Gallbladder and Pancreatic Disorders

These flashcards cover key vocabulary and concepts related to gallbladder and pancreatic disorders as covered in the lecture notes.

What is Cholecystitis?

Inflammation of the gallbladder, which can occur with or without gallstones.

Symptoms of Cholecystitis

Upper right quadrant or epigastric pain that may radiate to the right shoulder or back, nausea, vomiting, fever, chills, and possible jaundice.

Diagnosis of Cholecystitis

Physical examination (Murphy's sign), laboratory tests (elevated white blood cell count, liver enzymes), and imaging studies (ultrasound is the primary method, HIDA scan).

Treatment of Cholecystitis

Supportive care (IV fluids, analgesics), antibiotics, and definitive management often involves surgical removal of the gallbladder (cholecystectomy).

Management of Cholecystitis

Dietary modifications (low-fat diet), pain control, and monitoring for complications like perforation or sepsis. Post-cholecystectomy, most patients recover without long-term issues.

Medications for Cholecystitis

Analgesics (NSAIDs, opioids) for pain, antiemetics for nausea/vomiting, and broad-spectrum antibiotics (e.g., cefazolin, metronidazole, piperacillin-tazobactam) to cover potential bacterial infection.

What is Cholelithiasis?

The presence of gallstones in the gallbladder, which are hardened deposits of digestive fluid.

Symptoms of Cholelithiasis

Often asymptomatic; when symptomatic, referred to as biliary colic, characterized by sudden and rapidly intensifying pain in the upper right abdomen or epigastrium, radiating to the right shoulder or back. May include nausea, vomiting, and indigestion, typically after fatty meals.

Diagnosis of Cholelithiasis

Primarily diagnosed by ultrasound, which can visualize gallstones. Other tests may include liver function tests to rule out complications.

Treatment of Cholelithiasis

Asymptomatic stones generally do not require treatment. Symptomatic gallstones are typically treated with surgical removal of the gallbladder (cholecystectomy). In some cases, medication for stone dissolution or endoscopic procedures may be considered.

Management of Cholelithiasis

For asymptomatic individuals, watchful waiting. For symptomatic relief, advise low-fat diet. Post-cholecystectomy, most people tolerate regular diets, but some may experience post-cholecystectomy syndrome.

Medications for Cholelithiasis

Analgesics (e.g., NSAIDs, acetaminophen) for pain during biliary colic. Oral bile acid dissolution therapy (e.g., ursodeoxycholic acid) can dissolve cholesterol stones, but it is a slow process with a high recurrence rate and is not commonly used.

What is Murphy's Sign?

A physical examination finding indicative of gallbladder inflammation (cholecystitis), elicited by pain when pressure is applied to the right upper quadrant during inspiration.

Diagnosis using Murphy's Sign

It is a clinical sign used to aid in the diagnosis of acute cholecystitis when evaluating abdominal pain. A positive sign suggests gallbladder inflammation.

What is Empyema (gallbladder)?

A collection of pus within the gallbladder, typically a complication of acute cholecystitis, indicating a severe infection.

Symptoms of Gallbladder Empyema

Severe right upper quadrant pain, high fever, chills, leukocytosis, and potentially signs of sepsis. The pain is usually more intense and persistent than typical biliary colic.

Diagnosis of Gallbladder Empyema

Clinical presentation, significantly elevated white blood cell count, and imaging (ultrasound or CT scan) showing fluid collection with dependent debris or gas within the gallbladder lumen, consistent with pus.

Treatment of Gallbladder Empyema

Urgent surgical intervention (cholecystectomy) is usually required. Percutaneous cholecystostomy (drainage of the gallbladder) may be performed in unstable patients prior to definitive surgery.

Management of Gallbladder Empyema

Aggressive antibiotic therapy, fluid resuscitation, and monitoring for signs of sepsis and perforation. Post-surgical care focuses on infection resolution and recovery.

