzing, produces diabetes, gonadal atrophy, dilated cardiomyopathy, arrhythmia, micronodular cirrhosis
Dx: Serum Transferrin 60% saturated, serum ferritin elevated
Tx: phlebotomy |
|
Definition
|
|
Term
| From excessive dietary ingestion of iron, excess blood transfusions |
|
Definition
| Secondary Hemochromatosis |
|
|
Term
| Drug-induced acute liver injury from anythign from steroids, tylenol to mushrooms |
|
Definition
|
|
Term
Self-limited, caused by RNA virus, no carrier state, not chronic, fecal-oral infection, Syx mimic flu, jaundice, itching, weight loss
Dx: IgM if acute, IgG if past |
|
Definition
|
|
Term
Can cause acute hepatitis, carrier state,can be chronic, cause cirrhosis or HCC, caused by DNA virus, Transmitted via blood, body fluids,
Surfae ANTIGEN: HBsAg - earliest marker of acute infection
Syx: dark urine, jaundice, general ill health |
|
Definition
|
|
Term
Has a carrier state, can cause chronic infection, cirrhosis, or HCC. Most common blood borne infection in US. Leading cause of chronic liver dz. High risk = IVD user, certain medical conditions, organ transplant early,
RNA virus, targets hepatocytes causing persistent liver infections |
|
Definition
|
|
Term
| Chronic progressive disorder where the injury is directed toward the hepatocytes. Leads to cirrhosis |
|
Definition
|
|
Term
| Affects young women. Syx: fever, malaise, inflammed serous membranes, high transaminase levels. May lead to cirrhosis and transplant |
|
Definition
| Type I Autoimmune Hepatitis |
|
|
Term
| Assoc with antibodies P-450 isoenzyme in the liver & kidneys. Found in female children and teens, can be severe |
|
Definition
| Type II Autoimmune Hepatitis |
|
|
Term
| Final common pathway for most chronic liver diseases. Fibrosis & conversion of normal liver tissue into structurally abrnormal nodules, disrupts blood flow through liver, irreversible |
|
Definition
|
|
Term
| Regenerative nodules are smaller than 3 mm in diameter, uniform in size and shape, common in alcholism, old age, and malnutrition |
|
Definition
|
|
Term
| Regenerative nodules are large, irregular in shape and size, often seen in viral or autoimmune cases |
|
Definition
|
|
Term
| Develops f/increased portal vein inflow or increased resistance to portal blood flow. Portal-systemic collateral vessels form in an attempt to decompress the increase and then the collaterals can dilate. |
|
Definition
Portal Hypertension with Varices
Most common site for variceal formation is the lower esophagus followed by the stomach and then the rectum |
|
|
Term
| CP: Jaundice, ascites, dilated abdominal wall veins in the upper abd, Caput Medusae - bulging veins surrouding the umbilicus, GI bleed |
|
Definition
| Portal Hypertension with Varices |
|
|
Term
| Portal venous blood flow is blocked prior to entry into the sinusoidal network. These blocks usu cause variceal hemorrhage assoc with little liver dysfunction, encephalopathy, or ascites b/c the liver distal to the blockage is normal |
|
Definition
| Presinusoidal Portal Hypertension |
|
|
Term
| Cuased by increased resistance to blood flow secondary to compression, loss of sinusoid. Typical of cirrhosis, leads to increased portal vein pressure & transudation of fluid that contributes to formation of ascites |
|
Definition
| Intrasinusoidal Portal Hypertension |
|
|
Term
Congestion of liver that occurs when outflow of blood from sinusoids via hepatic vein is impeded commonly from 1. R sided heart failure
2. constrictive pericarditis
3. Budd-Chiari Syndrome |
|
Definition
| Postsinusoidal Portal Hypertension |
|
|
Term
| Collection of free fluid in the peritoneal cavity. Factors like increased sodium and water retention, increased sinusoidal portal pressure, and decreased capillary oncotic pressure aid in fluid formation |
|
Definition
|
|
Term
| Low Protein, may occur in cirrhosis & other edematous stated like CHF, contrictive pericarditis, or nephrotic syndrome |
|
Definition
|
|
Term
| High Protein. Occurs when peritoneum is involved with chronic infection (TB) or neoplastic processes (metastatic carcinoma) |
|
Definition
|
|
Term
Neuropsychiatric condition as a consequence of liver dz. Failure of liver to eliminate neurotoxins. They escape liver metabolism b/c hepatocellular mass is reduced & b/c they are shunted around the liver into systemic circulation. Seen in 70% of cirrhosis pts.
