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MRCS A(My Own) > HEPATOBILIARY AND PANCREATIC > Flashcards

HEPATOBILIARY AND PANCREATIC Flashcards

1
Q

Courvoisier’s law

A

if gallbladder is palpable in a jaundiced patient, it is unlikely to be due to gallstones

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2
Q

Charcot’s triad of symptoms

A

(pain, fever, jaundice)
Occurs in cholangitis

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3
Q

Which site of pancreatic carcinoma causes obstruction

A

Head of pancreas

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4
Q

Thrombophelebitis migrans occur in

A

Pancreatic Ca

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5
Q

Side effects of long term TPN usage

A

hepatic dysfunction and fatty liver

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6
Q

Which drug can be used for pancreatic necrosis

A

Imipenem

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7
Q

Rx of pancreatic necrosis

A

Radiological drainage or
Surgical necrosectomy.

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8
Q

Causes of Acute Pancreatitis

A

GET SMASHED’:

Gallstones
Ethanol (Alcohol)
Trauma
Steroids
Mumps
Autoimmune disease, such as Systemic Lupus Erythematosus (SLE) or Sjogren’s syndrome
Scorpion venom (a rare and unlikely cause in most countries)
Hypercalcaemia
Endoscopic retrograde cholangio-pancreatography (ERCP)
Drugs, such as Azathioprine, NSAIDs, or Diuretics

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9
Q

Which drug causes acute pancreatitis

A

Azathioprine, NSAIDs, esteogen containing drugs or Diuretics

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10
Q

Why hypocalcemia occurs in pancreatitis

A

Fat necrosis from pancreatic enzymes release fatty acids in circulation which combined with calcium of blood causing hypocalcemia

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11
Q

What is caused by the enzymes released from pancreas due to inflammation in systemic circulation

A

These enzymes cause fat necrosis and necrosis of blood vessels (the latter is the cause of retroperitoneal hemorrhage)

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12
Q

Differential causes of hyperamylasaemia

A

Acute pancreatitis
Pancreatic pseudocyst
Mesenteric infarct
Perforated viscus
Acute cholecystitis
Diabetic ketoacidosis

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13
Q

Assessment of severity of acute pancreatitis is done by

A

Glasgow, Ranson scoring systems and APACHE II

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14
Q

How how to assess gallstones as the cause of acute pancreatitis

A

An alanine transaminase (ALT) level >150U/L has a positive predictive value of 85% for gallstones as the underlying cause

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15
Q

Which infections causes acute pancreatitis

A

Mumps, Coxsackie virus,Typhoid

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16
Q

What is Balthazar score and when it should be done

A

A CT Scoring system to risk stratification of Pancreatitis
A/c to UK guidelines it should be done 6-10 days after admission in patients with features of persistent inflammatory response or organ failure*.

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17
Q

Pancreatic cyst usually presents at

A

lesser sac obstructing the gastro-epiploic foramen by inflammatory adhesions..

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18
Q

Pancreatic necrosis vs pseudocyst timeline

A

Necrosis occurs with evidence of persistent systemic inflammation for more than 7-10 days after the onset of pancreatitis.

Peudocyst: typically formed weeks after the initial acute pancreatitis episode.

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19
Q

Which criteria is used in first 48 hours of acute pancreatitis for risk stratification

A

The modified Glasgow criteria is used to assess the severity of acute pancreatitis within the first 48 hours of admission

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20
Q

Glasgow Score

A

Helpfully, the mneumonic to remember the score is PANCREAS:
pO2 <8kPa,
Age >55yrs,
Neutrophils (/WCC) >15×109/L,
Calcium <2mmol/L,
Renal function (Urea) >16mmol/L,
Enzymes LDH>600U/L or AST>200U/L,
Albumin <32g/L,
Sugar (blood glucose) >10mmol/L

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21
Q

MCC of HCC

A

Viral hepatitis

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22
Q

Causesof HCC

A

Viralnhepatitis, chronic alcohol excess, hereditary haemochromatosis, primary biliary cirrhosis (PBC), and aflatoxin exposure (a toxic fungal metabolite), smoking, >70 years

