When are pseudocysts unlikely to be present after an attack of acute pancreatitis?
< 4 weeks
Local complications of AP
Peripancreatic fluid collections Pseudocysts Pancreatic necrosis Pancreatic abscess Haemorrhage
What % of AP get peripancreatic fluid collections?
25%
Describe peripancreatic fluid collections
Located in or near the pancreas and a lack of granulation or fibrous tissue
What may happen to peripancreatic fluid collections?
May resolve
May turn into abscess
May turn into pseudocysts
Describe pseudocysts
In AP result from organisation of peripancreatic fluid collection
The collection is walled by fibrous or granulation tissue and typically occurs > 4 weeks after an attack of AP
Where are most pseudocysts due to AP found?
Retrogastric
What are 75% of pseudocysts associated with?
Elevation of amylase
Investigation of pseudocysts due to AP
CT
ERCP
MRI
Endoscopic USS
Management of pseudocysts due to AP
Symptomatic cases may be observed for 12 weeks as up to 50% resolve
Endoscopic or surgical cystogastrostomy or aspiration
Describe pancreatic necrosis
May involve both the pancreatic parenchyma and the surrounding fat
What are complications of pancreatic necrosis linked to?
Extent of parenchymal necrosis
Extent of necrosis overall
Treatment of pancreatic necrosis
If sterile necrosis - manage conservatively Early necrosectomy (although high mortality rate so try to avoid)
What is a pancreatic abscess?
Intraabdominal collection of pus associated with the pancreas in the abscess of necrosis
What do pancreatic abscesses generally occur due to?
As a result of an infected pseudocyst
Treatment of a pancreatic abscess
Antibiotics
Transgastric drainage
Endoscopic drainage
How may haemorrhage occur in terms of AP?
Infected necrosis may involve vascular structures which result in haemorrhage may occur de novo or as a result of surgical necrosectomy
What sign may be present if retroperitoneal haemorrhage may occur?
Grey turners sign
Preferred diagnostic test for chronic pancreatitis - what are you looking for?
CT pancreas with intravenous contrast
Looking for pancreatic calcification
3 criteria for aneurysm surgery
An asymptomatic aneurysm > 5.5cm in diameter
An asymptomatic aneurysm which is enlarging more than 1cm per year
A symptomatic aneurysm
Criteria for emergency repair of aneurysm
Symptomatic aneurysm
Rupture
Most common causes of ascending cholangitis
- E coli
2. Klebsiella
Another name for hartmans procedure
Proctosigmoidectomy
What is hartmans procedure?
The surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy
What reduces the risk of intra abdominal adhesions?
Use of laparoscopic approach over open approach
What is used to monitor the response to treatment of colon cancer?
CEA
Is there a screening programmme for aortic aneurysm? If so for who?
Yes
Men aged 65 y/o
Single AUSS
Indications for surgical treatment of a sigmoid volvulus
Repeated failed attempts at decompression
Necrotic bowel noted on endoscopy
Suspected or proven perforation
Peritonitis
1st line investigation for SBO
CT abdo
Two most common causes of SBO
Intraabdominal adhesions
Hernias
What is a defunctioning stoma?
The name given to any stoma which prevents the passage of bowel contents in the distal segment of the bowel
Are end stomas reversible?
No
What are intramural calcifications of the gallbladder a strong risk factor for?
Gallbladder cancer
What is Reynolds pentad?
Charcots triad + Hypotension + Confusion
Associations of sigmoid volvulus
Older patients Chronic constipation Chagas disease Neurological conditions e.g. PD, Duchennes Psych conditions e.g. schizophrenia
Assosiations of caecal volvulus
All ages
Adhesions
Pregnancy
What is used to assess the severity of an upper GI bleed?
Blatchford score
What may an enterovesical fistula cause?
Frothy urine
What is a common cause of enterovesical fistula?
Colorectal malignancy
Features of post op ileus
Occurs in the few days following surgery and can cause hypovolaemia and electrolyte disturbances BEFORE nausea and vomiting become apparent
What is the rule for eating and drinking before general anaesthesias?
No eating for 6 hours before operation
No clear fluids for 2 hours before operation
Definition of upper GI bleed
GI haemorrhage with an origin proximal to the ligament of Treitz
What is the ligament of Trietz?
Suspensory muscle of the duodenum
Describe richters hernia
Can present with strangulation without obstruction
Bowel lumen is patent whilst bowel wall is compromised
Is an anal fissure is present anteriorly what is it usually due to? And posteriorly?
Anteriorly - Underlying organic disorder (merit endoscopy)
Posteriorly - Passage of hard stool
What does the modified Glasgow criteria for severe pancreatitis involve?
P - PaO2 < 8 A - Age > 55 N - Neutrophilia C - calcium < 2 R - renal function - urea > 16 E - enzymes - LDH > 400, AST > 200 A - Albumin < 32 (serum) S - Sugar - BG > 10
What is an (odd) risk factor for acute limb ischaemia?
AF