Biliary and Pancreatic Disease Flashcards
Risk factors for cholesterol stones?
Caucasian Female Obesity Age over 40 contraceptive pill TPN diabetes
The majority of gallstones are symptomatic or asymptomatic?
asymptomatic
How do gallstones cause acute cholecystitis? Symptoms?
Block the cystic duct meaning bile cannot escape. Patient will have severe epigastric pain.
Biliary colic?
Temporary blockage of cystic duct by the gallstones and will get epigastric pain that usually gets worse after eating fatty foods and may also be associated with nausea and vomiting
How do gall stones cause obstructive jaundice?
Stone reaches the common bile duct
Complications of gallstones?
Acute or chronic cholecystitis Obstructive jaundice Acute pancreatitis Cholangitis and biliary sepsis Rarely gall stone ileum and carcinoma of the gallbladder
Treatment of patient with gallstones?
If asymptomatic nothing
If biliary colic can be treated with painkillers, obese patients advised to lose weight and if there are recurrent episodes of pain people are considered for a cholecystectomy. If patient is unfit for surgery they may be given ursodeoxycholic acid which helps stop the formation of stones.
In acute cholecystitis patients are given IV fluids and antibiotics and cholecystectomy
Symptoms of acute pancreatitis?
Patient will have acute onset of severe upper abdominal pain that usually begins in the epigastrium and is accompanied by nausea and vomiting
Specific signs that support severe necrotising pancreatitis?
Periumbilical bruising- Cullen’s sign
Flank bruising- Grey turners sign
What is usually elevated in acute pancreatitis?
Serum amylase
Complications of acute pancreatitis?
systemic inflammatory response syndrome Multiorgan dysfunction Pancreatic fluid collections, necrosis or abscess Pleural effusion, pneumonia and ARDS Metabolic complications (hypo, hyperglycaemia) Jaundice GI bleeding Acute kidney injury Portal venous thrombosis
Management of acute pancreatitis?
Initially need to rehydrate the patient may need to remove gall stones Pain relief NG feeding Anticoagulation with LMWH to prevent DVT as there is risk of portal vein thrombosis
Who gets chronic pancreatitis?
Mainly alcoholics- there is also an autoimmune type though
Presentation of chronic pancreatitis?
Pain in the epigastrium often radiating to the back. Anorexia and weight loss. May be diabetes and jaundice as fibroses head obstructs the common bile duct. There may be stearrhoea due to malabsorption. On examination patient may have masses, ascites or jaundice.
Most common complication of chronic pancreatitis?
Pancreatic pseudocyst. This is a fluid collection surrounded by granulation tissue and rupture or cyst infection may occur.
How can most pancreatic pseudocysts be treated?
Most can be successfully drained endoscopically others need open surgery
Management and treatment of chronic pancreatitis?
In alcohol related abstinence should be encouraged. In auto-immune steroids are effective. Short term flare ups of pain treated with NSAIDs and an opiate eg. tramadol. Chronic pain treated with tricyclic antidepressants e.g. amitriptyline and membrane stabilising agents e.g. pregabalin. In those with recurrent, severe or debilitating pain surgical intervention can help. Creon is given as enzyme replacement to help with malabsorption issues.
Risk factors for pancreatic cancer?
Smoking, chronic pancreatitis (particularly that caused by genetic mutation), alcohol and diabetes
Presentation of pancreatic cancer?
Most commonly presents with weight loss, anorexia and abdominal pain. Many patients have actually been experiencing low grade symptoms for months. The pain often radiates through to the back and can be relieved by leaning forwards. Jaundice occurs if the tumour obstructs the common bile duct and patients may also have an itch with no rash. May also have pale stools and dark urine. Examination may be insignificant.
Investigations for pancreatic cancer?
US is done first allowing you to see the bile ducts and the head of the pancreas. Negative result does not exclude cancer though. CT and endoscopic US can be done to confirm as well as blood tests to look for tumour markers.
Describe the whipple procedure
Done for pancreatic tumours of the head and neck- remove head of pancreas, duodenum, gall bladder and the common bile duct.
Describe total pancreatectomy
remove everything- pancreas, gall bladder, common bile duct, as well as parts of the stomach and small intestine and sometimes parts or all of the spleen.
Describe distal pancreatectomy
tail and some of the body removed and some of the spleen
