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Hepatobiliary > Hepatobiliary - Acute and Chronic Pancreatitis, Cirrhosis > Flashcards

Hepatobiliary - Acute and Chronic Pancreatitis, Cirrhosis Flashcards

1
Q

Acute Pancreatitis - what is acute pancreatitis?

A

ENZYME - MEDIATED AUTODIGESTION

Pancreas becomes inflamed

Pancreatic damage happens when the digestive enzymes are activated before they are released into small intestine, and so begin attacking the pancreas

It causes reversible damage

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2
Q

Acute Pancreatitis - what are the causes?

A

G - Gallstones
E - Ethanol
T - Trauma

S - Steroids
M - Mumps/malignancy
A - Autoimmune
S - Scorpion sting
H - Hyperlipidaemia/hypercalcaemia
E - ERCP
D - Drugs (azathioprine, mesalazine, bendroflumethiazide)
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3
Q

Acute Pancreatitis - what are the symptoms

A

Severe epigastric pain that may radiate to back

N+V

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4
Q

Acute Pancreatitis - what are the signs?

A

Grey Turners sign - bruising of the flanks

Cullen’s sign - superficial oedema with periumbilical bruising

Jaundice

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5
Q

Acute Pancreatitis - what are the blood test investigations?

A

Serum amylase - usually 3 times the upper limit of normal levels

Serum lipase - more useful for catching late presentations, more sensitive and specific

MOST IMPORTANT TWO TESTS

Bloods - FBC, U&Es, LFTs, CRP

ABG

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6
Q

Acute Pancreatitis - what scans can you do?

A

US

AXR

CT/MRI

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7
Q

Acute Pancreatitis - what are the early and late complications?

A

EARLY:
1. Shock

  1. ARDS - Acute Respiratory Distress Syndrome
  2. Sepsis

LATE:

  1. Bleeding
  2. Pseudocyst - results from collection of peripancreatic fluid collection, occur ≥ 4 weeks after acute attack
  3. Pancreatic abscesses - intraabdominal collection of pus associated with pancreas, typically a result of infected pseudocyst
  4. Pancreatic necrosis - involve both pancreatic parenchyma and surrounding fat
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8
Q

Acute Pancreatitis - what is the treatment?

A

Nil by mouth

I.V. saline

Analgesia

O2

Surgery

ITU

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9
Q

Chronic Pancreatitis - what is it?

A

Repeated bouts of acute pancreatitis, and so persistent inflammation

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10
Q

Chronic Pancreatitis - what structural changes occur to the pancreas?

A

Irreversible changes

Fibrosis, atrophy, calcification

This gradual process of pancreatic tissue getting replaced by mis-shaped ducts, fibrosis and calcium deposits, is chronic pancreatitis

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11
Q

Chronic Pancreatitis - most common cause?

A

Alcohol

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12
Q

Chronic Pancreatitis - what are the other causes?

A
  1. Autoimmune
  2. CF
  3. Hereditary
  4. Pancreatic duct obstruction
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13
Q

Chronic Pancreatitis - what are the clinical features?

A
  1. Epigastric pain radiating to back (relieved by sitting forward)
  2. Jaundice
  3. Weight loss
  4. Steatorrhea
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14
Q

Chronic Pancreatitis - what are the 1st line imaging methods?

A

Abdo US and CT - pancreatic calcifications confirm diagnosis

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15
Q

Chronic Pancreatitis - what is the management?

A

Drugs:

  1. Analgesia
  2. Lipase
  3. Fat-soluble vitamins
  4. Insulin (amount needed may be variable)

Diet:

  1. No alcohol
  2. Low fat

Surgery:
1. Pancreatectomy or pancreatojejunostomy

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16
Q

Chronic Pancreatitis - complications?

A

Pseudocyst

Diabetes - pancreas can’t keep producing hormones to regulate glucose

Biliary obstruction

17
Q

Cirrhosis - what is it?

A

Cirrhosis is when the liver does not function properly anymore due to long-term damage

Characterised by normal liver tissue being replaced with scar tissue

Chronic scarring - irreversible and fibrotic

18
Q

Cirrhosis - pathophysiology

A

When liver cells are injured, they start to come together and from REGENERATIVE NODULES

Classic sign of cirrhosis - why cirrhotic liver is bumpy

Between these nodules there is fibrotic tissue and collagen

19
Q

Cirrhosis - what is the most common cause in the UK and the world?

A

UK - Alcohol

World - Hepatitis B/C

20
Q

Cirrhosis - what are some other causes?

A

HBV

Haemochromatosis

Wilson’s disease

Primary Biliary Cirrhosis

21
Q

Cirrhosis - what are the two types of cirrhosis you can have?

A

Compensated - liver still functions effectively, no, or few clinical symptoms

Decompensated - liver damaged so much can’t function properly, complications occur
- Also known as chronic decompensated hepatic failure

22
Q

Cirrhosis - what are compensated liver symptoms?

A

Asymptomatic

Non-specific - weight loss, weakness, fatigue

23
Q

Cirrhosis - what are some decompensated liver symptoms?

A

Pruritus

Jaundice

Ascites

Hepatomegaly

Hepatic encephalopathy

Hands - clubbing, dupuytren’s contracture, palmar erythema

24
Q

Cirrhosis - what are the main complications, and what do they go on to cause?

A

LIVER FAILURE - causes COAGULOPATHY (due to low amount of clotting factors), ENCEPHALOPATHY, HYPOALBUMINAEMIA (albumin production decrease)

PORTAL HTN - causes ascites, splenomegaly, portosystemic shunt (oesophageal varices + UGIB)

INCREASED RISK OF HEPATOCELLULAR CARCINOMA

SPONTANEOUS BACTERIAL PERITONITIS

25
Q

Cirrhosis - what is the gold standard investigation?

A

Liver biopsy

26
Q

Cirrhosis - what will bloods show?

A

LFTs - raised ALP, ALT, AST, bilirubin

LOW - albumin, WCC, platelets

27
Q

Cirrhosis - what scans can you do and what are the findings?

A

MRI - big caudate lobe
small islands of regenerating nodules

Liver US - hepatomegaly

28
Q

Cirrhosis - what is the definitive treatment?

A

Liver transplant

29
Q

Cirrhosis - what is the management?

A
  1. Good nutrition, avoid alcohol
  2. Avoid NSAIDs, opiates
  3. Give Colestyramine - help pruritus
  4. Ascites - fluid restriction, low salt diet, give spironolactone
  5. Recurrent encephalopathy episodes - reduce freq with lactulose and rifaximin

Hepatobiliary (10 decks)

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