Precipitation Worksheets

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					                              Cholelithiasis                              Cholecystitis                         Cholangitis                Carcinoma of GB
                precipitation of cholesterol in bile due to
                                                                                                        obstruction of the common
  etiology       imbalance of: cholesterol, lecithin, bile
                                                                                                                  bile duct
                           salts - 4F risk factors
                  80% asymptomatic, RUQ pain (often                                                     Charcot's Triad: pain, fever,
                   after eating), steatorrhea, Murphy's                                                  jaundice - slow mentation,
                         sign, Mirizzi's syndrome                                                                  sepsis
    labs                      U/S, HIDA scan
                                                              acute: congestion, edema, necrosis,
                   villi bridging, muscle hypertrophy,
                                                              ulceration, fibrin, exudate - chronic:
 pathology         lymphoid infiltration, Rokitnasky-                                                   inflammation of biliary tree        adenocarcinoma
                                                               atrophy, fibrosis, scar, metaplasia,
                              Aschoff sinuses
                                                                  hyperplasia (wall thickening)
                ursodeoxycholic acid, lithotripsy, ERCP,
  treatment                                                                                                                                  poor prognosis
                     surgery (only if symptomatic)
                cholecystitis, choleangitis, pancreatitis,
                      gallstone ileus, carcinoma

                            Cystic Fibrosis                            Acute Pancreatitis                  Chronic Pancreatitis           Cancer of Pancreas
                 CFTR gene, hereditary: abnromal Cl-          autodigestion via trypsin: obstruction,       ETOH (Ca deposits),         duct epithelias dysplasia,
  etiology       channel, thick secretions in exocrine         cell injury, abnormal cell transport,     idiopathic, genetic (CFTR,     mut in K-ras, inactivation
                         glands, obstruction                             enzyme activation                   PRSS1, SPINK 1)                 of p16 and p53
                                                                men: ETOH, women: biliary tract          large duct disease: ETOH,
                  presents in kids: respiratory failure,                                                                               epigastric pain w/ back
                                                              disease - severe constant epigastric           small duct disease:
   clinical        pancreatic insufficiency, cirrhosis,                                                                              pain, weight loss, jaundice,
                                                                pain bores into back, N/V, shock             idiopathic - chronic
presentation     sinusitis, infertility, meconium ileus, R                                                                                Trousseau's sign:
                                                              signs, guarding/rigidity, Grey Turner     epigastric pain and exocrine
                     heart failure, abnormal sweat                                                                                       hypercoagulability
                                                                      sign - Atlanta Criteria                       failure
                                                                                                         serum trypsinogen, Sudan
    labs                  sweat test, gene test                   elev amylase, lipase, TG, LFT                                             CA 19-9, CEA
                                                                                                                 stain of stool
                                                                 tissue necrosis, fat necrosis and
                                                                                                      interstitial fibrosis, acinar
                   interstitial fibrosis, acinar atrophy,     soponification, vascular damage and                                       adenocarcinoma, more
 pathology                                                                                           atrophy, ducts not dilated -
                                dilated ducts                   hemorrhage, acute inflammation -                                            likely in head
                                                                                                      90% loss for steatorrhea
                                                                      interstitial v. necrotizing
  treatment                     supportive                           NPO, IV fluids, pain meds             treat symptoms                    poor prognosis
                                                              cytokines: shock, ARDS, renal failure,      pseudocyst, duct
complications                                                                                                                              new cancer: IPMT
                                                                      pseudocyst, obstruction        obstruction, malabsorption

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