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23
Q

initial imaging modality of choice for suspected HCC,

A

USS

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24
Q

Which scores are used to assess the risk of mortality from cirrhosis

A

Child-Pugh
MELD

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25
Q

Ca metastasiza from which organs to liver

A

bowel, breast, pancreas, gastric, and lung

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26
Q

Milan Criteria for TRANSPLANTATION

A

Milan Criteria: (1) one lesion is smaller than 5cm or three lesions are smaller than 3cm (2) no extrahepatic manifestations (3) no vascular infiltration

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27
Q

Non-Surgical Management for HCC

A

Image-Guided Ablation and Alcohol ablation in BCLC stage 0 or A
Transarterial Chemoembolisation (TACE) in BCLC stage B

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28
Q

MELD asses

A

creatinine, bilirubin, INR, sodium, and the use of dialysis (at least twice per week).

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29
Q

MELD us Child Pugh Score

A

Both asses riskof mortality from Cirrhosis but MELD score can also be used to predict the likelihood of a patient tolerating a potential liver transplant

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30
Q

Screening ofpatients with cirrhosis for HCC

A

serum AFP and liver USS every 6-12 months

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31
Q

If adenoma of liver found with ahealthy liver then what to do

A

Remove it as itis a risk factor for Hcc development

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32
Q

CT finding of HCC

A

suspicious lesion which is highlighted during the arterial phase with washout during the venous phase, this reflects the hypervascularity of the lesions.

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33
Q

TACE is done atwhat stage and with what

A

Stage B
With doxorubicin

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34
Q

Rx ofstage C of BCLC

A

Sorafenib’, oral multi tyrosine kinase inhibitor

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35
Q

Treatment of gallstone Ileus

A

remove the gallstone from an enterotomy proximal to the site of stone impaction and under almost all circumstances the gallbladder should beleft in situ

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36
Q

Acalculous cholecystitis develops in

A

Patients with inter current illness

37
Q

NICE guidance gfor cholecystectomy after axute cholecystitis

A

Ideally 48 hours
C must be After 1 week

38
Q

IV antibiotic in acute cholecystitis

A

Co amoxiclav +/- Metronidazole

39
Q

Bouveret’s Syndrome

A

stone impacts in the proximal duodenum, causing a gastric outlet obstruction

40
Q

Biliary colic occurs when

A

the gallbladder neck becomes impacted by a gallstone.
No inflammation

41
Q

Which size gallstones will pass on their own

A

5mm

42
Q

Which size CBD shouldn’t be explored

A

The exploration of a small duct is challenging and ducts of less than 8mm should not be explored

43
Q

By which ways a bile duct can be seen during laparoscopic cholecystectomy

A

Intra operative cholangiography or
Laparoscopic USS
to either confirm anatomy or to exclude CBD stones.

44
Q

In which route does bile duct can be surgically explored easily

A

Transcystic route

45
Q

MCC of cholangitis

A

gallstones, ERCP (iatrogenic), and cholangiocarcinoma

46
Q

Organisms causing cholangitis

A

Escherichia Coli (27%), Klebsiella species (16%), and Enterococcus

47
Q

Two common eponymous syndromes associated with cholangitis are:

A

Charcots Triad: Jaundice, Fever, and RUQ Pain
Reynold’s Pentad: Jaundice, Fever, and RUQ Pain, Hypotension, and Confusion

48
Q

The gold standard investigation for cholangitis is

A

ERCP

49
Q

If cholangitis with features of biliary tract obstruction and no response to antibiotic

A

Immediate ERCP

50
Q

definitive management of cholangitis

A

is via endoscopic biliary decompression,

51
Q

Commonest cholecystitis in diabetics type 2

A

Acalculous

52
Q

Rising AFP and liver USS showing a nodule greater than 1cm in diameter means suspected HCC so

A

Perform MRI now before resection

53
Q

Pale color stools which site jaundice

A

Post hepatic

54
Q

Calot is extremely difficult to delineate in which

A

. Mirrizi

55
Q

If jaundice them 1st test to perform,

A

USS

56
Q

If pancreas vs HEPATOBILIARY pathology onUSS then

A

CT with pancreatic protocol for pancreas
MRI/MRCP for liver/cholangiocarcinoma

57
Q

If the bile duct has been inadvertently excised then

A

a hepatico-jejunostomy will need to be created (difficult!)

