chapter 44

AMYLASE

pancreatic enzyme; aids in the digestion of carbohydrates

CHOLECYSTECTOMY

removal of the gallbladder

CHOLECYSTITIS

inflammation of the gallbladder which can be acute or chronic

CHOLECYSTOJEJUNOSTOMY

anastomosis of the jejunum to the gallbladder to divert bile flow

CHOLECYSTOKININ (CCK)

hormone; major stimulus for digestive enzyme secretion; stimulates contraction of the gallbladder

CHOLECYSTOSTOMY

surgical opening and drainage of the gallbladder

CHOLEDOCHOLITHIASIS

stones in the common bile duct

CHOLEDOCHOSTOMY

opening into the common bile duct

CHOLELITHIASIS

calculi in the gallbladder

DISSOLUTION THERAPY

the use of medications to break up/dissolve gallstones

ENDOCRINE

secreting internally; hormonal secretion of a ductless gland

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

procedure using fiberoptic technology to visualize the biliary system

ENDOSCOPIC ULTRASOUND (EUS)

invasive procedure using an ultrasound probe at the end of an endoscope to detect cholelithiasis and to decompress the gallbladder in the setting of acute cholecystitis.

EXOCRINE

secreting externally; hormonal secretion from excretory ducts

LIPASE

pancreatic enzyme; aids in the digestion of fats

LITHOTRIPSY

disintegration of gallstones by shock waves

PANCREATITIS

inflammation of the pancreas; may be acute or chronic secretin

SECRETIN

hormone responsible for stimulating bicarbonate secretion from the pancreas; also used as an aid in diagnosing pancreatic exocrine disease

STEATORRHEA

frothy, foul-smelling stools with a high fat content; results from impaired digestion of proteins and fats due to a lack of pancreatic juice in the intestine

TRYPSIN

pancreatic enzyme; aids in the digestion of proteins

ZOLLINGER-ELLISON SYDROME

hypersecretion of gastric acid that produces peptic ulcers as a result of a non–beta-cell tumor of the pancreatic islets

ABDOMINAL X-RAY

to rule out other causes; only 10–15% of gallstones visible

ULTRASONOGRAPHY(ULTRASOUND)

diagnostic test of choice; detects gallstones or dilated CBD (~90% accuracy)

RADIONUCLIDE IMAGING/CHOLESCINTIGRAPHY(HIDA SCAN)

used to diagnose acute cholecystitis or bile duct blockage (used when ultrasound is inconclusive)

ORAL CHOLECYSTOGRAPHY

detects gallstones and evaluates gallbladder function if ultrasound is unavailable/inconclusive

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

visualizes biliary system; identifies ductal stones; used mainly to treat confirmed CBD stones

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)

used when ERCP is unsafe; evaluates biliary system and obstruction

URSODEOXYCHOLIC ACID

dissolves cholesterol gallstones

CHENODEOXYCHOLIC ACID

decreases cholesterol saturation in bile

Dissolution therapy with solvents

dissolves stones (rarely used)

INTRACORPOREAL LITHOTRIPSY

fragments stones using laser/electrohydraulic pulses

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

breaks stones using external shock waves

LAPAROSCOPIC CHOLECYSTECTOMY

Standard treatment for symptomatic gallstones

OPEN CHOLECYSTECTOMY

gallbladder removal through abdominal incision

SMALL-INCISION CHOLECYSTECTOMY

gallbladder removal through smaller incision

CHOLEDOCHOSTOMY

common bile duct incision for stone removal and drainage

SURGICAL CHOLECYSTOSTOMY

gallbladder opened for drainage/removal of stones

PERCUTANEOUS CHOLECYSTOSTOMY

catheter drainage using imaging guidance

ENDOSCOPIC ULTRASOUND

guided gallbladder drainage procedure

ERCP WITH SPHINCTEROTOMY (PRE-OP)

used if common bile duct obstruction suspected

4 COMPLICATIONS OF CHOLELITHIASIS & PANCREATITIS

1. abscess

2. necrosis

3. perforation

4. generalized peritonitis

5 CMOPLICATIONS OF SEVERE ACUTE PANCREATITIS (NECROTIZING)

1. shock

2. respiratory failure

3. kidney failure

4. GI bleeding

5. pancreatic abscesses or cysts

2 COMMON CAUSES OF ACUTE PANCREATITIS

1. gallstones

2. chronic alcohol abuse

REVISED ATLANTA CLASSIFICATION

A system used to classify acute pancreatitis as mild, moderately severe, or severe based on organ failure and complications.

APACHE II SCORE

A scoring tool used to measure disease severity and predict mortality risk in critically ill patients using vital signs and laboratory findings.

RANSON CRITERIA

A scoring system used to assess the severity and mortality risk of acute pancreatitis based on clinical and laboratory findings within 48 hours.

BISAP SCORE

A bedside scoring tool used to predict severity and risk of death in acute pancreatitis using five clinical criteria within 24 hours.

2 MAJOY CAUSES OF CHRONIC PANCREATITIS

1. chronic alcohol consumption

2. malnutrition

5 COMPLICATION OF PANCREATIC CYST

1. infection

2. hemorrhage

3. rupture

4. sepsis

5. obstruction of adjacent organs

WHIPPLE PROCEDURE (PANCREATICODUODENECTOMY)

for tumors in the head of pancreas