Liver, pancreatic and biliary surgery Flashcards Preview

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Flashcards in Liver, pancreatic and biliary surgery Deck (22):
1

Why is parenteral nutrition a risk factor for gallstones?

It leads to alteration of bile constituents

2

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

3

Severe continuous RUQ pain - often radiates to right flank and back, associated with anorexia and pyrexia. Tenderness over gallbladder during inspiration (Murphy's sign)

Acute cholecystitis

4

When is Murphy's sign seen?

In acute cholecystitis

5

Complications of acute cholecystitis

Empyema

6

How do you know if it's empyema?

Swinging fever and severe localised pain

7

What is porcelain gallbladder?

Calcification of the gallbladder believed to be brought on by excessive gallstones

8

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

9

Risks of cholecystectomy

-conversion to open operation (5-10%)
-bile duct injury (<1%)
-bleeding (2%)
-bile leak (1%)

10

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

11

Why is MRCP good?

-avoids radiation exposure
-highly accurate

12

Name 4 risks of ERCP

-haemorrhage
-acute pancreatitis
-ascending infection
-perforation (usually retroduodenal, may cause peritonitis)

13

Gilbert's syndrome

Deficiencies/abnormalities of unconjugated bilirubin uptake system

14

Crigler-Najjar syndrome

Deficiencies/abnormalities of bilirubin conjugating enzymes

15

What type of hyperbilirubinaemia do gilber's syndrome abd crigler najjar syndrome cause?

UNconjugated hyperbilirubinaemia

16

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)

17

Causes of pancreatitis:
IGETSMASHED

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)

18

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

19

Grey-turner sign

Bruising of the left flank in acute pancreatitis

20

Cullen's sign

Bruising around the tummy button (periumbilicus) in acute pancreatitis

21

Asides from pancreatitis, when might amylase be elevated?

-intestinal ischaemia
-leaking aneurysm
-perforated ulcer
-cholecystitis

22

How to diagnose acute pancreatitis?

Generally serum amylase >1000U is diagnostic BUT can be normal even in severe cases. Amylase can also be elevated in other acute abdominal events.