Upper Abdominal Pain Flashcards Preview

MD2 Surgery and Anaesthesia > Upper Abdominal Pain > Flashcards

Flashcards in Upper Abdominal Pain Deck (36):
1

Where is Hartmann's pouch, and what is its relevance?

In gallbladder
Can get stone stuck in there > acute cholecystitis

2

What is inside Calot's triangle?

Cystic artery
Cystic node

3

What is the venous drainage of the gallbladder?

Drained directly into liver via series of small veins
(Therefore, cancer of gallbladder goes straight to liver)

4

What is the clinical presentation of biliary colic?

Episodic
In epigastrium and right subcostal to right infrascapular
After fatty meals - 30 min-2 hours
Lasts at least 15 min
Associated nausea
Usually abdominal exam normal

5

Why does biliary colic occur after fatty meals?

CCK released > gallbladder contracts > stone obstructs opening

6

Why can you sometimes get left-sided pain with gallstones?

Embryologically, gallbladder central organ, so pain can be either side

7

What is the gold standard for diagnosis of gallstones?

Ultrasound
Seen as acoustic shadow behind stone

8

What is the normal diameter of the bile duct?

Usually 3-4 mm
Dilates to 8-10 mm after cholecystectomy

9

What are cholestatic symptoms?

Jaundice
Dark urine
Pale stools

10

What is the clinical presentation of pancreatitis?

Sudden onset
Severe epigastric pain radiating to back
Nausea and vomiting
Unwell
Lying very still
Raised lipase
Deranged LFTs

11

Why can breath sounds be reduced at the bases in acute pancreatitis?

Big breath > diaphragm impinges on pancreas

12

What is the relationship between deranged serum calcium and pancreatitis?

Hyper-calcaemia rare cause of pancreatitis
Pancreatitis can cause hypocalcaemia

13

What are hypoxia and acidosis in acute pancreatitis markers of?

Severe pancreatitis

14

Why is an erect chest x-ray done whilst investigating upper abdominal pain?

?Free gas under diaphragm

15

Why are patients with their first bout of pancreatitis often sent to ICU?

Usually most severe episode

16

What are the four most common causes of acute pancreatitis?

Idiopathic
Gallstones
Ethanol
Trauma

17

What is LDH in acute pancreatitis a marker of?

Severity

18

Why is CT performed in acute pancreatitis?

Usually not needed to make diagnosis
Performed at weekly intervals in severe pancreatitis to demonstrate complications

19

What is a complication of ERCP?

Iatrogenic pancreatitis

20

What is the Ranson scoring system used for?

Assessing severity of pancreatitis

21

What is the management for mild pancreatitis?

Fasting
Analgesia
Gallstone pancreatitis
- Laparoscopic cholecystectomy + operative cholangiogram once pancreatitis resolved

22

What is the management for severe pancreatitis?

Supportive care
- Admit to ICU
- Fluid resuscitation
- O2 +/- ventilation
- Inotropes
- Haemofiltration
- Analgesia
Specific measures
- ERCP
- Abx
- Nutrition
Treat complications

23

What are the complications of severe pancreatitis, and how are they treated?

Infected necrosis
- Open, minimally invasive/endoscopic necrosectomy
Pancreatic abscess
- Ope/percutaneous drainage
Pancreatic pseudocyst
- Usually resolves if 6 cm or less
- Otherwise, surgical drainage into stomach/small intestine/endoscopic drainage into stomach
Haemorrhage
- Embolisation

24

What is Charcot's triad?

Pain
Fever
Obstructive jaundice

25

What do dark urine and pale stools mean?

Obstructive jaundice

26

What is Charcot's triad a clinical presentation of?

Acute cholangitis

27

What is the management for cholangitis?

Life-threatening!
Resuscitation
Broad spectrum Abx
- Ampicillin + gentamicin +/- metronidazole/tazobactam + pipericillin
Early (within 24 hours) ERCP/endoscopic sphincterotomy/extraction of stone
Laporoscopic cholecystectomy (within 3 weeks)

28

How can cholangitis cause septicaemia?

Bile usually has low-grade bacteria > obstruction > stasis > bacteria multiply > high back pressure pushes bacteria to liver > enter blood stream > septicaemia

29

Of what is painless jaundice a hallmark?

Carcinoma of head of pancreas

30

What is Courvoisier's sign?

Non-tender, palpable gallbladder under right costal margin

31

What is CA19.9 a tumour marker for?

Pancreatic
Gallbladder
Common bile duct

32

Why can you get coagulopathy if you have jaundice?

Bile not flowing > fat-soluble vitamins not being absorbed, including vitamin K

33

Which cancer survivals are measured in two years, not five?

Pancreatic cancer
Oesophageal

34

How is suitability for resection in pancreatic cancer assessed?

Actively look for reasons not to resect = metastases
Exclude advanced local disease
- Superior mesenteric artery encacement
- Coeliac/para-aortic lymphadenopathy

35

How is pancreatic cancer confirmed if resection is not possible?

Endoscopic US-guided fine needle aspiration

36

What does palliation for pancreatic cancer involve?

Relieve billiary obstruction, usually with ERCP
- Metal stent if reasonable expectation of survival
- Plastic stent if limited survival
+/- palliative chemotherapy
Supportive care