Elective General Surgery Case Flashcards
What are the two commonest causes of pancreatitis
alcohol
gall stones
What is a hint you should look for when you see pancreatitis?
A little blip in the LFT
What is the best way to see gall stones?
USS abdomen.
This shows gall stones better than CT
This should be done immediately after pancreatitis diagnosis.
CT is a waste of time here
What should you do if the patient’s pancreatitis don’t settle and the LFT become worse?
Then you should do a MRCP (Magnetic Resonance Cholangiopancreatography) as this isn’t greatly invasive
Why is it not wise to jump in to a ERCP?
It isn’t wise to jump into a Endoscopic Retrograde Cholangio-Pancreatography as this has several risks, such as perforation
After an MRCP investigating pancreatitis, what investigation can be done next?
ERCP Endoscopic Retrograde Cholangio-Pancreatography
What do surgeons need to be cautious for when performing an ERCP? (Endoscopic Retrograde Cholangio-Pancreatography)
To enter the common bile duct and not to enter the pancreatic duct.
From here the stone can be broken down
After an ERCP, with further pathology what investigation is a good idea for pancreatitis?
CT abdo/pelvis
How does a pancreas look on a CT scan when it is inflamed?
It looks a lot more blurry, and larger and planes cannot be made out very well.
What is murphy’s sign?
Placing the hand on the RUQ (above the gall bladder) and asking the patient to inhale causes pain to the patient, indicating cholecystitis.
Management of Cholecystitis
Management
Admit –bed –nursing instructions
Paperwork –nursing, drug chart, clerking, property
Analgesia and antipyretics
Blood cultures
Oral intake?? NBM-sips-clear fluids-free fluids-sloppy diet-light diet-normal diet - NBM given to give organs a rest, but arguably does not do anything - so why cause hassle for the patient
Antiemetics
IV access & fluids (fluid balance chart)
ABx - treats the cholecystitis
DVT prophylaxis
Communicate the above to pt (and relatives) and nurses and admitting team
Surgery??
Which are the two structures that need to be identified
and divided during laparoscopic cholecystectomy?
Cystic Duct and Cystic Artery
they are probably quite close to each other - so they probably are most often nicked
What does pancreatitis often present as?
Epigastric pain.
sometimes RUQ pain
Loin to groin pain??
ABDOMINAL AORTIC ANEURYSM!!
or ureteric colic
(or renal colic)
What is a vagotomy?
Removal of part of the vagus nerve
