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GS 🪢 > Biliary tract & Pancreas > Flashcards

Biliary tract & Pancreas Flashcards

1
Q

In any suspicion of biliary disease
(Cholecystitis/Cholangitis/Biliary pancreatitis)
[…] is always the first step even if pt obese

A

US

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2
Q

Complications of cholelithiasis: (5)

A
  1. Acute cholecystitis
  2. Choledocholithiasis
  3. Gallstone pancreatitis
  4. Gallstone ileus
  5. Cholangitis
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3
Q

Signs & Symptoms of cholecystitis :

A
  • Biliary colic “after fatty meal”
  • RUQ pain
  • Fever

🚫 NO jaundice
🚫 NO CBD dilation

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4
Q

[…] sign positive in acute cholecystitis

A

Murphy’s

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5
Q

US findings of cholecystitis:

A
  • GB wall thickening
  • peri-cholecystic fluid
  • GB stones (+/-)
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6
Q

Epigastric pain with Hx of Gastric sleeve,
US: gallbladder sludge
Management:

A

Lap chole
Cholecystitis

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7
Q

Management of Acute cholecystitis:
🔸Presentation within 72 hrs: […]
🔸Late presentation: […]
🔸Acutely ill patient: […]

A

🔸 Within 72 hrs: Emergent lap chole
🔸 >72 hrs: Elective lap chole in 6 weeks
🔸 Severy ill (ICU): Cholecystostomy tube

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8
Q

Signs & Symptoms of Ascending cholangitis:

A

Charcot triad:
1. RUQ pain
2. Jaundice
3. Fever

Raynaud pentade:
+ hypotension, tachycardia
+ confuaion

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9
Q

Management of cholangitis:

A

Drainage by ERCP

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10
Q

Epigastric / RUQ pain
& Dilated CBD (>8mm)
Are signs of […]

A

Biliary pancreatitis

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11
Q

For a dilated CBD […] is always done before lap chole

A

ERCP

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12
Q

In severe case or late presentation of biliary pancreatitis. Do […] to look for […]

A

CT abd
Necrotizing pancreatitis

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13
Q

Common Post lap chole complication that present with ascites:

A

Biloma

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14
Q

Patient present with RUQ pain, fever post lap chole.
Your next step:

A

US abdomen
(Biloma)

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15
Q

Case of Biloma post lap chole.
Management:

A

Stable » drainage - ERCP definitive
Unstable / peritonitis » Explaratory laparotomy

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16
Q

Gall stone ileus must be suspected in presence of long history of gallstone.
Usually present with triad of:

A
  1. Pneumobilia
  2. Small Bowl Obstruction
  3. Ectopic gallstone
17
Q

If you are suspecting Gallstone ileus
Your next step in investigation is :

A

CT abdomin

18
Q

In the presence of Gallbladder polyp
Observation is main management. Unless:

A
  • Size >1cm
  • Symptomatic
  • Age >50
19
Q

Tumor at the junction of Rt & Lt hepatic ducts.
Shrunken GB + Dilated intrahepatic ducts

A

Klutskin tumor

20
Q

Couvoiser’s sign (Enlarged palpable GB)
Usually present with […]

A

Pancreatic cancer

21
Q

[…] tumor
Cause dilatation of intra- & extra- hepatic ducts

A

Ampullary

22
Q

Patient with history of MI recommended to delay elective surgery for […] weeks total from event

A

8

23
Q

In pregnant patient what are the indications of lap chole in acute cholecystitis?

A
  • Recurrent attacks
  • uncontrolled symptoms
  • failed to gain weigh
24
Q

The safest trimester for lap chole during pregnancy […]

A

Second

25
Q

Patient develope surgical emphysema post ERCP
Most likely injured/perforated organ

A

Duodenum

26
Q

💡 Presentation of
Acute pancreatitis: […]
Chronic pancreatitis: […]

A

Acute pancreatitis: Chronic pancreatitis:
-Epigastric pain -Epigastric pain
-N/V -Steotorrhea
-Fever -wt loss

27
Q

Acute pancreatitis that fails to resolve pain

A

Pancreatic pseudocyst (most common)
VS
Walled-off pancreatic necrosis

28
Q

US: mass with thick wall and fluid inside which is homogenous

Dx: […]
Tx: […]

A

Pancreatic pseudocyst
-Observation
-Endoscopic drainage (duration +6 weeks size +6 cm)

29
Q

US: mass with thick wall and fluid inside which is heterogenous

Dx: […]
Tx: […]

A

Walled-off pancreatic necrosis
Percutaneous drainage

30
Q

Typically we observe pancreatic pseudocyst cases unless :

A

6+ weeks history
6+ cm collection
Or infected (Walled-off necrosis or abscess with fever)

31
Q

Splenic or portal vein thrombosis can be complicated by bleeding gastric varices.
If patient has repeated UGIB episodes […] need to be done

A

Splenectomy

32
Q

Post splenectomy, pneumococcal vaccine given to patient […] after operation

A

2 weeks

33
Q

[…] indicates poor prognostic factor in Cholangitis

A

INR

GS 🪢 (20 decks)

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