Biliary tract & Pancreas Flashcards
In any suspicion of biliary disease
(Cholecystitis/Cholangitis/Biliary pancreatitis)
[…] is always the first step even if pt obese
US
Complications of cholelithiasis: (5)
- Acute cholecystitis
- Choledocholithiasis
- Gallstone pancreatitis
- Gallstone ileus
- Cholangitis
Signs & Symptoms of cholecystitis :
- Biliary colic “after fatty meal”
- RUQ pain
- Fever
🚫 NO jaundice
🚫 NO CBD dilation
[…] sign positive in acute cholecystitis
Murphy’s
US findings of cholecystitis:
- GB wall thickening
- peri-cholecystic fluid
- GB stones (+/-)
Epigastric pain with Hx of Gastric sleeve,
US: gallbladder sludge
Management:
Lap chole
Cholecystitis
Management of Acute cholecystitis:
🔸Presentation within 72 hrs: […]
🔸Late presentation: […]
🔸Acutely ill patient: […]
🔸 Within 72 hrs: Emergent lap chole
🔸 >72 hrs: Elective lap chole in 6 weeks
🔸 Severy ill (ICU): Cholecystostomy tube
Signs & Symptoms of Ascending cholangitis:
Charcot triad:
1. RUQ pain
2. Jaundice
3. Fever
Raynaud pentade:
+ hypotension, tachycardia
+ confuaion
Management of cholangitis:
Drainage by ERCP
Epigastric / RUQ pain
& Dilated CBD (>8mm)
Are signs of […]
Biliary pancreatitis
For a dilated CBD […] is always done before lap chole
ERCP
In severe case or late presentation of biliary pancreatitis. Do […] to look for […]
CT abd
Necrotizing pancreatitis
Common Post lap chole complication that present with ascites:
Biloma
Patient present with RUQ pain, fever post lap chole.
Your next step:
US abdomen
(Biloma)
Case of Biloma post lap chole.
Management:
Stable » drainage - ERCP definitive
Unstable / peritonitis » Explaratory laparotomy
Gall stone ileus must be suspected in presence of long history of gallstone.
Usually present with triad of:
- Pneumobilia
- Small Bowl Obstruction
- Ectopic gallstone
If you are suspecting Gallstone ileus
Your next step in investigation is :
CT abdomin
In the presence of Gallbladder polyp
Observation is main management. Unless:
- Size >1cm
- Symptomatic
- Age >50
Tumor at the junction of Rt & Lt hepatic ducts.
Shrunken GB + Dilated intrahepatic ducts
Klutskin tumor
Couvoiser’s sign (Enlarged palpable GB)
Usually present with […]
Pancreatic cancer
[…] tumor
Cause dilatation of intra- & extra- hepatic ducts
Ampullary
Patient with history of MI recommended to delay elective surgery for […] weeks total from event
8
In pregnant patient what are the indications of lap chole in acute cholecystitis?
- Recurrent attacks
- uncontrolled symptoms
- failed to gain weigh
The safest trimester for lap chole during pregnancy […]
Second
Patient develope surgical emphysema post ERCP
Most likely injured/perforated organ
Duodenum
💡 Presentation of
Acute pancreatitis: […]
Chronic pancreatitis: […]
Acute pancreatitis: Chronic pancreatitis:
-Epigastric pain -Epigastric pain
-N/V -Steotorrhea
-Fever -wt loss
Acute pancreatitis that fails to resolve pain
Pancreatic pseudocyst (most common)
VS
Walled-off pancreatic necrosis
US: mass with thick wall and fluid inside which is homogenous
Dx: […]
Tx: […]
Pancreatic pseudocyst
-Observation
-Endoscopic drainage (duration +6 weeks size +6 cm)
US: mass with thick wall and fluid inside which is heterogenous
Dx: […]
Tx: […]
Walled-off pancreatic necrosis
Percutaneous drainage
Typically we observe pancreatic pseudocyst cases unless :
6+ weeks history
6+ cm collection
Or infected (Walled-off necrosis or abscess with fever)
Splenic or portal vein thrombosis can be complicated by bleeding gastric varices.
If patient has repeated UGIB episodes […] need to be done
Splenectomy
Post splenectomy, pneumococcal vaccine given to patient […] after operation
2 weeks
[…] indicates poor prognostic factor in Cholangitis
INR