CP: liver flap(asterixis) confusion, fetor hepaticus (musty odor), loss of diurnal rhythms |
|
Definition
Hepatic Encephalopathy
Tx: Restrict dietary protein, increase stools to get rid of toxins, antibiotics to decrease urea production, liver transplant curative |
|
|
Term
| Oxidation of ETOH cause triglycerides & fat accumulation within the hepatocytes. Firm, smooth, enlarged, bright yellow greasy liver. Develops in days after ETOH consumption w/ anorexia & nausea, with abstinence it will dissapear |
|
Definition
| Alcoholic Fatty Liver (Steatosis) |
|
|
Term
Inflammatory disorder causes liver dysfucntion & can progress to cirrhosis. Develops after yearrs of ETOH use, As Hepatocytes are killes that are replaced w/fibrous tissue
If severe it can ause near complete obliteration of the central portion of the lobule including central veins
Can be resolved |
|
Definition
|
|
Term
Characterized by Regenerative nodules of hepatic parenchyma completely circumscribed by fibrosis. Loss of Hepatocellular mass by necrosis lead to grossly recognizable regenerative nodules. Irreversible! Prognosis worsens with development of ascites or encephalpathy - esp once varices form.
HCC is a late complication |
|
Definition
|
|
Term
| Five factors responsible for accumulation of fat in the liver |
|
Definition
1.Mobilization of F.A f/peripheral deposits
2.Decreased oxidatio of F.A by liver
3.Increased hepatic F.A synthesis
4.Increased esterification of F.A into triglycerides
5. Decreased secretion of fat from liver |
|
|
Term
| Resembles alcoholic liver dz, with no Hx of use. Assoc with obesity, and diabetics w/ hypertriglyceridemia. Can be seen in pt w/excessive tube feedings, most are mild cases |
|
Definition
| Nonalcoholic Steatohepatitis (NASH) |
|
|
Term
Most common in women of child-bearing age using Oral contraceptives.
Syx: Abd. discomfort, pressure f/enlarging mass, can rupture |
|
Definition
|
|
Term
Not very common in N. America. Strong correlation w/ Hep. B&C.
CP: RUQ pain/fullness, hepatomegly, hepatic bruit, 70-80% pt have elevated alpha-fetoprotein, alk phos. |
|
Definition
HCC
70% of neoplasms that arise in cirrhotic liver are HCC
98% that arise in non-cirrhotic liver are metastatic |
|
|
Term
| Most common malignant tumor of the liver in N. America. Commonly from: |
|
Definition
Metastatic Tumor
Lung, breast, GI, pancreas, prostate |
|
|
Term
Evolves rapidly, abd. pain, vomiting.
Occurs when pancreatic digestive pro-enzymes become activated inappropriately within the parenchyma, most common cause is gallstones obstructing ampulla of vater, or alchol consumption |
|
Definition
|
|
Term
| Process w/ duct obstruction, atrophy of cells & parenchymal fibrosis. Recurrent or persistent pain. Destruction of islets of Langerhans. Permanent loss of acinar parenchyma results in exocrine insuffciency |
|
Definition
|
|
Term
Assoc with more extensive destruction
Four morphologic alterations occur:
proteolytic destruction of the pancreatic parenchyma forms areas of grey-white softening
hemorrhage into tissues follows breakdown of blood vessels by activated elastases
enzymatic fat necrosis caused by lipases can be noted in stromal and peripancreatic fat
acute inflammation is triggered by release of kinins from injured tissues
Release of pancreatic enzymes into the abdominal cavity can cause chemical peritonitis
Transudation of massive amounts of fluid into the peritoneal cavity causes inflammatory ascites
effusion is typically brown-tinged, contains globules of fat and resembles beef broth |
|
Definition
| Severe Acute Pancreatitis |
|
|
Term
Inflammation and necrosis of pancreatic cells are assoc with release of pancreatic enzymes in the bloodstream
Elevated levels may suggest pancreatic injury but are not entirely specific
Lipase is more specific for pancreatic disease
Amylase in salivary glands and fallopian tube |
|
Definition
|
|
Term
US probe in duodenum next to pancreas
Most accurate for detecting small pancreatic neoplasms especially islet cell tumors
Can perform fine needle biopsy for tissue dx |
|
Definition
|
|
Term
If there is severe acute pancreatitis with gallstone impaction, perform? to extract the stone
Reduces the incidence of infectious complications
Most reserve urgent surgery for those with infected necrosis |
|
Definition
|
|
Term
| In extremely severe cases the pancreas may be transformed into an ill-defined mass of liquefying necrotic tissue and inflammatory exudate can become infected via the bloodstream or by intestinal bacteria that ascend into the pancreatic duct. This can be difficult to treat since dead tissue helps bacteria grow and protects them from phagocytosis.Pancreatic infection should be suspected when pain, tenderness and fever fail to resolve or progressively worsen despite absolute fasting and antibiotic treatment |
