Term
| Stores bile secreted from liver; absorbs water and electrolytes; facilitates fast delivery of bile |
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Definition
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Term
| Higher in Western Caucasians, Hispanic, and Native Americans; Lower in Eastern European, African Americans, Japanese |
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Definition
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Term
| Gallstone Disease Risk Factors |
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Definition
| > 40 years of age; Female; Oral Contraceptives; Pregnancy; Obesity (120% IBW); Rapid weight loss |
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Term
| 85-95% of gallstones; radiolucent |
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Definition
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Term
| 5-10% of gallstones; radio-opaque |
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Definition
| Pigment stones (Bilirubin stones) |
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Term
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Definition
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Term
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Definition
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Term
| Solubilizes cholesterol and decreases cholesterol secretion into bile |
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Definition
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Term
| Ursodiol (Actigall) indications |
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Definition
| Radiolucent (cholesterol) stones; Surgery refusal, poor candidate; choledocholithiasis after cholecystectomy |
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Term
| Best outcomes for Ursodiol (Actigall) |
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Definition
| Functional gallbladder; treatment of small (< 5 mm) gallstones |
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Term
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Definition
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Term
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Definition
| 8-12 mg/kg/day PO divided BID-TID |
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Term
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Definition
| GI complaints, increased serum cholesterol, increased AST/ALT |
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Term
| Ursodiol: 25% complete and 25% partial dissolution over 2 years BUT |
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Definition
| Endoscopic retrograde cholangio-pancreatography (ERCP) |
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Term
| ERCP: Diagnostic and therapeutic |
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Definition
| Visualize biliary tree; Stone removal; stent placement |
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Term
| ERCP: Antibiotic Prophylaxis: Enteric GNR (E. coli, Klebsiella sp.) |
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Definition
| Cefazoline; Fluoroquinolone (Ciprofloxacin; Levofloxacin) |
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Term
| ERCP: Antibiotic Prophylaxis: Cover enterococcus sp. if endocarditis risk (ex: prosthetic valve) |
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Definition
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Term
| Occurs with 20% of patients w/ gall stones |
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Definition
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Term
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Definition
| Nausea/vomiting; sudden onset of pain |
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Term
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Definition
| RUQ pain > 5 hrs, N/V, leukocytosis |
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Term
|
Definition
| RUQ pain > 5 hrs, N/V, leukocytosis |
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Term
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Definition
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Term
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Definition
| Obstructed common bile duct |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Minimal elevations in bilirubin and LFTs |
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Term
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Definition
| Increased bilirubin (>5 mg/dL) and LFTs |
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Term
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Definition
| Fluid + electrolyte replacement; Pain management; Antibiotics; Cholangitis --> ERCP; Cholecystitis --> Cholecystectomy |
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Term
| Community-acquired acute cholecystitis: mild-moderate |
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Definition
| Cefazolin, Cefuroxime, or Ceftriaxone (Consider adding metronidazole) |
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Term
| Community-acquired acute cholecystitis: Severe, immunocompromised, advanced age |
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Definition
| Piperacillin/tazobactam, Imipenem-cilastatin, meropenem, or doripenem AND consider adding metronidazole OR Ciprofloxacin, Levofloxacin, or Cefepime each WITH metronidazole |
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Term
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Definition
| Piperacillin/tazobactam, Imipenem-cilastatin, meropenem, or doripenem AND consider adding metronidazole OR Ciprofloxacin, Levofloxacin, or Cefepime each WITH metronidazole |
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Term
| Healthcare-associated biliary infection |
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Definition
| Piperacillin/tazobactam, Imipenem-cilastatin, meropenem, or doripenem AND consider adding metronidazole OR Ciprofloxacin, Levofloxacin, or Cefepime each WITH metronidazole WITH VANCOMYCIN |
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Term
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Definition
| Insulin, Glucagon, Somatostatin |
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Term
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Definition
| Bicarbonate, Digestive enzymes |
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Term
| Acute Pancreatitis Symptoms |
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Definition