Medications for Gallbladder Empyema

Broad-spectrum intravenous antibiotics are critical (e.g., piperacillin-tazobactam, meropenem, or a combination of a third-generation cephalosporin with metronidazole).

What is Acute Pancreatitis?

An inflammatory condition of the pancreas that often presents with abdominal pain and can range from mild to severe, potentially leading to systemic complications.

Symptoms of Acute Pancreatitis

Severe epigastric pain radiating to the back, often worsened by eating and unrelieved by vomiting; nausea, vomiting, abdominal tenderness, fever, and tachycardia. Severe cases may show Cullen's sign (periumbilical ecchymosis) or Grey Turner's sign (flank ecchymosis).

Diagnosis of Acute Pancreatitis

Clinical symptoms accompanied by at least a three-fold elevation in serum amylase or lipase levels, and often confirmed by imaging (CT scan or MRI) showing pancreatic inflammation.

Treatment of Acute Pancreatitis

Primarily supportive care: aggressive intravenous fluid resuscitation, pain management, and nutritional support (initially NPO and then gradual reintroduction of oral intake). Removal of the causative agent (e.g., gallstones via ERCP) if applicable.

Management of Acute Pancreatitis

Monitoring for complications (necrosis, pseudocyst, infection, organ failure), strict bowel rest (NPO) in severe cases, and gradual diet progression. Management of underlying causes (e.g., alcohol cessation, gallstone removal).

Medications for Acute Pancreatitis

Analgesics (often intravenous opioids like hydromorphone or fentanyl) for pain, antiemetics for nausea, and sometimes prophylactic antibiotics for severe necrotizing pancreatitis (though controversial).

What are Ranson's Criteria?

A scoring system used to assess the severity and prognosis of acute pancreatitis, based on clinical and laboratory findings at admission and within the first 48 hours.

Factors in Ranson's Criteria (Admission)

Age >55 years, White blood cell count >16,000/mcL, Glucose >200 mg/dL (11 mmol/L), Lactate dehydrogenase (LDH) >350 IU/L, Aspartate aminotransferase (AST) >250 IU/L.

Factors in Ranson's Criteria (48 Hours)

Hematocrit fall >10\% from admission, Blood urea nitrogen (BUN) increase >5 mg/dL (1.79 mmol/L) from admission, Calcium

Interpretation of Ranson's Criteria

A higher number of criteria met correlates with increased severity and mortality risk. For example, 0-2 criteria usually indicate mild pancreatitis with low mortality, while 3 or more suggest severe pancreatitis with significant mortality.

What is a Whipple Procedure (Pancreaticoduodenectomy)?

A complex surgical procedure involving the removal of the head of the pancreas, the duodenum, the gallbladder, and part of the bile duct, commonly performed for pancreatic cancer or other pancreatic/biliary tumors.

Treatment with Whipple Procedure

It is the primary curative surgical treatment for resectable cancers of the pancreatic head, distal common bile duct, duodenum, and ampulla of Vater.

Management after Whipple Procedure

Intensive post-operative care, including managing pain, fluid balance, and monitoring for complications (e.g., pancreatic fistula, delayed gastric emptying, infection). Long-term management may involve enzyme replacement, diabetes control, and nutritional support.

Medications after Whipple Procedure

Pancreatic enzyme replacement therapy (e.g., Creon, Zenpep) to aid digestion, insulin or oral hypoglycemic agents for post-surgical diabetes, and analgesics for pain control as needed.

What is Cirrhosis?

Permanent and irreversible scarring (fibrosis) of the liver due to long-term liver damage, leading to impaired liver function and portal hypertension.

Symptoms of Cirrhosis

Fatigue, weakness, nausea, loss of appetite, weight loss. Later symptoms include jaundice, ascites (fluid in abdomen), edema, pruritus (itching), dark urine, easy bruising, spider angiomas, palmar erythema, and confusion (hepatic encephalopathy).

