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Year 4: General Surgery + GI > Biliary Disease > Flashcards

Biliary Disease Flashcards

1
Q

what causes biliary colic

A

gall stones passing through biliary tree

- may become impacted in gall bladder neck or cystic duct which causes pain

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2
Q

presentation of biliary colic

A

colicky RUQ pain

  • provoked by fatty meal
  • may radiate to right shoulder
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3
Q

what are the majority of gallstones composed of

A

cholesterol

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4
Q

risk factors for biliary colic

A

4 ‘F’s : Female, fertile, fat, forty

- also COP, fibrates, crohns, diabetes, rapid weight loss

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5
Q

Ix for biliary colic

A

Bloods: LFTs, FBC, U+Es, amylase
USS 1st line - looking for duct dilatation
- MRCP considered if there is duct dilatation and/or abnormal LFTs

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6
Q

non-operative management for biliary colic

A

analgesia

Nil by mouth, IV fluids

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7
Q

operative management for biliary colic

A

laparoscopic cholecystectomy

ERCP for stones in the common bile duct

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8
Q

what is cholecystitis?

what is the most common cause?

A

inflammation of the gall bladder, most commonly develops secondary to gall stones

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9
Q

presentation of cholecystitis

A

RUQ pain worse on inspiration (Murphy’s sign +ve)

fever, nausea + vomiting

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10
Q

Ix for cholecystitis

A 
USS
- thickened gall bladder wall
- gallstones
- pericholecystic fluid (fluid around gallbladder)
Bloods: raised WBC, CRP
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11
Q

management of cholecystitis

A

IV fluids, analgesia, IV antibiotics (e.g.cefotaxime)

cholecystectomy within 72 hours

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12
Q

surgical management of patients with cholecystitis who are not fit for a cholecystectomy

A

cholecystostomy

- gall bladder drain in place for 8-12 weeks

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13
Q

what is cholangitis

A

infection of biliary tree

- most common predisposing factor is gallstones

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14
Q

what organisms most commonly cause cholangitis

A

E.Coli

Enterococcus

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15
Q

presentation of cholangitis

A

Charcots triad: fever, RUQ pain, jaundice

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16
Q

what type of jaundice is there in cholangitis?

how does it present?

A

obstructive jaundice

- dark urine, pale stools, itch

17
Q

management of cholangitis

A

antibiotics (IV amoxicillin, metronidazole, gentamicin) + IV fluids
ECRP = definitive Ix + management

18
Q

what is gallstone ileus

A

large gallstone erodes through gall bladder into duodenum causing small bowel obstruction

19
Q

most common causes of acute pancreatitis in UK

A

alcohol

gall stones

20
Q

what drugs can cause pancreatitis

A 
thiazides
azathioprine 
sodium valproate
tetracyclines
mesalazine
21
Q

I GET SMASHED pneumonic for causes of pancreatitis

A 
Idiopathic (20%)
Gallstones (50%)
Ethanol (20%)
Trauma
Steroids
Mumps / Malignancy 
Autoimmune
Scorpion sting
Hyperlipidaemia + Hypercalcaemia
ERCP
Drugs
22
Q

pathophysiology of acute pancreatitis

A

autodigestion of pancreatic tissue by pancreatic enzymes, leading to necrosis

23
Q

presentation of acute pancreatitis

A

epigastric pain that radiates to back
N+V
tenderness, guarding, rigidity on examination
Cullens sign - periumbilical discolouration
Grey-Turners sign- flank discolouration

24
Q

what is raised in acute pancreatitis

A

serum amylase / lipase (3x normal limit)

25
Q

scoring systems for acute pancreatitis

A

APACHE II

Ranson

26
Q

what score on
- APACHE II
- Ranson (Glasgow criteria)
indicates severe pancreatitis

A

APACHE >8

Ranson >3

27
Q

features indicating severe pancreatitis

A 
age > 55
hypocalcaemia
hypoxia
hyperglycaemia 
neutrophilia
28
Q

imaging for pancreatitis

A

USS 1st line - used to look for gall stones

CT - gold standard but only needed if diagnosis is uncertain

29
Q

management of acute pancreatitis

A

IV fluids, analgesia, antiemetics
antibiotics if signs of infection
if due to alcohol - thiamine, folate, B12 replacement

30
Q

complications of acute pancreatitis

A

pancreatic necrosis + infection
pancreatic abscess
pancreatic pseudocyst

31
Q

what does cholelithiasis mean

A

gallstones in the gallbladder

32
Q

what is Mirizzi syndrome

A

rare complication where stones in the gallbladder or cystic duct cause obstructive jaundice via extrinsic compression of common bile duct

33
Q

what is Choledocholithiasis

A

gallstones in the common bile duct

34
Q

most common cause of chronic pancreatitis

A

excess alcohol

35
Q

presentation of chronic pancreatitis

A

recurrent epigastric pain radiating to back, typically 15-30 mins after a meal
exocrine pancreatic insufficiency – steatorrhea + malnutrition
diabetes

36
Q

genetic causes of chronic pancreatitis

A

cystic fibrosis
hyperparathyroidism
haemochromatosis
alpha 1 antitrypsin deficiency

37
Q

investigations for chronic pancreatitis

A

Blood glucose
CT
- calcifications
- ductal dilatation

38
Q

what is decreased in chronic pancreatitis

A

faecal elastase

39
Q

management of chronic pancreatitis

A

analgesia
pancreatic enzyme supplements
diabetes management

Year 4: General Surgery + GI (13 decks)

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