Term
| The common bile duct converges with the pancreatic duct to empty into the second part of the _______ via the ____ __ _____. |
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Definition
| duodenum via the Ampula of Vater |
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Term
| outflow of pancreatic/bile into the duodenum is controlled by: |
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Definition
|
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Term
| hormone that causes contraction of the galbladder: |
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Definition
|
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Term
| hormone that causes relaxation of the sphincter of Odi: |
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Definition
|
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Term
| the most common type of gallstone in the western population: |
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Definition
| (75%)mixed type containing high levels of cholesterol |
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Term
| small dark stones made of bilirubin and calcium: |
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Definition
|
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Term
|
Definition
|
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Term
| 5 major risk factors for gallstones: |
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Definition
1. obesity
2. multiparity
3. high dose estrogen (contraceptives)
4. some chol meds
5. rapid weight loss |
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Term
| explain xs hormones related to gallstones: |
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Definition
| progesterone/estrogen are steroid hormones similar to cholesterol in structure so increased levels of the steroid molecules may cause cholesterol to precipitate in the gallbladder. |
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Term
| describe chronic gallstones sx: |
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Definition
| dull,steady, fairly severe pain lasting 1-4hrs in the RUQ from temopary blockage of the cystic duct by a stone.Pt phys well <episode, usually start after a heavy meal. |
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Term
| why would there be pain after a meal high in fat in chronic gallstones? |
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Definition
| once the fatty meal reaches the duodenum/jejunum CCK is released and causes contraction of the GB against the stone. |
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Term
| describe sx of acute gallstones: |
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Definition
| sharp,steady,well localized RUQ pain lasting longer than 3-4hrs maybe even days. due to a stone that is STUCK in the bile duct. Pt usually has N/V |
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Term
| jaundice w light colored stools and dark urine suggests: |
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Definition
| extrahepatic biliary obstruction; common bile duct obstruction causing bile to back up into the liver increasing bilirubin in blood |
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Term
| liver enzymes elevated w extrahepatic obstruction: |
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Definition
|
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Term
| pt doubled up, restless, tossing back and forth w severe pain: |
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Definition
| biliary colic with stone in galbladder |
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Term
| pt motionless, and don't want to move at all bc of pain: |
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Definition
| inflammatory type, most like stone stuck in tract |
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Term
|
Definition
| direct bili = conjugated bili that has reached the liver and is xfered into bile. |
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Term
| define indirect bliirubin: |
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Definition
| indirect bilirubin = unconjugated bili that comes from the breakdown of the heme molecules from RBCs taken out of circ by the spleen. albumin binds heme and xports it to the liver |
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Term
| which stones are visible with xray? |
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Definition
| calcium stones (20%) only 10-15% of gallstones have enough calcium to be able to see on xray |
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Term
| initial study of choice for gallstones: |
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Definition
|
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Term
| imaging study other than US for gallstones: |
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Definition
|
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Term
| Dx imaging: IV inj of radiopaque dye that is excreted by liver into bile tract |
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Definition
| Radionuclide biliary scanning (HIDA scan) |
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Term
| DX imaing: inj dye into bile ducts to visualize proximal ducts. also able to bx, extract stones and place a biliary drainage cath |
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Definition
| Percutaneous Transhepatic Cholangiogram |
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Term
| dx imaging: inj of dye into the biliary tree and pancreas so they can be seen on xray; most common bile duct stones are removed by this method, also may perform sphincterotomy (Odi) |
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Definition
| Endoscopic retrograde cholangiopancreatogram (ERCP) |
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Term
| dx imaging: begining to replace PTC & ERCP bc its nonivasive and wo radiation |
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Definition
| magnetic resonance cholangiography (MRC) |
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Term
| N/V, pain, intolerance to fatty foods, dyspepsia: |
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Definition
|
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Term
| chronic cholecystitis tx: |
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Definition
| IV analgesics, observation, elective cholecystecomy |
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Term
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Definition
|
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Term
| if acute cholecystitis fvr >101 r/o: |
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Definition
|
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Term
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Definition
| NPO, IVfl, Abx, cholecystectomy |
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Term
|
Definition
| gallstone blocking the common bile duct |
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Term
|
Definition
1. jaundice
2. RUQ pain
3. Fvr
Acute cholangitis |
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Term
|
Definition
1. jaundice
2. RUQ pain
3. Fvr
4. hypotension
5. confusion
pus in biliary ducts resulting in acute suppurative cholangitis |
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Term
|
Definition
| NPO, IVfl, abx post Blood cultures. |
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Term
| how can cholecystitis result in pancreatitis? |
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Definition
| stone blocks pancreatic duct causing back up of pancreatic digestive enzymes; pancreas begins digesting itself |
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