Hepatobiliary disease Mazen Hassanain

Gall stones / Pathophysiology Bile facilitates the absorption of lipids and fat-soluble vitamins Bilirubin, bile salts, phospholipids, and cholesterol Failure to maintain cholesterol and calcium salts in a solubilized state Classified by their cholesterol content as: cholesterol or pigment Pigment stones are further classified as either black or brown.

Types / cholesterol 75% cholesterol, Biliary sludge: in prolonged fasting states or with the use of long-term TPN Cholesterol supersaturation is present in many normal humans without gallstones Nucleation Stone growth

Type / Pigment 25% black pigment Hemolytic conditions or cirrhosis Not associated with infected bile 5% brown pigment Earthy in texture and are typically found in the bile ducts, especially in Asian populations. Disorders of biliary motility and associated bacterial infection

Biliary colic 1% / year role Symptoms (meal, 60 min, 1-5h) Diagnosis Nuclear scan Treatment Acute attack Other complications

P/E Exam – Acute abdomen Murphy’s sign, Courvoisier’s sign.

Acute pancreatitis Acute Pancreatitis Biliary tract stones Drugs ERCP Ethanol abuse Hypercalcemia Hyperlipidemia Idiopathic Infections Ischemia Parasites Postoperative Scorpion sting Trauma Chronic Pancreatitis Autoimmune Duct obstruction Ethanol abuse Hereditary Hypercalcemia Hyperlipidemia Idiopathic

Ranson’s Prognostic Signs Admission Gallstone Pancreatitis Age > 70 yr WBC > 18,000/mm3 Glucose > 220 mg/100 mL LDH > 40 IU/L AST > 250 U/100 mL Non-Gallstone Pancreatitis Age > 55 yr WBC > 16,000/mm3 Glucose > 200 mg/100 mL LDH > 350 IU/L AST > 250 U/100 mL Initial 48 Hours Gallstone Pancreatitis Hct fall > 10 BUN elevation > 2 mg/100 mL Ca2+ > 8 mg/100 mL Base deficit > 5 mEq/L Fluid sequestration > 4 L Non-Gallstone Pancreatitis Hct fall > 10 BUN elevation > 5 mg/100 mL Ca2+ > 8 mg/100 mL Pao2 > 55 mm Hg Base deficit > 4 mEq/L Fluid sequestration > 6 L

Chronic pancreatitis Symptoms Complications Acute Complications Chronic Pseudocyst – Pathophysiology – Symptoms – Diagnosis

Pancreatic neoplasm Pathology Symptoms Diagnosis