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finals - general surgery > Biliary pathology > Flashcards

Biliary pathology Flashcards

1
Q

A 41 year old female presents with right upper quadrant pain and jaundice. She has a temperature of 38.4 degrees Centigrade and feels generally unwell.

Most likely diagnosis?

A

Ascending cholangitis

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2
Q

What is the definitive management of Ascending cholangitis?

A

Endoscopic biliary decompression.

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3
Q

What is the management for acute cholecystitis?

A

NBM
Fluids
Antibiotics (Cefuroxime)
Analgesia (Paracetamol/NSAID’s)

A laparoscopic cholecystectomy should be carried out within 1 week of the episode of acute cholecystitis.

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4
Q

Clinical presentation of acute cholecystitis?

A 
Right upper quadrant/epigastric pain (radiating to right shoulder tip if the diaphragm is irritated)
Fever
Nausea and vomiting
Right upper quadrant tenderness
Murphy's sign positive
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5
Q

How do you diagnose acute cholecystitis?

A

USS abdomen

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6
Q

What are most gallstones made of?

A

Cholesterol

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7
Q

What structure does the common bile duct and pancreatic duct drain into before it opens into the duodenum?

A

Ampulla of vater, surrounded by the sphincter of oddi.

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8
Q

What does cholelithiasis mean?

A

Gallstones are present

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9
Q

What condition involves inflammation of the bile ducts?

A

Cholangitis

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10
Q

What condition refers to pus in the gallbladder?

A

Gall bladder empyema

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11
Q

What procedure involves inserting a drain into the gallbladder?

A

Cholecystostomy

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12
Q

What are the four memorable risk factors for gallstones?

A

Fat

Fair

Female

Fourty

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13
Q

What is the characteristic symptom of gallstones?

A

Biliary colic

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14
Q

What hormone is secreted in response to fat entering the digestive system, causing contraction of the gallbladder?

A

Cholecystokinin secreted from the duodenum

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15
Q

What do pale stools and dark urine indicate?

A

Obstruction to flow within the biliary system

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16
Q

What pattern of enzymes will be seen on liver function tests in patients with cholestasis?

A

ALT and AST can increase slightly, with a higher rise in ALP

17
Q

What is the first-line investigation in patients with symptoms of gallstone disease?

A

Ultrasound

18
Q

What investigation of the biliary system involves an MRI scan?

A

MRCP

19
Q

What procedure can be used to assess the biliary system and treat gallstones stuck in the ducts?

A

ERCP

20
Q

What typical incision is used in an open cholecystectomy?

A

A right subcostal “Kocher” incision

21
Q

What is the more characteristic presenting symptom in acute cholecystitis?

A

Right upper quadrant pain

22
Q

What specific sign is suggestive of acute cholecystitis?

A

Murphy’s sign

23
Q

What is Charcot’s triad and what does it indicate?

A

Right upper quadrant pain
Fever
Jaundice (raised bilirubin)

Indicates acute cholangitis

24
Q

Where do cholangiocarcinomas originate and what is their typical histological type?

A

Bile ducts and adenocarcinoma

25
Q

What are the key risk factors for cholangiocarcinoma?

A

Primary sclerosing cholangitis and liver flukes

26
Q

What law states that a palpable gallbladder along with jaundice is unlikely to be gallstones?

A

Courvoisier’s law

27
Q

What histological type are the majority of pancreatic cancers?

A

Adenocarcinoma

28
Q

What organ does pancreatic cancer usually spread to first?

A

Liver

29
Q

What sign refers to migratory thrombophlebitis as a sign of malignancy, particularly pancreatic cancer?

A

Trousseau’s sign of malignancy

30
Q

What tumour marker is most relevant in pancreatic cancer?

A

CA 19-9 (carbohydrate antigen)

31
Q

What name is given to a pancreaticoduodenectomy procedure, used to treat early pancreatic cancer?

A

Whipple procedure

32
Q

What are the three top causes of pancreatitis?

A

Gallstones
Alcohol
Post-ERCP

33
Q

What scoring system is used to assess the severity of pancreatitis?

A

Glasgow score

34
Q

What enzyme often needs replacing in chronic pancreatitis?

A

Lipase

35
Q

What incisions may be used for a liver transplant?

A

“Rooftop” or “Mercedes Benz” incision

finals - general surgery (13 decks)

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