|
Definition
|
|
Term
Continued inflammation of the pancreas characterized by irreversible morphological changes typically causing pain and/or permanent loss of function
Assoc with alcohol abuse (60%)
1/3 of cases are idiopathic
Atrophy and fibrous replacement of exocrine glands with distortion of the duct system
Duct may contain stones with areas of stricture and dilation |
|
Definition
|
|
Term
| 5 clinical Features of Chronic Pancreatitis |
|
Definition
1. PAIN Epigastric pain that radiates to the back – precipitated by heavy meals or alcohol ingestion pain waxes and wanes in intensity partial relief from knee-chest position pain is usually intractable and is alleviated only with narcotics
2.Exocrine Insufficiency Atrophy of acinar cells leads to diminished secretion of pancreatic enzymes and results in exocrine insufficiency After 90% of pancreatic enzyme secretion has been lost, impairment of fat digestion occurs and leads to diarrhea and weight loss Chronic pancreatitis is probably most common cause of fat malabsorption in adults in the USA
3. Endocrine Insufficiency Loss of insulin-producing islet cells causes pancreatic endocrine insufficiency – clinically manifested as diabetes mellitus Results in insulin deficiency rather than insulin resistance, so pattern of disease resembles insulin-dependent DM
4.Pancreatic Duct Leaks Obstruction of pancreatic ducts by stones and strictures produces high intraductal pressures that may lead to disruption and leakage of pancreatic secretions Insidious onset and may be painless May become secondarily infected or rupture
5. 2* inflammation of peripancreatic structures Chronic pancreatitis is a common cause of obstructive fibrous strictures of distal common bile duct Intestinal obstruction from fibrosis developing around the duodenum Splenic vessels along superior edge of pancreas can be fibrosed Pseudoaneurysm of splenic artery can rupture and bleed Thrombosis of splenic artery can cause splenomegaly |
|
|
Term
| Whats the Puestow Procedure? |
|
Definition
Pancreaticojejunostomy
relief of obstruction
surgically open pancreatic duct along its entire length
drain it via side to side anastamosis to a loop of jejunum
Temporary relief from pain
Pain may return in years |
|
|
Term
|
Definition
Syx are related to hormone secretion
5 Types, they progress slowly and mestatize late |
|
|
Term
Second most common malignant gastrointestinal tumor
Typically affects the elderly
Carcinomas that arise in the head of the pancreas will compress or invade the common bile duct to cause jaundice
these are usually detected earlier
Usually symptoms are nonspecific and develop late stage in the disease
CP:Weight loss, altered bowel habits
Vomiting or dull epigastric pain that often penetrates to the back
Pain is vague, diffuse
sitting up and leaning forward may provide relief |
|
Definition
| Adenocarcinoma of Pancreas |
|
|
Term
Affects 4 areas: Lung, Pancreas, Intestine, and liver.Pancreas
Mucus causes cystic dilation of pancreatic ducts with secondary atrophy of cells and progressive fibrosis leading to pancreatitis
Cholestasis and cirrhosis may be caused by chronic mucus obstruction of the bile ducts
Risk of digestive tract cancers may be increased
DX:Suspected in any child who presents with meconium ileus, cholestasis, recurrent lung disease or malabsorption
Sweat chloride should be checked in any child with unexplained chronic illness |
|
Definition
|
|
Term
Seen most commonly in disorders that obstruct bile ducts
Increase in pressure above the obstruction leads to the release of alkaline phosphatase and retention of bilirubin
1) Intrahepatic Causes
Viral hepatitis, Cirrhosis, Drug toxicity
2) Extrahepatic Causes
Gallstones
Carcinoma of: Bile ducts, Ampulla of Vater, and Head of Pancreas
Cholangitis |
|
Definition
| Cholestasis (flow of bile from liver to duodenum blocked) |
|
|
Term
Chronic cholestatic liver disease
Idiopathic disorder characterized by patchy, fibrous obliteration and progressive inflammation of extrahepatic and large intrahepatic bile ducts
Autoimmune disorder
50% of patients have either Ulcerative colitis or Crohn's disease
Jaundice before itching
Asymptomatic presentation to:
malaise, jaundice, pruritis, abdominal pain, wt loss, FUO
Symptoms are slowly progressive
Suspect if patient with inflammatory bowel disease develops elevated serum alk phos (4-10x Normal)
May have intermittent episodes of bacterial infection of the bile
assoc with fever and worsening cholestasis