| Abdominal Pain (95%): sudden onset, Knife-life, persists for days; Nausea/Vomiting (85%): electrolyte disturbances |
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Term
| Chronic Pancreatitis Symptoms |
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Definition
| Abdominal Pain: dull radiation pain, days to weeks; Steatorrhea; Occasional Nausea/Vomiting; Malabsorption: decreased fat and protein absorption, weight loss, Vitamin B12; Diabetes (Insulin dependent) |
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Term
| Acute Pancreatitis Laboratory |
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Definition
| Increased Amylase and Lipase; Increased AST/ALT/alk phos |
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Term
| Chronic Pancreatitis Laboratory |
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Definition
| Usually within normal limits |
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Term
| Acute Pancreatitis Fever? |
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Definition
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Term
| Chronic Pancreatitis Fever? |
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Definition
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Term
| Acute Pancreatitis Leukocytosis? |
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Definition
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Term
| Chronic Pancreatitis Leukocytosis? |
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Definition
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Term
| Acute Pancreatitis Abdominal CT |
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Definition
| Pancreatic inflammation and possible necrosis or fluid collection |
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Term
| Chronic Pancreatitis Abdominal CT |
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Definition
| Pancreatic calcifications, but imaging studies may be normal |
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Term
| Acute Pancreatitis Primary Events |
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Definition
| Premature activation of enzymes; Pancreatic ischemia; Pancreatic duct obstruction |
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Term
| Acute Pancreatitis Secondary Events |
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Definition
| Inflammation, Vascular/cellular damage, translocation of colonic bacteria |
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Term
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Definition
| Majority of cases; recovery within 2-7 days; self limited (80% of cases) |
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Term
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Definition
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Term
| Acute Pancreatitis Etiology |
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Definition
| Gallstones; Alcohol (acute exacerbation--chronic); idiopathic; other (procedure induced; medication induced) |
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Term
| Drug induced pancreatitis |
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Definition
| rare overall: "definite", "probable" or "possible" association |
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Term
| Alcohol induced pancreatitis |
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Definition
| 4-7 years of abuse; as little as 50 g of ethanol/day (4 beers); 10% of chronic EtOH abusers; Binge drinking |
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Term
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Definition
| gallstone migration; bile duct or pancreatic duct; smaller stones increased risk; pancreatic reflux of bile |
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Term
| Acute Pancreatitis Medical Management |
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Definition
| Decrease exocrine stimulation; pain management; ERCP and/or cholecystectomy; supportive therapy; antibiotics |
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Term
| Decreased exocrine stimulation |
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Definition
| discontinue oral intake; nasal gastric suction; enteral feeding vs. TPN |
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Term
| Pain management (acute pancreatitis) |
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Definition
| usually requires narcotics: Sphincter of Oddi- Meperidine; Morphine; Hydromorphone |
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Term
| Acute Pancreatitis Supportive Therapy |
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Definition
| H2 blockers/PPIs, Octreotide |
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Term
| Acute Pancreatitis: considered for necrotizing pancreatitis |
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Definition
| Empiric treatment: Imipenem; Meropenem; Doripenem. Inconsistent data on benefit; gut-derived bacteria |
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Term
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Definition
| Chronic inflammation of the pancreatitis |
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Term
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Definition
| Usually progressive and irreversible |
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Term
| Chronic Pancreatitis Causes |
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Definition
| Prolonged alcohol consumption (70%); Idiopathic (20%); "Other" (10%) |
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Term
| Chronic Pancreatitis Treatment |
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Definition
| Diet modification (No EtOH!); pain control; pancreatic enzymes |
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Term
| Chronic Pancreatitis Pain Control |
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Definition
| Initially NSAIDs or APAP; Narcotics: around the clock-- sustained release forms |
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Term
| Pancreatic enzymes (Chronic Pancreatitis) |
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Definition
| Uncertain place in therapy. Supplementation of fat soluble vitamins (esp. vit. D); enteric coated microspheres or microtabs (Creon, Pancreaze, Pancrelipase, Zenpep); Lipase content; Initial dosing based on age, diet, and symptoms |
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