58
Q

Cirrhosis
AFP >400
Lesion >2cm
Diagnosis

A

HCC

59
Q

If gallbladder empyema only vs associated issue
of Calot triangle like MiWrizi

A

Ifonly GB empyema thenTreatment is via laparoscopic cholecystectomy*
If associated issue of Calot triangle then percutaneous cholecystostomy

60
Q

What proportion of patients presenting for cholecystectomy for treatment of biliary colic due to gallstones will have stones in the common bile duct?

A

Up to 10% of all patients may have stones in the CBD

61
Q

From criteria of severity of infratitis what score shows severe pancreatitis

A

> 3 positive criteria indicates severe pancreatitis.

62
Q

Infective hepatitis in travellers is by

A

Hep A

63
Q

Traveler from India
Painless jaundice
No Orgernomegaly

A

HepA infection

64
Q

Hepatocellular Adenomas in males are likely to be

A

smaller but have a greater risk of malignant transformation

65
Q

critena of Hepatocellular adenoma resection

A

> 5cm
In males
haemorrhage or symptoms

66
Q

Hepatocellular adenoma

A

In women
Linked to use ofOCP
Asymptomatic >5cm are usually excised

67
Q

USS and CT of Hepatocellular carcinoma

A

On ultrasound the appearances are of mixed echoity and heterogeneous texture. On CT most lesions are hypodense

68
Q

You wish to exclude a perforated viscus, and determine whether pancreatitis is present

A

CT scan with IV contrast

69
Q

When cholecystostomy is preferred over sub total cholecystectomy in difficult calot

A

When only fundus is visible

70
Q

If severe abdominal pain post ercp then what could be the cause

A

Either pancreatitis or perferated small bowl and they can be differentiated through CT scan

71
Q

Normal size of bile duct

A

4mm

72
Q

If pancreatic necrosis infection is suspected then what to do

A

First line is FNAC
If unsuitable or any other issue or in fection is proved then perform Pancreatic Necrosectomy

73
Q

Enteral feed relation with pancreatitis

A

Enteral feeding helps minimise gut bacterial translocation and should be given to most patients with pancreatitis.

74
Q

If pancreatitis 2° gallstones then

A

undergo early cholecystectomy.

75
Q

Steps after pancreatic necrosis

A

Extensive necrosis with suspected infections&raquo_space;FNAC to rule out infections&raquo_space; ‘If infection positive then two options
1. radiological drainage or
2. \ surgical necrosectomy.

76
Q

Steps after pancreatic necrosis

A

Extensive necrosis with suspected infections&raquo_space;FNAC to rule out infections&raquo_space; ‘If infection positive then two options
1. radiological drainage or
2. \ surgical necrosectomy.

77
Q

If resectable head of Pancreas carcinoma then best method of biliary decompression

A

ERCP and placement of stent

77
Q

If resectable head of Pancreas carcinoma then best method of biliary decompression

A

ERCP and placement of stent

77
Q

If resectable{ no mets} head of Pancreas carcinoma then best method of biliary decompression

A

ERCP and placement of stent

77
Q

If resectable head of Pancreas carcinoma then best method of biliary decompression

A

ERCP and placement of stent

78
Q

If resectable head of Pancreas carcinoma then best method of biliary decompression

A

ERCP and placement of stent

79
Q

Rokitansky-Aschoff sinuses, or Luschka’s crypts seen in

A

Chronic cholecystitia

80
Q

Typically painless jaundice with palpable gallbladder

A

Shows distal biliary obstruction due to head ofpancreas carcinoma

81
Q

If suspected bile duct injury due to Cholecystectomy then

A

Perform ERCP first then stent can also be placed

81
Q

If suspected bile duct injury due to Cholecystectomy then

A

Perform ERCP first then stent can also be placed

82
Q

If suspected bile duct injury due to Cholecystectomy then

A

Perform ERCP first then stent can also be placed

83
Q

If suspected bile duct injury due to Cholecystectomy then

A

Perform ERCP first then stent can also be placed

84
Q

Ultrasound of the liver in biliary atresia

A

in biliary atresia infant may have tiny or invisible gallbladder

85
Q

Early vs late sign of Metastatic biliary disease

A

Combination of liver synthetic failure (late) and extrinsic compression by nodal disease and anatomical compression of intra hepatic structures (earlier

MRCS A(My Own) (28 decks)

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