usually responds to antibiotics
Dx: onion-skin fibrosis of lg. intrahepatic bile ducts |
|
Definition
| Primary Sclerosing Cholangitis |
|
|
Term
Percutaneous transhepatic cholangiography (PTC)
Endoscopic retrograde cholangiopancreatography (ERCP)
Best for examining the anatomy of biliary ducts
Inject contrast material directly into the biliary tree via percutaneous or retrograde approach
Allows cytologic sampling, drainage of bile, dilation or stenting of strictures, extraction of stones |
|
Definition
|
|
Term
Allows for rapid evaluation of the biliary tract, pancreatic duct and gallbladder without contrast material administration, instrumentation or radiation
Imaging sequences are utilized to depict the biliary tract, pancreatic duct and gallbladder
comparable to ERCP in the evaluation of choledocholithiasis, malignant obstruction, anatomic variants and chronic pancreatitis
Disadvantage – purely diagnostic |
|
Definition
| Magnetic Resonance Cholangiopacreatography |
|
|
Term
Chronic, progressive cholestatic liver disease
Progressively destroys interlobar bile ducts leading to cholestasis and end-stage liver disease
Autoimmune process
Middle-aged women and may be assoc with other autoimmune disorders
DX:Anti-mitochondrial antibodies (AMA) |
|
Definition
| Primary Biliary Cirrhosis |
|
|
Term
Pain from acute distention of the bile ducts or gallbladder
Most commonly caused by impacted gallstone that obstructs the flow of bile
Pain located in the RUQ or under the sternum, often radiating to the tip of the right scapula
Mild at first, growing more intense, plateau lasting 1-5 hrs
Colic subsides as fatigued gallbladder muscle relaxes or obstructing stone is passed
It's Dull, boring, steady |
|
Definition
|
|
Term
Presence of calculi in the gallbladder or common bile duct
behave as foreign bodies in the biliary tree and episodically may obstruct the normal flow of bile
10-20% of men, 30-40% of women in their lifetime will develop |
|
Definition
|
|
Term
Fat, fertile, female, forty, flatulence
Risk factors for what? |
|
Definition
|
|
Term
From bilirubinate, carbonate, phosphate salts of calcium
Radiopaque due to high calcium content
hard and brittle
Primary cause:
increased biliary secretion of bilirubin
people with accelerated turnover of RBCs |
|
Definition
|
|
Term
From calcium salts of fatty acids and bilirubin
soft clay-like consistency
Occurs in the biliary tree when bacterial colonization accompanies chronic bile stasis |
|
Definition
| Brown Pigement/Earthy Gallstones |
|
|
Term
| Gallstone disease divided into 4 stages: |
|
Definition
Lithogenic state
formation of calculi
Asymptomatic Cholelithiasis
stones that float free in the gallbladder, cause no pain and are clinically silent
Symptomatic Cholelithiasis
patients experience episodes of biliary colic. Vague symptoms like dyspepsia, indigestion, flatulence, bloating. Colic when stone obstructs cystic duct or common bile duct.
Complications of cholelithiasis |
|
|
Term
Acute inflammation of the gallbladder caused by obstruction of cystic duct
Common surgical emergency
Obstruction of cystic duct leads to bacterial overgrowth
distention and bacterial overgrowth may cause systemic sepsis
10% of cases occur in absence of gallstones |
|
Definition
|
|
Term
Assess the patency of the cystic duct and the common bile duct
Hydroxy-iminodiacetic acid (HIDA)
Diisopropyl-iminodiacetic acid (DISIDA)
Administered IV, taken up by liver, excreted into bile and tracked with a gamma camera
Failure to enter the gallbladder or intestine suggest obstruction of the cystic duct or the common bile duct |
|
Definition
|
|
Term
inflammation and fibrosis of the gallbladder
Wall of gallbladder is thickened by inflamed fibrous tissue
Can be shrunken and contracted or if filled with gallstones can be dilated and rigid
Can lead to calcium deposition in the wall of the gallbladder with an eggshell appearance on xray (porcelain gallbladder)
Will lead to impaired gallbladder function
May develop adenocarcinoma of the gallbladder
Require cholecystectomy if develop symptoms of biliary colic
Some surgeons will recommend removal if no symptoms due to the increased risk of gallbladder carcinoma |
|
Definition
|
|
Term
Stones may become impacted in common bile duct and impair bile flow
results in obstructive jaundice
presence of biliary colic, elevated alk phos and bilirubin
may have intermittent pain and jaundice
hrs to days, stone passes into intestine and sxs resolve
Stone may become impacted in the ampulla and obstruct both the CBD and the pancreatic duct triggering acute pancreatitis
Tx: Cholecystectomy w/exploration of common bile duct to remove any stones |
|
Definition
|
|
