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MSPA- Gastroenterology > Surgical Liver & Biliary Disease > Flashcards

Surgical Liver & Biliary Disease Flashcards

1
Q

what is the normal liver span and weight ?

A

11 to 14 cm and 1.5 to 2 kg.

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2
Q

what is the blood supply of liver ?

A
  • 80% portal vein
  • 20% common hepatic artery
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3
Q

~75% of functional liver
parenchyma is located in which lobe ?

A

Right lobe.

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4
Q

What is the cause of portal hypertension ?

A

CLD

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5
Q

What are the complications of portal HTN ?

A
  • GI bleeding (oesophageal /
    gastric / rectal varices)
  • Ascites
  • Spontaneous bacterial
    peritonitis
  • Heart Failure
  • Pulmonary HTN
  • Hepatopulmonary syndrome
  • Hepatorenal syndrome
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6
Q

What is the approach to Variceal Bleeding?

A

Start with ABC as it is an acute hemodynamiclally unstable presentation. Place 2 large bore IVs for fluid and blood transfusion. Give prophylactic anti-biotics and provide IV terlipression or octreotide, IV B-blocker. Endoscopic management can be band ligation or sclerotherpay.

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7
Q

what is the advantage of TIPSS in Variceal bleeding ?

A

Transjugular Intrahepatic Portosystemic Shunt can relieves portal pressure by bypassing liver.

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8
Q

What are the indications for TIPS ?

A
  • Used in refractory/recurrent variceal bleeding
  • Used in refractory ascites
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9
Q

What is the marker of cholestatic liver disease or biliary obstruction?

A

ALP

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10
Q

What are the biomarker of hepatocellular injury ?

A

Increase in ALT ,AST and ALT/AST ratio.

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11
Q

What is the marker of alcoholic liver injury ?

A

GGT

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12
Q

What are the indicators of compromise in liver synthetic function ?

A

Increase in PT or INR and decrease in albumin.

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13
Q

What is the hepatocellular injury pattern ?

A

> 10x increase in ALT with <3x increase in ALP =
hepatocellular injury

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14
Q

What is the cholestasis pattern ?

A

<10x increase in ALT with >3x increase in ALP =
cholestatsis

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15
Q

What are the cholestasis biomarkers ?

A

Raised ALP + GGT

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16
Q

Isolated increase in bilirubin indicates ?

A

Direct bilirubin = Dubin Johnson syndrome and Rotor syndrome.
Indirect bilirubin = Gilbert’s syndrome and Craygal Najar type 01 and 02.

17
Q

What is the ALT, AST pattern in CLD ?

A

ALT>AST

18
Q

What is the ALT, AST pattern in cirrhosis, and acute alcoholic hepatitis?

A

AST>ALT

19
Q

What is the main surgical cause of Jaundice ?

A

Jaundice due to intra- or extra-hepatic organic obstruction to biliary outflow.

20
Q

What is the commonest cause of obstructive surgical jaundice ?

A

extrahepatic obstruction due to gall stone.

21
Q

What are the main etiologeis of surgical jaundice ?

A
  • Malignancy
  • Inflammation (pancreatitis)
  • Merrizi’s syndrome
  • Primary Sclerosing Cholangitis (PSC)
22
Q

What forms ampula of Vater ?

A

Distal end of common bile duct and pancreatic duct.

23
Q

What are the Five F’s of gallblader stone ?

A

“The 5* Fs” – Fat, 40, Fertile, Female, Family History, Fair

24
Q

What is Mirizzi’s Syndrome?

A

stone in Hartman’s
pouch causing obstructive jaundice

25
Q

What are the complications of galstone ?

A
  • Gallstone Ileus is the main complication.
    The uncommon ones are
    *Fistula between gallbladder and duodenum
    *Presents as sub-acute small bowel obstruction
26
Q

What is the presentation and approach to Gallstone Pancreatitis?

A

The patients presents with severe RUQ + epigastric pain. The labs will show Raised LFTs, CRP and amylase. The management are
Aggressive supportive therapy
* Urgent ERCP + sphincterotomy
* Laparoscopic cholecystectomy
when resolves

27
Q

What are the key symptom constellations in acute obstructive cholangitis?

A

*Charcot’s triad
* Reynolds pentad

28
Q

What is the management of Ascending cholangitis?

A
  • IV fluids and antibiotics broad-spectrum
  • Emergency decompression of biliary system with ERCP
29
Q

What is the presentation of Choledocholithiasis?

A

RUQ pain with obstructive jaundice. No fever.

30
Q

What is the diagnsositic work-up and management of Choledocholithiasis?

A
  • Initially diagnosed by USfollowed by MRCP.
  • Requires urgent ERCP and
    sphincterotomy
  • Laparoscopic Cholecystectomy
31
Q

What is the presentation of Acute Cholecystitis?

A
  • RUQ pain and Murphy’s sign +/- temperature.
  • Bloods will show Normal LFTs, Raised CRP, +/- raised WBCs.
32
Q

What is the management of Acute Cholecystitis?

A
  • NPO and Analgesia
  • Abdominal US and IV antibiotics
  • IV fluids
  • Laparoscopic Cholecystectomy

MSPA- Gastroenterology (14 decks)

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