Diagnosis of Cirrhosis

Clinical presentation, abnormal liver function tests (elevated AST/ALT, bilirubin, decreased albumin), imaging (ultrasound, CT, MRI showing nodular liver surface), and liver biopsy (gold standard) to confirm fibrosis.

Treatment of Cirrhosis

Managing complications (e.g., diuretics for ascites, lactulose for encephalopathy, beta-blockers for varices), identifying and treating the underlying cause (e.g., antiviral therapy for hepatitis, alcohol abstinence), and liver transplantation for end-stage liver disease.

Management of Cirrhosis

Lifestyle modifications (alcohol abstinence, healthy diet), regular screening for hepatocellular carcinoma and varices, vaccinations (hepatitis A/B, influenza, pneumococcal), and close monitoring of liver function.

Medications for Cirrhosis

Diuretics (spironolactone, furosemide) for ascites, lactulose and rifaximin for hepatic encephalopathy, non-selective beta-blockers (propranolol, carvedilol) to reduce portal pressure and variceal bleeding, and vitamin K for coagulopathy.

What is Portal Hypertension?

Increased blood pressure in the portal venous system (the veins that carry blood from the digestive organs to the liver), most commonly caused by cirrhosis.

Symptoms of Portal Hypertension

Mainly related to its complications: gastrointestinal bleeding from esophageal or gastric varices, ascites, splenomegaly, and hepatic encephalopathy.

Diagnosis of Portal Hypertension

Clinical signs (ascites, splenomegaly), imaging (ultrasound with Doppler showing increased portal vein flow velocity, dilations of portal vessels), endoscopy to detect varices, and direct measurement of hepatic venous pressure gradient (HVPG).

Treatment of Portal Hypertension

Treating the underlying cause (e.g., cirrhosis). Specific treatments for complications include endoscopic variceal ligation or sclerotherapy for varices, TIPS (Transjugular Intrahepatic Portosystemic Shunt) for refractory ascites or bleeding, and paracentesis for ascites.

Management of Portal Hypertension

Regular monitoring for complications, dietary sodium restriction for ascites, and avoidance of NSAIDs which can worsen kidney function and increase bleeding risk. Prophylactic treatment of varices if present.

Medications for Portal Hypertension

Non-selective beta-blockers (propranolol, nadolol, carvedilol) to reduce splanchnic blood flow and portal pressure, reducing the risk of variceal bleeding. Diuretics (spironolactone with furosemide) for ascites. Rifaximin for hepatic encephalopathy.

What is Nonalcoholic Fatty Liver Disease (NAFLD)?

A condition characterized by excess fat accumulation in the liver in individuals who consume little to no alcohol. It ranges from simple fatty liver (steatosis) to nonalcoholic steatohepatitis (NASH), which involves inflammation and liver cell damage.

Symptoms of NAFLD

Often asymptomatic. When symptoms occur, they are usually mild and non-specific, such as fatigue, malaise, and dull pain or discomfort in the upper right abdomen.

Diagnosis of NAFLD

Exclusion of other liver diseases, medical history (minimal alcohol use), elevated liver enzymes (AST/ALT), and imaging (ultrasound, CT, MRI) to detect fat in the liver. Liver biopsy is the gold standard for distinguishing NAFLD from NASH and assessing fibrosis severity.

Treatment of NAFLD

Primarily focuses on lifestyle modifications: weight loss (especially for obese or overweight individuals), dietary changes (reducing refined carbohydrates and saturated fats), and regular physical activity.

Management of NAFLD

Managing associated metabolic risk factors such as obesity, type 2 diabetes, dyslipidemia, and hypertension. Regular monitoring of liver function tests and imaging to assess disease progression or regression.

Medications for NAFLD

Currently, there are no FDA-approved medications specifically for NAFLD/NASH. However, medications used to manage comorbidities, such as insulin sensitizers (e.g., pioglitazone for diabetes) and vitamin E (for non-diabetic NASH), may be used off-label or in trials. Statins are used to manage dyslipidemia.