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Surgery > Gallbladder & Pancreas > Flashcards

Gallbladder & Pancreas Flashcards

1
Q

Charcots triad of ascending cholangitis

A

Intermittent- pain, fever, jaundice

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2
Q

Reynold’s Pentad of acute obstructive cholangitis

A

Charcot+ shock + altered mental status

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3
Q

Investigation for choledocholithiasis

A

CT & helical CT cholangiography
USG- stone, CBD>8mm
MRCP
EUS
ERCP

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4
Q

Rx of choledocholithiasis

A
  1. Remove stone by ERCP
    2.Lap Chole + on table cholangiogram to see CBD block
  2. Choledochotomy done if stones in CBD
  3. Use Bakes CBD dilator to confirm CBD patency
  4. Place T tube for 14 days
  5. Do T tube cholangiogram— if stone persists- extract with Dormia basket or Fogarty catheter
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5
Q

__% gallstones are radiolucent

A

90

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6
Q

Multiple Stones are faceted due to

A

Exertion of equal pressure in a compact gallbladder

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7
Q

Plain X ray finding of gallstone

A

Seagull sign / merc Benz sign (central radiolucent)
Gallstone in lateral view- in front of vert
Kidney stone- overlaps vert

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8
Q

Best investigation for gallbladder function assessment

A

Radioisotope HIDA/ PIPIDA Scan

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9
Q

Limey gallbladder

A

Gallbladder filled with toothpaste like mixture of CaCO3 & Ca3PO4
X ray—> opaque gallbladder

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10
Q

Porcelain gallbladder

A

Calcified wall of GB In chronic cholecystitis
- potentially Mx

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11
Q

Moynihans aphorism

A

“Gallstone is a tombstone erected in memory of the organism within it”

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12
Q

Saints triad

A

Gallstone
Colon diverticulitis
Hiatus hernia

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13
Q

Xanthogranulomatous cholecystitis

A

Due to ulcer or rupture of Rokitansky Aschoff sinuses—> bile extravasated into GB wall—> accumulation of lipid laden yellowish xanthoma cells & inflammatory cells in the wall—> mimics Carcinoma in CT

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14
Q

2nd mc non obstetric indication for Sx during preg

A

Acute chole

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15
Q

Courvoisier’s law

A

In a patient with jaundice, if there is palpable gallbladder, it is not due to stones

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16
Q

Exceptions to Courvoisiers law

A
  1. Double impacted stone
  2. Large stone in Hartmann’s pouch
  3. Empyema GB with CBD stone
17
Q

Sump syndrome

A

After choledochoduodenostomy, CBD distal to it acts as a reservoir with stasis of food particles, bile, sludge and stones.
It causes cholangitis & narrowing of the choledochoduodenostomy stoma

18
Q

Causes of obstructive jaundice

A
  1. Congenital: Biliary atresia, choledochal cyst.
  2. Inflammatory: Ascending cholangitis, sclerosing cholangitis.
  3. Obstructive: CBD stones, biliary stricture, parasitic infestation
  4. Neoplastic: Carcinoma of head or periampullary region o pancreas, cholangiocarcinomas, Klatskin tumour.
  5. Extrinsic compression of CBD by lymph nodes or tumours.
19
Q

Tumor marker for ca pancreas

A

CA 19/9

20
Q

Urine tests for obstructive jaundice

A

Fouchets
Hays
Ehrlichs

21
Q

Klatskin tumor

A

Cholangiocarcinoma at the confluence of hepatic ducts and common hepatic duct above the level of cystic duct

• causes obst jaundice with hydrohepatosis without enlargement of GB

• 4 types

22
Q

Parasites causing cholangiocarcinoma

A

Clonorchis sinensis, opisthorchis viverrini

23
Q

Hemobilia

A

Bleeding from the liver Or GB into the biliary tract.
Abn commu.cn b/w biliary tract and bv

24
Q

C/F of hemobilia

A

Colic- pain
Obs Jaundice
Hemetemesis, malena
GI bleed
= SANDBLOM’S/ QUINCKES TRIAD IN HEMOBILIA

25
Q

White bile

A

Mucous secreted by lining of biliary tree
Signifies severe CBD obstruction due to stone or ca head of pancreas or periampullary carcinoma

26
Q

Mucinous ca of pancreas

A

Body & tail of panc
Ovary Like stroma
ER, PR+
High CEA.
H/o pancreatitis

27
Q

CT finding in mucinous ca pancreas

A

Egg shell calcification with enlarged size

28
Q

IPMN

A

Intraductal papillary mucous neoplasm

29
Q

Triad in IPMN

A

Ohashi’s triad:

30
Q

Solid pseudopapillary tumour/ Gruber Frantz tumour/ Hamoudi tumour

A

Slow progressing malignant panc lesion
Beta catenin/ vimentin mutation
More in females

31
Q

Gene in hereditary pancreatitis

A

PRSS

32
Q

Tropical calcific pancreatitis gene

A

SPINK 1 gene

33
Q

Syndromes associated with panc carcinoma

A

Peutz Jeghers syndrome
Familial atypical mole and multiple melanoma syndrome
FAP
Lynch synd
BRCA2

34
Q

Whipples surgery

A

Pancreaticoduodenectomy

For Ca head of pancreas
Incision: CHEVRON/ ROOFTOP incision

35
Q

Modified whipples procedure

A

Pylorus preserving whipple
Aka LONGMIRE & TRAVERSO PROCEDURE
Adv- less dumping.

36
Q

Tunnel of love

A

Tunnel created between portal vein and pancreas in Whipples procedure

37
Q

Chemotherapy drugs for panc ca

A

Gemcitabine + capecitabine
FOLFIRINOX (also for colorectal ca)

38
Q

Patients with jaundice has bradycardia because

A

Deposition of bile salts in pacemakers

Surgery (8 decks)

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