4- inflammatory & malignant pancreaticobiliary disease Flashcards
what is HPB surgery?
hepatobiliary surgery
are all biliary trees the same?
no - lots of variation
what is ERCP?
therapeutic procedure - endoscopy where go through oesophagus,stomach, duodenum , open ampulla and squirt dye to see anatomy of biliary tree
→use to visualise biliary and see if any stones, cancer, stricture
what is structure of pancreas?
4 segments = head, neck, body & tail
head has uncinate process which is like tongue going behind 2 vessels (superior mesenteric vessels)
= it like loops around them
the 3rd part of duodenum is also behind superior mesenteric vessels
what happens if need pancreas removed?
means you’re a special type of diabetic (3C) - don’t produce insulin or glucagon →at risk of hypoglycemic episodes
what is inflammatory HPB diseases?
= inflammatory or benign can be severe & life threatening
- commonly due to gall stones
is surgery for removal of gallstones common?
no = risks of operation of removing gallstones is much higher than benefits so not common
where are gallstones formed?
mostly formed in gallbladder but any type of bile stasis can cause gallstones so can form anywhere in biliary tree
what are the 4 types of gallstones?
cholesterol, pigmented, calcium & mixed
what are risk factors for gallstones?
female sex, obesity, contraceptives, age, fatty diet, rapid weight loss (gastric bypass), haemolytic anaemia
what are complications of gallstones?
- biliary pain/biliary colic
- acute cholecystitis
- ascending cholangitis
- pancreatitis
what is biliary pain/biliary colic common presentation?
everytime eat gallbladder contracts and causes irritation and pain = people see usually after eating, feels like wind but goes away, may have nausea or acid reflux
what are investigations for biliary pain?
- U&E, FBC, LFTs (may be normal)
- ultrasound (if see stones here then make plan)
- MRCP (MRI test that will image biliary tree)
what is treatment of biliary pain?
change in diet & analgesia then if still symptoms = laparoscopic cholecystectomy
what is common presentation of acute cholecystitis?
if gallstone blocks then infection occurs and inflammation →fever, pain, nausea, vomiting. Murphy’s sign = abdominal exam of RUQ pain (stop breathing in due to pain)
what are investigations for acute cholecystitis?
high WWC/CRP, possible raised LFTs
what is treatment for acute cholecystitis?
antibiotics, analgesia (fluids) , laparoscopic cholecystectomy
what is ascending cholangitis?
stones go down main bile duct, can then get stuck there and this can cause jaundice & infection within biliary tree (much more severe than just infection for gallbladder as affects loads of areas) - can lead to abscesses = long hospitalisation to drain pus
what are symptoms of ascending cholangitis?
- pain, jaundice, pale stools & dark urine
- charcot triad (fever, RUQ, jaundice)
- sepsis (fever, tachycardia, low BP), jaundice
what are investigations for ascending cholangitis?
- bloods (U&Es, LFTs, amylase, CRP)
- ultrasound
what is treatment for ascending cholangitis?
- IV antibiotics
- ERCP
what is pancreatitis?
stone comes down through bile duct and goes through intrapancreatic bile duct →cause inflammation everywhere in pancreas = very serious (mostly fatal)
what are causes of pancreatitis (mnemonic)?
I GET SMASHED
I = idiopathic
G = gallstones
E = ethanol
T = trauma
S = steroids
M = mumps/malignancy
A = autoimmune
S = scorpion stings
H = hypercalcaemia/hipertrigliceridemia
E = ERCP
D = drugs (thiazide diuretics, azathioprine etc)
what are symptoms of gallstone pancreatitis?
main cause stone stuck in bile duct →can be life threatening
- severe epigastric pain radiating to back, vomiting
what are diagnostic biochemical findings if gallstone pancreatitis?
raised amylase & often raised LFTs, raised CRP
what is treatment of acute pancreatitis?
- supportive measures →aggressive fluid resuscitation, analgesia, nutrition, antibiotics (debatable)
- removing cause - ERCP
- preventing future attacks →laparoscopic cholecystectomy
what are main malignant HPB diseases?
- hepatocellular carcinoma
- cholangiocarcinoma
- gallbladder cancer
- pancreatic cancer
what diagnostic biochemical finding is for hepatocellular carcinoma?
increased AFP
what is treatment for hepatocellular carcinoma?
→surgery, TACE, ablation, chemotherapy
what is cholangiocarcinoma?
- cancer of bile ducts
- 3 types →hilar, intrahepatic, extrahepatic
what is prognosis like for gallbladder cancer?
- poor prognosis
- few cases can have surgery
- low response rates to chemo
what is prognosis like for pancreatic cancer?
- lowest 5 year survival among solid malignancies
- usually find late because symptoms start late
