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COMAT - Surgery > Cholestatic Diseases > Flashcards

Cholestatic Diseases Flashcards

1
Q

What is Cholestasis?

A

Reduced bile flow

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2
Q

Chronic Cholestasis is often caused by what general things?

A

Cancer
Strictures
Autoimmune conditions

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3
Q

Chronic Cholestasis will present as Obstructive Jaundice. List signs.

A
  • Jaundice
  • Pruritus
  • Xanthelasma
  • Clay-colored stools
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4
Q

Chronic Cholestasis will present as Obstructive Jaundice. List signs.

A
  • Jaundice
  • Pruritus
  • Xanthelsama
  • Clay-colored stool
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5
Q

In general what 3 diagnostic tests should be done with signs of Obstructive Jaundice are present?

A
  1. MRCP
  2. CT with IV contrast
  3. Biopsy
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6
Q

What are 2 risk factors for a Pancreatic Adenocarcinoma?

A

Smoking
Chronic Pancreatitis

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7
Q

Where in the pancreas must the Pancreatic Adenocarcinoma be to cause Obstructive Jaundice?

A

Head

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8
Q

What mutations are commonly present with Pancreatic Adenocarcinomas?

A

KRAS
CDKN2A

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9
Q

What 3 tests should be done for a Pancreatic Adenocarcinoma?

A
  1. MRCP
  2. CT with IV contrast
  3. Endoscopic ultrasound biopsy
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10
Q

What is the treatment for a Pancreatic Adenocarcinoma?

A

Whipple surgery

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11
Q

Describe the Whipple surgery?

A

Removes:
- Distal stomach/pylorus
- Duodenum
- Pancreas
- Proximal jejunum
- Gallbladder and common bile duct

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12
Q

What is a Cholangiocarcinoma?

A

Bile duct malignancy

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13
Q

What are 2 risk factors for a Cholangiocarcinoma?

A
  • Liver flukes in southeast Asia
  • Primary Sclerosing Cholangitis
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14
Q

Most of the conditions in this deck will present with?

A

Obstructive jaundice signs
= Jaundice, itching, clay-colored stool, xanthelasma

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15
Q

Where does Hepatopancreatic Ampulla cancer occur?

A

Intraluminal mass at the ampulla of Vater

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16
Q

What are the results of the fecal occult blood test and colonoscopy with Hepatopancreatic Ampulla Cancer?

A

(+) fecal occult blood test
(-) colonoscopy

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17
Q

What is the treatment for Hepatopancreatic Ampulla Cancer?

A

Whipple surgery

18
Q

What causes Gallbladder cancer?

A

Chronic gallstones

19
Q

Describe what will be present with Gallbladder cancer

A

Distended and palpable gallbladder that is NONtender

20
Q

Will the distended gallbladder be tender with Gallbladder cancer?

A

NO

21
Q

How does the Gallbladder look on imaging with gallbladder cancer?

A

“Porcelain gallbladder” – calcified

22
Q

What is Mirizzi’s Syndrome?

A

Gallstones in the cystic duct leads to Common Bile Duct proximal occlusion

23
Q

Gallstones in the cystic duct leads to Common Bile Duct proximal occlusion

A

Mirizzi’s Syndrome

24
Q

What general signs will be present with Mirizzi’s Syndrome?

A

Cholecystitis findings + Choledocholithiasis findings

25
Q

What are 3 risk factors for Acute Pancreatitis?

A

High triglycerides
Alcohol
Gallstones

26
Q

What occurs with Acute Pancreatitis?

A

Autodigestion of the pancreas due to early activation of the zymogens (enzymes)

27
Q

What symptoms will be present with Acute Pancreatitis?

A

Epigastric pain that radiates to the back
- pain is worse with eating
- N/V

28
Q

What symptoms will be present with Acute Pancreatitis?

A

Epigastric pain that radiates to the back
- Pain is worse with eating
- N/V

29
Q

To diagnose Acute Pancreatitis, you must have 2/3 of the following:

A
  1. Epigastric pain
  2. Lipase that is > 3x the upper limit of normal
  3. CT changes consistent with pancreatitis
30
Q

What CT changes are consistent with Acute Pancreatitis?

A

Peripancreatic fat stranding

31
Q

What is the treatment for Acute Pancreatitis?

A

NPO, IVF and pain control until able to tolerate food

32
Q

What causes Chronic Pancreatitis?

A

Repeated bouts of Acute Pancreatitis

33
Q

What are the signs of Chronic Pancreatitis?

A
  • Chronic epigastric pain
  • Diabetes Mellitus
  • Malabsorption
34
Q

What will be seen on MCRP with Chronic Pancreatitis?

A

Chains of lakes

35
Q

What will be seen on CT with Chronic Pancreatitis?

A

Atrophy and calcifications

36
Q

What is the treatment for Chronic Pancreatitis?

A

Pain control, Insulin for DM, enzymes for malabsorption

37
Q

What are those with Chronic Pancreatitis at an increased risk for?

A

Pancreatic Adenocarcinoma

38
Q

In order to diagnose Acute Pancreatitis, the patient must have 2/3 of the following:

A
  1. Epigastric pain
  2. Lipase > 3x the upper limit of normal
  3. CT changes
39
Q

What is Primary Sclerosing Cholangitis and in what gender is it more common?

A

Fibrosis/strictures of the intrahepatic AND extrahepatic bile ducts
– More common in Males

40
Q

What other disease process does Primary Sclerosing Cholangitis often present with?

A

Ulcerative colitis

41
Q

Describe the symptoms of Primary Sclerosing Cholangitis?

A

Like Ascending Cholangitis
- RUQ pain
- Fever
- Jaundice
- Hypotension
- Altered mental status

42
Q

What is Primary Biliary Cholangitis and what gender does it more commonly present in?

A

Autoimmune attack against intrahepatic bile ducts only
– More common in Females

COMAT - Surgery (13 decks)

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