Cholecystitis and Pancreatitis Quiz

Cholecystitis

• Gallbladder (cystic duct) obstruction by stone leads to inflammation/infection.
• 50-80% of cases are caused by E. coli.
• Acute acalculous cholecystitis is more common in critically ill patients and is often caused by biliary stasis.
• Chronic cholecystitis is often associated with gallstones and can lead to a thickened gallbladder wall.
• MCC: cholelithiasis or alcohol abuse (chronic).

Pancreatitis

• Can be caused by trauma, hyperlipidemia, drugs, hypercalcemia, penetrating peptic ulcers, or medications.
• Chronic pancreatitis involves loss of endocrine function and damage to the gland (fibrosis, calcification, ductal inflammation).
• Acute pancreatitis is often related to gallstones or alcohol use.
• Severe tearing pain during bowel movements can accompany pancreatitis.
• Symptoms include: upper abdominal pain radiating to the back, pain better with leaning forward or sitting, nausea and vomiting, dehydration/shock, and occasionally peritonitis.

Anal Fissure

• Painful linear lesions in the distal anal canal.
• Most commonly located in the posterior midline.
• May involve the full thickness of the mucosa if left untreated.
• Associated symptoms include painful bowel movements, bright red blood on stools or toilet paper, and chronic skin tags.

Anorectal Abscess/Fistula

• Caused by bacterial infection of anal ducts/glands.
• Common symptoms: throbbing rectal pain, worsened by sitting, coughing, or bowel movements.
• Usual pathogens are S. aureus and E. coli.
• Usually located in the posterior midline.

Appendicitis

• Obstruction of the appendix is a common cause.
• Common causes include: fecaliths, inflammation, malignancy, foreign bodies.
• Most common in 10-30 year olds.

Bariatric Surgery

• Used to maintain weight loss and reduce obesity-related issues in cases where other methods have failed.
• BMI > 40, or ≥35 with comorbid conditions.
• Individuals should be psychologically stable to follow post-operative instructions.
• Complications: regurgitation, prolapse, esophageal dilation, dumping syndrome.

Bowel Obstruction

• Small Bowel Obstruction (SBO): Usually from adhesions, hernias, neoplasms, IBD, or volvulus.
• Large Bowel Obstruction (LBO): Often from neoplasms, strictures, hernias, volvulus, or intussusception, fecal impaction.
• Common symptoms: abdominal pain, distention, SBO has high-pitched tinkles, visible peristalsis, LBO has less active sounds
• XR shows air fluid levels in step ladder patterns; CT if unclear.
• Severe mechanical obstruction requires urgent surgical consultation.

Appendicitis

• Appendicitis most commonly occurs in individuals aged 10-30 years old.
• Characteristic symptoms include anorexia, periumbilical pain that becomes constant and more severe in the RLQ (McBurney's point), nausea and vomiting, low-grade fever, rebound tenderness.
• A 20% chance of perforation or peritonitis, which is severe generalized abdominal pain + increased WBC + fever.

Volvulus

• Twisting of a loop of bowel
• Most common location is the sigmoid colon.
• Risk factors for cecum volvulus: chronic constipation, medications that inhibit gut motility, prior abdominal surgery.

Primary Sclerosing Cholangitis

• Autoimmune, progressive cholestasis with diffuse fibrosis of the intrahepatic and extrahepatic ducts.
• It is frequently associated with inflammatory bowel disease, most patients will have Ulcerative colitis.

Ascending Cholangitis

• Biliary tract infection caused by gallstone obstruction.
• Commonly from choledocholithiasis.
• Presentation of s/s may include RUQ pain, jaundice, fever.
• Reynolds Pentad: Includes shock, altered mental status (AMS) with the Charcot's triad.

Cholelithiasis

• Asx gallstones, 90% are cholesterol stones; 5-10% are pigmented stones.

Diarrhea

• Increased frequency or volume of stools for ≥2-3 consecutive days.
• Different types include inflammatory, secretory, osmotic (large volumes w/o inflammation) , and malabsorptive.
• Inflammatory (bloody, w fever, dysentery) suggests invasive organisms or IBD.

Esophageal Neoplasms

• Squamous cell carcinoma
• Commonly associated with tobacco and alcohol use; decreased veggie and fruit consumption.
• Adenocarcinoma
• More common in younger patients.
• MC in lower 1/3 of esophagus.
• RF: GERD, Barrett's esophagus, obesity.

Esophageal Strictures

• Complication of GERD/ Barrett's esophagus/ obesity that causes narrowing in the esophagus.

Gastric Carcinoma

• Adenocarcinoma is MC.
• SQUAMOUS cell carcinoma is less common •RF: H. pylori, salted, cured, smoked, pickled foods. •S/s: dysphagia with solids, indigestion, weight loss, early satiety.

Constipation

• Decreased stool volume + increased stool firmness with straining.
• Diverticulitis: Inflammation of diverticula, commonly in sigmoid & descending colon, caused by obstruction/fecaliths.