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Annular Pancreas
What causes annular pancreas? Annular pancreas is when tissue from the head of the pancreas surrounds the descending duodenum resulting in obstruction. How does annular pancreas present? Suspect annular pancreas in an infant with bilious vomiting after feeding and a double bubble sign on abdominal x-ray (air in the stomach and duodenum proximal to the obstruction). Annular pancreas can also present in adulthood and with similar symptoms. This is less common. Lab findings in annular pancreas? Laboratory testing in patients with annular pancreas reveals: hypochloremic metabolic alkalosis and hypokalemia. Labs: low K, low Cl, high pH. Imaging findings in annular pancreas? Abdominal x-ray: air in the stomach and proximal duodenum…
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Acalculous Cholecystitis
What causes acalculous cholecystitis? The gallbladder in acalculous cholecystitis has stasis of bile within it and is also hypoperfused leading to inflammation (cholecystitis). By definition it is cholecystitis that occurs without a gallstone being present in the gallbladder. What are some risk factors for developing acalculous cholecystitis? Acalculous cholecystitis is typically seen in patients that are critically ill. Risk factors include: immunosuppression recent surgery total parenteral nutrition (TPN) sepsis hypotension How is the diagnosis of acalculous cholecystitis made? The diagnosis is made based on findings in the history and physical exam along with laboratory tests and imaging. Suspect acalculous cholecystitis in patients with risk factors (recent surgery, TPN, etc) who have…