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Non-neoplastic Biliary and Pancreatic Diseases - Coggle Diagram
Non-neoplastic Biliary and Pancreatic Diseases
Gall Stone
Imaging
Radiography has no use in acute choelcystitis
Ultrasound is highly accurate particularyly if there are signs of gallbladder wall thickening/edema
Further Imaging may include CT abdomen
Endoscopic US
Labs
Increase Bilirubin, AST, ALT, ALP
Treatment
ABCs, IV fluids, Blood cultures, IV antibioptics, arrange for non-invasive stone extraction
Acute Pancreatitis
Labs
Elevated Bilirubin, Platelets, hemogloin, lipase, amylase, AST, ALT, ALP
Amylase
Elevates within hours, and can remain elevated for many days
Lipase
Preferred test for diagnosis of pancreatitis which increases 4-8hr after onset, and peaks around 24 hrs
Causes
Idiopathic, Gall stones, EtOH, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hyper Ca, ERCP, Drugs
Prognosis
At Admission
Age >55, WBC >16, Glu >200, AST >250, LDH >350
At 48 hrs out
Caa<8, HCT fall > 10%, PO2 < 60, BUN increase >5, Base deficit >4, Sequestration of fluids >6L
Imaging
Ultrasound
Determine etiology of pancreatitis: assess for gallstone, and assess bile duct
CT
Look for presence of suspected or proven gall stone etiology, cholangitis, jaundice, dilated bile ducts
Management
Removal of offending agents, supportive care, monitor for complications
Supportive care: NPO to clear fluid, IV fluid and electrolytre replacement, analgesia, Nutritional support
Antibiotics
For cholangitis, infected necrosis, abscess, infected pseudocyst
Chronic Pancreatitis
Investigations
CT Scan
May find calcification of the pancreas
CT is moderately accurate
Pathophysiology
Irreversible parenchymal destruction leading to pancreatic dysfunctions
Exocrine insurfficienfy - Enzymes -> weight loss and steatorrhea
Endocrine insufficiency - islet cell -> Diabetes
Souorces of Pain
Stenosis of bile duct, duodenum, acute inflammation, neural inflammation, increased pressure (parenchyma, duct pseudocyst)
Causes
EtOH, idiopathic, gallstones, autoimmune, hyperparathyroidism
Management
Alcohol discontinuation, enzyme therapy replacement due to exocrine insufficiency