Flashcards in Liver, pancreatic and biliary surgery Deck (22):
Why is parenteral nutrition a risk factor for gallstones?
It leads to alteration of bile constituents
Intermittent severe epigastric pain and RUQ pain usually associated with nausea and vomiting. Resolves after a few hours, tenderness over gallbladder during acute episodes.
Gall bladder stones
Severe continuous RUQ pain - often radiates to right flank and back, associated with anorexia and pyrexia. Tenderness over gallbladder during inspiration (Murphy's sign)
When is Murphy's sign seen?
In acute cholecystitis
Complications of acute cholecystitis
How do you know if it's empyema?
Swinging fever and severe localised pain
What is porcelain gallbladder?
Calcification of the gallbladder believed to be brought on by excessive gallstones
Who is suitable for cholecystectomy?
-patients with symptoms caused by gallstones
-asymptomatic patients with gallbladder stones at risk of complications (e.g. really fat people, diabetes, porcelain gallbladder, hx of pancreatitis, long term immunosuppression)
Asymptomatic obese people with gallstones will eventually have symptoms so just take it out
Risks of cholecystectomy
-conversion to open operation (5-10%)
-bile duct injury (<1%)
-bile leak (1%)
When might you use percutaneous drainage of the gallbladder?
When you have a gallbladder empyema and surgery is not suitable
-done under US or CT guidance
-after resolution of the infection, the calculi may be removed percutaneously
Why is MRCP good?
-avoids radiation exposure
(but some patients might not be able to tolerate it because of radiation)
Name 4 risks of ERCP
-perforation (usually retroduodenal, may cause peritonitis)
Deficiencies/abnormalities of unconjugated bilirubin uptake system
Deficiencies/abnormalities of bilirubin conjugating enzymes
What type of hyperbilirubinaemia do gilber's syndrome abd crigler najjar syndrome cause?
What could cause conjugated hyperbilirubinaemia?
Infection (viral - hep A, B, C, CMV), bacterial (e.g. liver abscess, leptospirosis); parasitic (e.g. amoebic)
Drugs (e.g. paracetamol OD, antipsychotics, antibiotics)
Non-infective hepatitis (e.g. chronic active hepatitis, alcohol-related)
Causes of pancreatitis:
I - idiopathic
G - gallstones
E - ethanol (most common)
T - trauma
S - steroids
M - mumps/malignancy
A - autoimmune
S - scorpion sting
H - hypercalcemia / hypertriglycerides (usually TG >1000)
E - ERCP
D - drugs (e.g oestrogens, azathioprine, thiazide, valproic acid, sulfasalazine, tetracycline)
PANCREAS mneumonic for severity
P - PO2 (<8KPa)
A - age (>55years)
N - neutrophils (>15 x10^9 L)
C - calcium <2mmol/L
R - renal function (urea >16mmol/L)
E - enzymes (LDH >600iU/L / AST >2000iU/L)
A - albumin (<32g/l)
S - sugars (glucose >10mmol/L)
Three or more criteria within 48hours of admission = severe pancreatitis
Bruising of the left flank in acute pancreatitis
Bruising around the tummy button (periumbilicus) in acute pancreatitis
Asides from pancreatitis, when might amylase be elevated?