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Risk factors, Digestion of food, TBL 7.03 MECHANISTIC DIAGRAM, Gerry Guo,…
Risk factors
Female
82 years old
Gallstones
CHOLELITHIASIS
Abdominal US
Consider cholecystectomy
Take into account co-morbidities and age
Common bile duct obstruction
CHOLEDOCHOLITHIASIS
Cholestatic disease
Biliary colic from functional spasm of ducts
Transmitted by thoracic splanchnic nerves
RUQ pain
Not relieved by antacids
Intermittent
Sudden onset, severe, lasts several hours
Radiates to the back
Build up of bile acid in blood
Pruritis
Scratch marks on forearms
UDCA
Build up of conjugated bilirubin in blood
OBSTRUCTIVE JAUNDICE
Scleral icterus
Serum bilirubin 175 µmol/L
Excreted by kidneys
Dark urine
Urinalysis - bilirubin +
Decreased bile flow through bile duct into GIT
E. coli translocates through major duodenal papilla
E. coli infection
ASCENDING CHOLANGITIS
1 more item...
Positive blood culture
Decreased bile acid in GIT
Decreased absorption of fat-soluble vitamin K
Decreased synthesis of coagulation factors
Elevated INR (1.4)
Elevated ALP, GGT & bilirubin
No bilirubin in GIT from block
No stercobilin
Pale stool
ERCP
Endoscopic extraction of gallstones via ERCP
High BMI
Lifestyle modification
Frusemide
Hypokalemia
Serum potassium 3.3 mmol/L
IV Potassium resuscitation
Concern about independence and ability to care for husband
Reassurance
Consider primary carer for husband
Digestion of food
Exacerbated by fatty food
Reduce fat intake
CCK release
Gallbladder contracts
Obstruction causing pain
Postprandial
TBL 7.03 MECHANISTIC DIAGRAM
Gerry Guo, Kara Harris, Mohammed Hassan, Christy Hou & Daniel Kasunic