GI Packet 2

Where is the Location of the Gallbladder (GB)

Right Upper Quadrent under the Liver

What is the approximant size of the GB?

3-4 Inches

What is the function of the GB?

Stores Bile that is made by the liver

What are Gallstones?

Gallstones are circular, small pebble-like stones that are made from bile when it hardens

Where do gallstones form?

In the gallbladder or in the duct system

What are the two types of stones?

-Cholesterol stones

-Pigment stones

Gallstones are mostly? (symptomatic or asymptomatic)

Most are asymptomatic

How may the pain be?

Intermit or constant

What is the medical name for inflammation of the gallbladder?

Cholecystitis

What is the medical name for stones in the GB?

Cholelithiasis

What is the medical name for stones in the duct system, Common bile duct?

Choledocholithiasis

What are the 5 risk biggest risk factors for Gallstones?

1. Female

2. Family History

3. Forties

4. Fat (Overweight

5. Fertile

Difference between sign and symptom?

Signs are what the you can observe

Symptoms are what the patient tells you

What are the three signs that are common with gallstones?

A. RUQ tenderness

B. Dehydration (if persistent vomiting)

C. Murphy's sign

What is Murphy's sign and what does it indicate?

Halted inspiration over the right upper quadrant as you push a finger into the liver where the gall bladder is. Indicative of cholecystitis.

What are the common symptoms of gallstones?

-Abdominal Pain

-RUQ pain

-Epigastric pain

-Poorly localized pain

-Pain that radiate to the shoulder or back

-Generalized pain in the upper-abdomen

How is the timing of abdominal pain?

Pain sometimes 30-60min after meal (may last hours)

What are some associated symptoms of gallstones?

-Nausea & Vomiting

-Diarrhea

What are a couple DDx for gallstones?

-Liver

-Stomach Ulcers

-Pancreatitis

-Gastritis

-MI

What are the six ways for Dx for gallstones?

1. Labs-elevated WBC count

2. Abdominal Ultrasound

3. Endoscopic retrograde cholangiopancreatography (ERCP)

4. Helical CT (Spiral CT)

5. Oral Cholecystogram

-Xray of GB after oral contrast is taken

6. HIDA Scan

-Nuclear medicine Scan

What is the management for asymptomatic gallstones?

Don't do anything. Wait and see

What if the patient has only one attack of gallstone pain?

Wait and see

What do you do if the patient has really bad pain and can't tolerate the gallstones?

Cholecystectomy

Where is the pancreas located?

behind the stomach. Sits in the C of the duodenum.

what is the size of the pancreas?

6 inches long

What are the two types of tissue in the pancreas? What do they do?

Exocrine Tissue: This tissue produces digestive enzymes to help with digestion like amylase and lipase

Endocrine Tissue: Regulates Glucose

What is pancreatitis? When does it occur?

Inflammation of the pancreas.

Occurs when digestive enzymes, usually contained within ducts in the pancreas, leak into the rest of the pancreas, and irritate it.

What are the top three risk factors for pancreatitis?

Alcohol abuse

Gallstones

High Triglycerides

Common signs of pancreatitis?

decreased bowel sounds - hypoactive

abdominal rigidity - especially in acute pancreatitis

Name the typical symptoms of pancreatitis

Sudden onset

epigastic pain

radiates to back

may increase with eating

10/10 pain is common

feels like knives going through into back

anorexia

N & V and fever could be there

Diagnosis for pancreatitis?

Labs for enzymes amylase and lipase

CBC

LFT

CT of abdomen *PREFERED

Ultrasound of abdomin

management for pancreatitis?

Pain management

Intravenous saline

Antibiotics if WBC is high

Address underlining problem

What is the definition of bowel obstruction?

any condition that prevents the flow of chyme through the bowel

Where is bowel obstruction more common?

In the small bowel but still can happen in the large

Common symptoms of bowel obstruction?

Nausea, Vomiting, Cramps, Distention, Absence of bowel movement, can occur in stages

What is a mechanical blockage?

Some type of physical blockage

What are some types of mechanical blockages?

-Adhesions - Fibrous ands that occur in abdomen

-Hernias

-Tumor of Growth

-IBD

-Volvulus - Bowel Twists

-intussusception - Telescoping in on itself

What is a Functional Blockage?

Nothing Blocking, lack of peristalsis

What are some examples of a functional blockage?

-Prior Surgery

-Infection

-Medication

-Nerve or muscle disorder

What is string of pearl sign?

radiograph of the abdomen demonstrates a row of small air bubbles , which represents air trapped in small bowel

What complications can occur due to bowel blockage?

Death of intestinal wall - due to no blood supply

What is the treatment for partial bowel obstruction?

-Put the bowel to rest. Give it time to recover

-May have to put nasogastric tube to remove stomach acid that might be causing problems

What is the treatment for complete bowel obstruction?

Surgery to remove whatever is blocking

What is the appendicitis? What does it look like? Size? Location?

inflammation of the appendix

Finger shaped pouch that projects from cecum

Pinky Size

RLQ

Causes of appendicitis?

-Fecal Obstruction

-excessive mucous

-tumor of appendix

-Infection

Clinical manifestations of appendicitis?

-RLQ pain, most start with periumbilical pain, maybe epigastric

-Anorexia, N & V

-Pain localizes to LRQ

-Low grade fever may be present

-Diarrhea

What could be some DDx for appedicitis?

-Bowel obstruction

-Testicular torsion

-Ovarian Cyst

-UTI

-Etopic pregnancy

Diagnosis of appendicitis?

-CT - test of choice

-Ultrasound

-CBC - look at WBC 10-20,000

Management of appendicitis?

Appendectomy. + or - antibiotics