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304: GI > Pancreas, biliary and liver > Flashcards

Pancreas, biliary and liver Flashcards

(47 cards)

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1
Q

Acute cholecystitis
- Definition
- Causes

A

Inflammation of the gallbladder

Causes
- Gallstones: blocks bile flow, thickens bile in gallbladder, leading to bacteria infection. Stone is mainly of cholesterol.
- Without stones: vascuilitis,, chemo, trauma

Bacteria
- Gut bacteria: E.coli, bacteriodes

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2
Q

Complications of gallstones/ acute cholecystitis

A

Empyema/ mucocele

GB perforation
- Can escalate to peritonitis

GS ileus: stone obstructs bowel

Pancreatitis

Fistula- with bowel

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3
Q

Ascending cholangitis
- Definition
- Causes
- Symptoms

A

Inflammation of bile duct, typically caused by infection ascending from duodenum.

Causes
- Gallstones
- Strictures
- Malignancy
- ECRP

Symptoms
- Charcot’s triad: jaundice, abdominal pain, fever.

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4
Q

Surgery for gallstones, biliary colic

A

Surgery best done within 48 hrs of cholecystitis/ biliary colic

  1. Laparoscopic cholecystectomy + Antibiotics
  2. Biliary stones = ERCP.
    + Lap chole +
    - If cholangitis= antibiotics
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5
Q

Cholecystectomy complications

A

Early
- Bleeding
- Bile duct injury
- Bile leak

Long term
- Adhesions

Post-surgery due to lack of bile
- Steatorrhea
- Abdominal discomfort

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6
Q

ERCP complications

A

Bleeding

Pancreatitis

Perforation

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7
Q

Gallstones risk factors
- 5 Fs

A

Female
Fertile (pregnant)
Fat
Fair (Caucasian)
Fifty (Age >50)

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8
Q

Causes of pancreatitis
I GET SMASHED

A

Idiopathic

Gallstones (common)
Ethanol (common)
Trauma

Steroids
Mumps
Autoimmune
Scorpion toxin
Hypertryglyceridaemia/ Hypothermia/ Hypocalcaemia
ERCP
Drugs

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9
Q

Management of pancreatitis

A

Initial
1. Large IV access: Fluids
2. Analagesia
3. O2 if needed
4. NBM, NGT?

Further

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10
Q

Complications of pancreatitis

A

Hypovolaemic shock

Haemorrhagic pancreatitis

Pseudocyst
- Made of pancreatic fluid

Infected necrosis

ARDS, SIRS

T2DM

Chronic pancreatitis

Multiorgan failure

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11
Q

Pneumoperitoneum

A

Air in the peritoneal cavity, can be within the abdominal cavity.

Causes
- Perforated duodenal/ peptic ulcer
- Bowel perf/ obstruction
- Post operation

Diagnosis
- Erect CXR
- CT (more information)

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12
Q

Murphy’s sign

A

Pressing on RUQ, asking Pt to breathe in.
- If painful= positive
- Cause= acute cholecystitis

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13
Q

GS ileus

A

Big stone gallstone enters the bowel and gets trapped in the ileocaecal junction.

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14
Q

Cholangiocarcinoma

A

Malignancy of bile duct

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15
Q

Pancreatic cancer categories

A

Adenocarcinoma
- Most common
- Exocrine tumour

Neoendocrine
- From endocrine source: insulinoma, glucagonoma etc

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16
Q

Tumour markers for pancreatic cancer

A

CA19-)
- Carbohydrate antigen 19.9
- Sensitivity= 80%, specificity 73%

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17
Q

Whipple’s surgery

A

Removal
- Gallbladder
- Antrum of stomach
- Head of pancreas
- Curve of duodenum

Bypasses food from stomach to jejunum

Jejunum loop attached to cystic duct to drain bile.

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18
Q

Prehepatic causes of jaundice

A

Haemolytic anaemia causes
- SCD
- Hereditary spherocytosis
- Autoimmune
- Transfusion reaction
- Drug toxicity

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19
Q

Hepatic causes of jaundice

Study These Flashcards
A

Unconjugated hyperbilirubinaemia
- Gilbert’s syndrome
- Crigler Najjar

Conjugated
- Alcohol, chronic hepatatis
- Viral infection: Hepm EBV, BMV
- Bacterial infection: abscess
- Drugs: paracetamol, antibiotics

20
Q

Post-hepatic jaundice causes

Study These Flashcards
A

Biliary obstruction
- Gallstone
- Pancreatic cancer
- Stricture
- Blood clot

Cholangiocarcinoma
Sclerosing cholangitis

21
Q

Investigations for jaundice

Study These Flashcards
A

Blood
- Reticulocyte count (haemolytic)
- Clotting (hepatic)
- Hepatitis screen: Hep A, B, C, CMV, EBV
- ASM ab, AMA
- LFTs

Imaging
- USS
- MRCP

Liver biopsy

22
Q

Gallstones types
- 3

Study These Flashcards
A

Most common
- Mixed

Cholesterol
- Often large and solitary

Pure pigment (bile salts)
- Black (haemolytic disease)
- Brown (Chronic cholangiitis, biliary parasites)

