Term
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Definition
| inflammation of the gall bladder |
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Term
| what are the different kinds of cholecystitis? |
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Definition
| acalculous cholecystitis, acute cholecystitis, and chronic (6 wks +) cholecystitis |
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Term
| what is acalculous cholecystitis? |
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Definition
| inflammation of the gall bladder with a high mortality rate - pts with this present as critically ill and with signs of sepsis w/out an obvious source - *there are no gallstones involved*. suspected causes are bile stasis, chemical inflammation, and mucosal ischemia secondary to major sx, critical illness, trauma, *burns, TPN, and PEEP. complications include: gangrene, empyema, and perforation of the gall bladder. |
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Term
| how is acalculous cholecystitis diagnosed? |
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Definition
| on ultrasound/CT, the gallbladder wall will be thickened, there may be pericholecystic fluid - but *no ascites. |
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Term
| how is acalculous cholecystitis treated? |
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Definition
| the gallbladder has to be drained via cholecystostomy (laparoscopy) |
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Term
| what is acute cholecystitis? |
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Definition
| acute inflammation of the gallbladder, the most common cause of which is obstruction of the cystic duct by *gallstones. |
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Term
| how does acute cholecystitis present? |
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Definition
| n/v, murphy sign (*arrest of inspiration w/palpation of RUQ), jaundice and/or a palpable mass. |
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Term
| how is acute cholecystitis diagnosed? |
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Definition
| hepatobiliary scintigraphy, which after a 2-4 hr fast, IV technetium is excreted through bile ducts and the gall bladder, common bile duct and small intestine should be visible w/in 90 min. if a person has acute cholecystitis, the gallbladder will not be visible after 90 min, even if the other structures are. |
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Term
| what is chronic cholecystitis? |
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Definition
| this is associated with gallstone complications such as recurrent pancreatitis, choledocholithiasis (stones in the ducts), and cholangitis (inflammation of the ducts) (6 wks +). the gallbladder often appears *thickened and fibrotic w/invaginated mucosal pouches (rokitansky-aschoff sinuses) |
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Term
| if an HIV pt presents with abdominal pain, what should be at the top of the ddx? |
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Definition
| AIDs related cholangiopathy. CMV and cryptosporidum can also infect the biliary system and producee cholecystitis and cholangitis. |
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Term
| if an HIV pt presents with abdominal pain, what should be at the top of the ddx? |
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Definition
| AIDs related cholangiopathy. CMV and cryptosporidum can also infect the biliary system and producee cholecystitis and cholangitis. |
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Term
| what is tx for chronic cholecystitis? |
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Definition
| cholecystectomy, either via laproscopic or open |
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Term
| what is acute pancreatitis? |
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Definition
| inflammation of the pancreas, which can be due to alcohol, cholelithiasis, post-op, ERCP (no longer standard for dx), trauma (#1 in kids), metabolic, acute fatty liver of pregnancy, infections, drugs, PUD, pancreatic divisium (congentital malformation), and hereditary pancreatitis. it can be either edematous (mild, self-limiting) or necrotizing (severe) |
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Term
| what is the mechanism believed to be the cause of acute pancreatitis? |
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Definition
| autodigestion. this is when proteolytic enzymes (trypsinogen, chymotrypsinogen, proelastase, and phospholipase A) are activated. also, bradykinin peptides and vasoactive substrates can cause vasodilation, increased vascular permeability and edema. this eventually results in necrotizing pancreatitis. |
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Term
| what are the clinical features associated with acute pancreatitis? |
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Definition
| abdominal pain is the major symptom, which can be mild to severe. steady and boring in the epigastrium/periumbilical and radiating back to the back, chest, flanks and lower abdomen. this *pain worsens w/supine position, pts prefer flexed trunk w/knees drawn up. pts will often present with n/v. |
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Term
| how will pts with acute pancreatitis present? |
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Definition
| distressed/anxious w/low grade fever, tachycardia, hypotension and possible shock. pts may also have erythematous skin nodules, cullen's sign (blue discoloration around the umbilicus) and/or turner's sign (blue-red/green-brown discoloration of the flanks). the last two are indicative of hemorrhagic pancreatitis. |
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Term
| how is acute pancreatitis diagnosed? |
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Definition
| elevated serum lipase (most specific), trypsin, amylase (appears first). |
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Term
| what is in the ddx for acute pancreatitis? |
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Definition
| PUD w/perforation, small bowel obstruction (particularly if pt presents with n/v - check hx and scarring), inferior MI, renal colic, dissecting aortic aneurysm, DKA, acute cholecystitis, and biliary colic |
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Term
| what are the ranson criteria for admission of acute pancreatitis pts? |
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Definition
| > 55 yrs, > 16 WBC, > 200 glucose, 400 LDH, and > 250 AST. if 3+ of these criteria are met - pt needs to be admitted for monitoring. |
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Term
| if a acute pancreatitis pt has qualified for ranson criteria of admission, what needs to be checked w/n 48 hrs? |
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Definition
| if there is: > 10% call in Hct, > 4 L fluid deficit, <8 mg/dl Ca+, < 60 mmHg pO2, > 5 mg/dl BUN increase, and <3.2 gm/dl albumin |
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Term
| what are complications of acute pancreatitis? |
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Definition
| pleural effusion (left), ARDS, hypotension, DIC, renal artery/vein thrombosis, purtscher's retinopathy, abscess, pseudocysts, pancreatic ascites, psychosis, fat emboli, acute tubular necrosis, sudden death, PUD, and erosive gastritis. |
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Term
| what is the level of acute pancreatitis incidence in AIDS pts? |
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Definition
| increased. CMV/cryptosporidium/MAI infections are also increased. tx: didanosine, pentamidine, and bactrim. |
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Term
| how is necrotizing pancreatitis diagnosed? |
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Definition
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Term
| what is the morbidity for necrotizing pancreatitis? how is it treated? |
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Definition
| > 20% in 1-2 wks. surgical debridement may be necessary if infected (40-60% of the time) and antibx are obviously used. |
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Term
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Definition
| necrotic tissue, granulation tissue and fibrous tissue *w/no epithelial cells*. these can occur up to 4 wks after onset of acute pancreatitis, and if still present after 6 wks - need to be drained. if the pseudocyst ruptures and there is blood, there is a 60% chance of rupture (if no blood, less of a chance of rupture) |
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Term
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Definition
| an ill defined collection of pus which can appear up to 6 wks after onset of acute pancreatitis. it is treated via sx or percutaneous drainage and is less life threatening than infected necrosis. it may be the result of a pseudocyst communicating with the colon. |
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Term
| what is the most common cause of chronic pancreatitis in adults? children? |
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Definition
| adults: alcohol abuse. children: CF |
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Term
| how does chronic pancreatitis present? what can it lead to? |
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Definition
| pts present with severe abdominal/back pain. chronic pancreatitis can lead to malabsorption syndrome (diarrhea, electrolyte imbalance), DM, calcifications, and increased CA risk. |
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Term
| how is chronic pancreatitis treated? |
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Definition
| narcotics, enzymes, sx resection, ERCP stent, antibx, iv fluids/NPO (no solid food to give pancreas rest). 85-90% of cases are self-limited. |
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Term
| what is an infectious concern with acute necrotizing pancreatitis? |
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Definition
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