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)
