Obstructive jaundice Flashcards
(16 cards)
Can you survive without a liver
No
What % of a normal liver do you need to survive? how about damaged?
how can you tell how much liver is damaged ?
25% fully functioning liver but not stable; 33% is safe
40% for unhealthy cirrhosis liver.
Child Pugh score can be used to check liver functions. Also check for encephalopathy or ascites
Can you surve without a pancreas? Expand on your answer
No
there’s no digestions; no pancreatic enzymes
However just take crions- pancreatic enzyme supplement contained mainly lipases. Take them before you eat
What are the 2 major symptoms someone would experience if you didnt ave enough pancreas?
Brittle diabetes- NO INSULIN IN THE BACKGROUND AT ALL
Fat not disgusted; stearhoea
Pseudo cysts
What is the meaning of colicky pain
Abdominal squeezing pain
usually a sharp, localized gastrointestinal or urinary pain that can arise abruptly, and tends to come and go in spasmlike waves.
What specific questions should you ask in history to help confirm the probable cause of his jaundice?
Is it associated with eating fatty food?-
Was the Jaundice a sudden onset? Gradual is malignancy or cirrhosis whereas sudden (8-24hr) is gallstones
Has the jaundice fluctuated? If it has then its CBD or ampullary cancer; sometimes small galllstone comes out. If it’s progressive its other malignant cancer
Family history of anaemia, splenectomy and gallstones?
ASK about dark colour urine and weight? If weight gain it’s gallstones. If weight loss, its cancer
What is the symptoms for cholangitis? Explain prognosis
Fevers or rigors (if patient says they’re having the shakes).
Act quickly to rehydrate as patient can get unwell very quickly
What other blood tests are requested in someone with obstructive jaundice?
Elevated Serum Amylase to exclude associated acute pancreatitis; gallstones can cause pancreatitis. However be aware that amylase can fluctuate; the pancreatitis causes it to increase in serum levels and it’ll be low when it gets to hospital
Clotting time (PT) - Vit K deficient
- Prolonged PT but uncorrectable in hepatic jaundice
- Normal in prehepatic jaundice
- Prologned but correctable with Vit K in Obstrucitve/extrahepatic jaundice
What are the most appropriate radiological investigations in order of relevance?
Start with ultrasound scan to look for gallstones; you’d see acoustic shadows. However fluctuating jaundice caused by small gravels cant be seen by ultrasound
if not clear on ultrasound and you still believe it’s obstructive then you should use MRCP to look for the CBD stones
if till not seen clearly then use CT to exclude other pathologies
Imaging shows it’s common bile duct (CBD) gallstones, what are the treatment options to relieve jaundice
Use of ERCP to clear CBD stones and then laparoscopic cholecystectomy after patient has recovered
NB: if impossible to remove stones endoscopically then use an OPEN cholecystectomy with CBD exploration NOT LAPAROSCOPIC
What would you expect to see in a CT scan for a CBD gallstones
What are the post hepatic causes of Obstrucitive jaundice
- Common bile duct stones- MUST KNOW
- gall bladder cancer
- mirizzi’s syndrome
- Hilar cholangiocarcinoma
- hydrated cyst
- acute pancreatitis/pseudo cyst
What are the causes of low and high PR bleeding ? Most commonenst and. Least commonest
How can you tell whether bleeding in the GI is upper or in the colon
OGD- may show bleeding in duodenal ulcer. hecne if there’s too much bleeding at level of duodenal that it obstructs view , it may ssuggest that the point of PR bleeding is in the upper GI
Colonoscopy- can show active bleeding in large bowel, hence if you can reach a point in large bowel where bleeding stops then its a large bowel source of PR bleeding.
CT angiogram can be used if both above methods fail to check the source.
How can PR bleeding be stopped? What is a complication of this treatment
Angiographic embolsiaition
if it doesnt work; ie a complication of rendering large bowel ischaemic then do surgery to stop it endoscopically
Label this disease
Mallor weis tear- laceration in gastro-oesophageal junction due to anything that causes violent constant vomitng (friction casues the laceration). Causes are alcoholism, bullamia, food poisoning
can lead to haematemesis - vomitnign of blood
