hepatobiliary and pancreatic surgery Flashcards
Sequelae of pancreatitis?
Peripancreatic fluid collections
Pseudocyst
Pancreatic necrosis
Pancreatic abscess
Haemorrhage
Classic symptoms of gallstones?
right upper quadrant pain that occurs post prandially (worst post prandially)
Who is at risk of acalculous cholecystitis?
Patients with inter current illness (e.g. diabetes, organ failure)
Patient of systemically unwell
Management of gallstone ileus?
The gallstones should always be removed, the enterotomy site is proximal to the site of obstruction.
leave gallbladder alone
do not interfere with fistula site
what is mirizzi syndrome?
gallstones compress bile duct
rare time cholecystitis may present with jaundice
what is charcots triad ?
pain, fever, jaundice
cholangitis
which procedure is likely to increase the risk of gallstone formation?
ileal resection
Bile salt reabsorption occurs at the ileum. Therefore cholesterol gallstones form as a result of ileal resection.
Differential causes of hyperamylasaemia
Acute pancreatitis
Pancreatic pseudocyst
Mesenteric infarct
Perforated viscus
Acute cholecystitis
Diabetic ketoacidosis
How is severity of acute pancreatitis assessed?
Glasgow, Ranson scoring systems and APACHE II
Biochemical scoring e.g. using CRP
Features that may predict a severe attack within 48 hours of admission to hospital? [initial assessment]
Clinical impression of severity
Body mass index >30
Pleural effusion
APACHE score >8
Features that may predict a severe attack within 48 hours of admission to hospital? [24 hours after admission]
Clinical impression of severity
APACHE II >8
Glasgow score of 3 or more
Persisting multiple organ failure
CRP>150
Features that may predict a severe attack within 48 hours of admission to hospital? [48 hours after admission]
Glasgow Score of >3
CRP >150
Persisting or progressive organ failure
Assessment of severity of pancreatitis?
Mnemonic for the assessment of the severity of pancreatitis: PANCREAS
(Ann R Coll Surg Engl 2000; 82: 16-17
P a02 < 60 mmHg
A ge > 55 years
N eutrophils > 15 x 10/l
C alcium < 2 mmol/l
R aised urea > 16 mmol/l
E nzyme (lactate dehydrogenase) > 600 units/l
A lbumin < 32 g/l
S ugar (glucose) > 10 mmol/l
> 3 positive criteria indicates severe pancreatitis.
Management of hepatocellular carcinoma?
In patients with haemorrhage or symptoms removal of the adenoma may be required
Asymptomatic adenomas >5cm are usually excised
Adenomas in males are likely to be smaller but have a greater risk of malignant transformation
Imaging of hepatocellular carcinoma?
Lesions are usually solitary
They are usually sharply demarcated from normal liver although they usually lack a fibrous capsule
On ultrasound the appearances are of mixed echoity and heterogeneous texture.
On CT most lesions are hypodense when imaged prior to administration of IV contrast agents
