Hepatobiliary + pancreas Flashcards
Acute pancreatitis
Causes and symptoms
Usually due to alcohol or gall stones - GET SMASHED.
Severe epigastric pain that might radiate to the back. Vomiting. Low grade fever.
Periumbilical discoloration- Cullen’s sign. Flank discolouration- Grey-Turner’s sign.
Acute pancreatitis
Investigations and management
Serum amylase raised 3x normal limit. Can be raised in mesenteric infarcts, acute cholecystitis, DKA.
Serum lipase- more specific.
USS, contrast enhanced CT.
Fluid resuscitation due to third space loss.
Aim for urine 0.5ml/kg/hr
Analgesia- IV opioids
Nil by mouth, enteral nutrition
If due to gallstones- early cholecystectomy.
Pancreatic cancer
Most common type
Risk factors
Diagnosed late.
Adenocarcinomas at the head of the pancreas.
Age, smoking, diabetes, chronic pancreatitis, HNPCC, MEN, BRCA2
Pancreatic cancer
Symptoms
Tests
Management
Painless jaundice- pale stools, dark urine, pruritis.
Cholestatic LFTs.
Anorexia, weight loss, epigastric pain.
Loss of exocrine and endocrine functions- steatorrhea, diabetes.
Courvoisier’s law- painless jaundice, palpable gallbladder unlikely to be gall stones.
USS and CT
Whipple’s resection
Chemotherapy
Chronic pancreatitis
80% due to alcoholism.
Pain after meals, steatorrhea and diabetes mellitus long term complications.
CT -> pancreatic calcification.
Acute liver failure- causes, symptoms
Paracetamol OD, alcohol, Hep A or B, acute fatty liver of pregnancy
Jaundice, raised prothrombin time, hypoalbuminemia, hepatic encephalopathy, renal failure.
Ascites
Accumulation of fluid in abdomen.
SAAG > 11 indicates portal hypertension, SAAD < 11 indicates hypoalbuminemia, infection or malignancy
Liver cirrhosis- causes
Alcohol, non alcoholic fatty liver disease, Hep B and C
Fibroscan to measure stiffness of liver.
Screening for Hep C people, men who drink > fifity units/week, women who drink > thirty five, endoscopy to check for varices and USS every 6 months with AFP to check for hepatocellular carcinoma.
Hepatocellular carcinoma
Most common cause is chronic Hep B worldwide and Hep C in Europe.
Late presentation, liver cirrhosis, jaundice, ascites, RUQ pain, hepatomegaly, raised AFP.
Gall stones
Right colicky abdo pain postprandially. Worse following fatty meals when CCK levels are high and gall bladder contraction in maximal.
USS and LFTs- show stones and raised ALP.
Acute cholecystitis
Due to gallstones in 90%.
RUQ pain, fever, Murphy’s sign, mildly deranged LFTs. Very deranged- Mirizzi syndrome.
USS, antibiotics and early cholecystectomy.
Ascending Cholangitis
RUQ pain, fever, + jaundice -> Charcot’s triad.
Raised inflammatory markers.
Give antibiotics and ECRP.
Hemochromatosis
Mutation on HFE gene on chromosome 6.
Autosomal recessive, iron accumulation.
Fatigue, erectile dysfunction, arthralgia, bronze skin, DM, chronic liver disease, cardiac failure, hypogonadism.
Measure transferrin saturation > 55% in men and over 50% in women and ferritin > 500.
Venesection and desferrioxamine.
Wilson’s disease
Excess copper build up. Vomiting, fatigue, ascites, swelling in legs, jaundice, itchiness.
Kayser-Fleischer rings in eyes.