23
Q

Features of Acute cholecystitis

Study These Flashcards
A

Biliary colic
- RUQ intermittent pain.
- With nausea/ vomtting
- Murphy’s sign= tenderness on gallbladder on inspiration

24
Q

Gold standard bile stone investigation

Study These Flashcards
A

USS

MRCP
- if US is inconclusive

25
Chronic pancreatitis - Description - Pathology
Irreversible destruction of pancreatic parenchyma Pathology - May be global or focal - In chronic alcohol disease= head most affected - Chronic inflammatory changes causing; glandular atrophy, duct ectasia, microcalcification, intraductal stone
26
Causes of chronic pancreatitis
Reurrent pancreatitis Secondary to pancreatic duct obstruction - Cyst - Tumours - Structuures - CF AI diseasse - PBC, PSC Congenital
27
Chronic pancreatitis presentation
Recurrent/ persistent abdominal pain Signs of exocrine insuffiiciency - malabsorption: weight loss, anorexia, steatorrhoea Signs of endocrine insufficiency - Dabetes
28
Treatment of chronic pancreatitis
Preventative management of further damage - no OH - Anti-oxidant rich diet Control symptoms - Diet: less fat - Exocrine enzyme supplement - Control DM - Analgesia Surgical - Treat reversible cause (tumour, stone, stricture) - Severe: pancreatectomy
29
Porto-systemic vascular anastomosis
Left gastric-Oesophageal veins Superior rectal- inferior rectal veins Umbilical vein- epigastric vein
30
Investigationns into liver cirrhosis
LFTs, clotting - AST, ALT Congential screen - Ferrtin (haemochromatosis) - Ceruloplasmin (Wilson's) - Alpha-1 antitrypsin Autoimmune screen (AIH) - Anti-mitochondrial antibodies - Anti-smooth muscle antibodies Viral Hepatitis screen - Hep A-E - EBV, CMV Imaging - Abdominal ultrasoudn Liver biopsy
31
Pancreatic cancer - Peak age - Risk factors
Age: 60-70 Risk factor - Smoking - Age - High fat diet - DM - Alcoholism - Chronic pancreatitis
32
Pancreatic cancer - Pathology types
Majority= ductal adenocarcinoma - Mainly affects the head (then body and tail respectively) Mucinous cyst neoplasms Islet cell tumours
33
Carcinoma of head of pancreas - Presentation
Obstructive jaundice - Palpable gallbladder Epigastric/ LUQ pain General - Nausea, vomitting - Fatigue, malaise - Anorexia Mets - Hepatomegaly
34
Carcinoma of body and tail of pancreas - Presentation
Most common - Weight loss - Back pain Epigastriic mass DM
35
Pancreatic cancer investigations
Bloods - Marker= CA 19-9 (70% specificity) - Amylase - U+Es - Calcium - Glucose Imaging - USS: transabdominal, endoscopic (better for smaller lesions) - Doppler for portal vein and SMVessels - ERCP if obstructive jaundice
36
Management of pancreatic cancer - Curative - Palliative
Curative - Whipple's: pancreatoduodenectomy - Total/ distal pancreatomy Palliative - Relief jaundice: bilary stenting, drainage via PTC/ surgery - Sugrical gastric bypass to relief duodenal obstruction - Pain: morphine, chemical ablation of celiac ganglia
37
Commonest tumours that metastasize to the liver (5)
Pancreas Bowel Stomach Breast Oesophagus
38
Hepatocellular cancer - Risk factors
Cirrhosis
39
Cholangocarcinoma - Description - Typical sites
Neoplasm of biliary tree - Typically extrahepatic, diistal CBD/ common hepatic duct, confluence of hepatic ducts.
40
Adenocarcinoma of gallbladder - Associations - Presentation
Associations - UC - PSC Presentation - Gallbladder mass - Obstructive jaundice
41
Classifications of acute pancreatitis
Oedematous - Most common - Simple/ associated with phlegmon formation Severe/ necrotising - May form pseudocyst (large peripancreatic fluid collection) Haemorrhagic
42
Acute pancreatitis - Investigations
Bloods - FBC - U+E: Na, K - LFT - Serum amylase: >1000 is diagnostic - Group + save Abdominal US - Rules our gallstone obstruction CT - Pancreatic oedema, loss of fat planes
43
Glasgow Imrie criteria
Scoring criteria to assess the severity of acute pancreatitis. 3+ within 48hrs= severe - PANCREAS: P- PaO2 <8 A- Age >55 N- Neutrophils/ WCC >15 C- (Corrected) Calcium <2 R- Raised blood urea >16 E- Elevated enzymes (AST, LDH) A-Albumin (hypo) S- Blood glucose >10
44
What is the 2 week referral indication of suspected pancreatic cancer
Age >40 with unexplained jaundice
45
what is the urgent indication for CT/USS in suspected pancreatic cancer
>60 with weight loss and: - diarrhoea - Back pain - Abdominal pain - Nausea - Vomiting - Constipation - New diabetes
46
What is the Cullen's sign and which condition is it associated with?
Oedema + bruising around the umbilicus within 24-48 hours of acute abdominal pain - Associated with acute pancreatitis
47
What is the Grey-Turner's sign and which condition is it associated with?
Bruising in the flanks (caused by retroperitoneal haemorrhage) - Sign of acute pancreatitis

304: GI (20 decks)

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