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Emergency general surgery > Hepatic/biliary/spleen > Flashcards

Hepatic/biliary/spleen Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

What percentage of the population has gallstones? Of these what percentage has acute cholecystitis?

A

10-15%
-of these that are symptomatic 20% develop acute cholecystitis

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2
Q

Gallbladder wall thickness above what indicates inflammation?

A

> 3mm

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3
Q

What imaging modality has the highest sensitivity and specificity for diagnosing acute cholecystitis? The second?

A

-HIDA scan
-US and MRCP are tied

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4
Q

What are the benefits of early cholecystectomy for acute cholecystitis?

A

-lower risk of major bile duct injury
-shorter hospital stay
-decreased risk of recurrent gallstone symptoms within 3 months

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5
Q

If a cholecystectomy for acute cholecystitis needs to be delayed how long should it be delayed?

A

45-60 days after onset of symptoms

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6
Q

What are the most common bacteria found associated with acute cholecystitis?

A

-E. coli
-Klebsiella
-Enterobacter

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7
Q

What are the top 3 antibiotics in terms of biliary penetration?

A

-Zosyn (pip-tazo)
-tigecycline
-Augmentin (amox-clavulanate) and ciprofloxacin

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8
Q

What percentage of patients with cholelithiasis have associated common bile duct stones? With acute cholecystitis?

A

-10-20%
-5-15%

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9
Q

What is the negative predicitive value that a patient with normal LFTs and acute cholecystitis will have CBD stones? The positive predictive value of abnormal LFTS?

A

-97%
-15%

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10
Q

What is the specificity of serum bilirubin for common bile duct stones in acute cholecystitis?

A

-if cutoff value is 1.7 it’s 60%
-if cutoff value is 4 it’s 75%

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11
Q

What predictive factors place an acute cholecystitis patient at moderate risk for associated CBD stones?

A

-abnormal LFTs other than bilirubin
-age > 55
-clinical gallstone pancreatitis

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12
Q

What predictive factors place an acute cholecystitis patient at strong risk for associated CBD stones?

A

-CBD diameter > 6mm (prior to cholecystectomy)
-bilirubin 1.8-4

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13
Q

What predictive factors place an acute cholecystitis patient at very strong risk for associated CBD stones?

A

-can see stone on RUQ US
-clinical ascending cholangitis
-bilirubin >4

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14
Q

What are risk factors to an increased postop morbidity and mortality for a cholecystectomy?

A

-age > 80
-Mannheim peritonitis index >/= 29
-significant comorbidities

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15
Q

What factors indicate an increased risk of mortality in patients with gangrenous cholecystitis?

A

-increased age
-low WBC

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16
Q

What postop morbidities are associated with DM?

A

-cardiovascular events
-renal failure
-infections

17
Q

What percent of patients with cholangitis have all of Charcot’s triad?

A

50-70%
(fever, pain, jaundice)

18
Q

What are the most common symptoms of cholangitis in the elderly?

A

-hypotension
-confusion

19
Q

Per the Tokyo guidelines what qualifies as moderate (grade II) cholangitis?

A

-WBC >12k or <4k
-fever > 39
-age >75
-total bilirubin >5
-hypoalbuminemia

20
Q

Per the Tokyo guidelines what qualifies as severe (grade III) cholangitis?

A

-cardiovascular dysfunction requiring dopamine
-LOC
-respiratory distress
-oliguria or creatinine >2
-INR > 1.5
-PLT < 100k

21
Q

What is the cellular origin of biliary cystadenoma?

A

thought to be ectopic clusters of embryonic bile ducts

22
Q

Which hepatic lobe is biliary cystadenoma more commonly found int?

A

left

23
Q

What percent of biliary cystadenoma has malignant transformation? Into which cancer?

A

-20%
-biliary cystadenocarcinoma

24
Q

What is the treatment for autoimmune hemolytic anemia?

A

-typically steroids
-splenectomy reserved for adult pts w/ steroid resistant disease

25
Q

What is the most common congenital anemia?

A

spherocytosis

26
Q

What is the curative treatment for spherocytosis?

A

splenectomy

27
Q

What is the inheritance pattern of elliptocytosis?

A

autosomal dominant
-see in Mediterranean and African descent

28
Q

What is the inheritance pattern of thalassaemia?

A

autosomal recessive

29
Q

What is the inheritance pattern of glucose-6-phosphate deficiency?

A

x-linked

30
Q

What are the 3 ligamentous attachments of the spleen?

A

-gastrosplenic
-splenorenal
-splenocolic

31
Q

What are the risk factors for splenic abscess?

A

-immunocompromised
-metastatic infection
-diabetes
-splenic infarction
-previous IR procedure

32
Q

What is the pathophysiology of G6PD?

A

disorder of the glutathione pathway
-leads to damage of RBCs by toxin oxygen products

33
Q

What is the treatment for symptomatic immune thrombocytopenic purpura?

A

prednisone 1mg/kg/day x7-10 days then taper
-only need PLT transfusion for severe hemorrhage

34
Q

What is the treatment for symptomatic immune thrombocytopenic purpura that is refractory to steroids?

A

rituximab

Emergency general surgery (2 decks)

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