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Phase 2- Periop > Hepatobiliary Problems > Flashcards

Hepatobiliary Problems Flashcards

1
Q

What is biliary colic?

A

Sudden, severe abdominal pain felt in the epigastric region. The pain is intermittent and can be brought on by eating fatty foods.

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2
Q

What is acute cholecystitis?

A

Inflammation of the gallbladder

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3
Q

What is ascending cholangitis?

A

Inflammation of the biliary tree causing RUQ pain, fever and jaundice (Charcot’s triad) and potentially hypotension and confusion (Reynaud pentad)

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4
Q

How is acute cholecystitis treated?

A

IV antibiotics and laparoscopic cholecystectomy within 1 week of diagnosis

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5
Q

How is ascending cholecystitis treated?

A

IV antibiotics, ERCP and fluids

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6
Q

Give 5 risk factors for developing gallstones

A 
Obesity 
Female 
Over 40 
COPD
Cirrhosis
Crohn's disease
IBS
Family history 
Weight loss 
Ceftriaxone
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7
Q

What is Murphy’s sign?

A

Pressing down on the right hypochondrium and asking the patient to breath in. The gallbladder becomes exposed and the hand touches it so the patient feels pain. Positive in acute cholecystitis

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8
Q

What size does a gallstone need to be to pass naturally?

A

<5mm

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9
Q

Give 2 conservative ways to manage gallstones

A

Avoid fatty foods
Eat a healthy diet
Stop smoking
Avoid alcohol

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10
Q

How are gallstones managed medically?

A

Ursodeoxycholic acid

Pain killers

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11
Q

How are gallstones managed surgically?

A

Laparoscopic cholecystectomy

ERCP

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12
Q

Give 4 risks of ERCP

A

Bleeding
Duodenal perforation
Pancreatitis
Cholangitis

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13
Q

What is porcelain gallbladder?

A

Calcium deposits build up on the inside of the gallbladder usually after recurring inflammation of the gallbladder.

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14
Q

What is Courvoisier’s law?

A

Jaundice with a painless, palpable gallbladder is unlikely to be gallstones

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15
Q

What is the most common type of gallbladder cancer?

A

Adenocarcinomas

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16
Q

Give 4 symptoms of gallbladder cancer

A 
Abdominal pain 
Nausea
Jaundice
Distended abdomen 
Weight loss 
Loss of appetite
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17
Q

Give 4 risk factors for developing gallbladder cancer

A 
Obesity 
Smoking 
Unhealthy diet 
Gallstones 
Cholecystitis
Diabetes 
Family history 
Porcelain gallbladder
18
Q

What is gallstone ileus?

A

Fistula forms between the gallbladder and the bowel and large gallstones can exit the gallbladder and block the bowel. Needs urgent treatment due to risk of bowel perforation

19
Q

Give 6 causes of acute pancreatitis

A 
Gallstones 
Ethanol 
Trauma 
Steroids
Mumps
Autoimmune
Scorpion bite 
Hyperlipidaemia 
ERCP
Drugs
20
Q

Give 3 drugs which can cause pancreatitis

A 
Azathioprine 
Thiazide
Sulfasalazine 
Trimethoprim 
Tetracycline 
Sodium valproate
21
Q

Give 4 symptoms of acute pancreatitis

A 
Severe, dull epigastric pain worse on eating and drinking and radiating to the back 
Nausea
Diarrhoea
Indigestion 
Fever 
Jaundice
22
Q

What are the factors involved in the GLASGOW score for pancreatitis?

A 
PaO2 (<8 kPa) 
Age (>55 years) 
Neutrophils (>15 x 10^9/L) 
Calcium (<2 mmol/L)
Renal function (urea >16mmol/L)
Enzymes (LDH >600 or AST >2000) 
Albumin (<32g/L) 
Sugar (glucose >10mmol/L)
23
Q

How is acute pancreatitis managed?

A

Treat underlying cause
Fluids
Oxygen
Analgesia

24
Q

Give 4 potential complications of acute pancreatitis

A

Chronic pancreatitis
Sepsis
Infected pancreatic necrosis
Pseudocysts

25
Q

Give 4 symptoms of chronic pancreatitis

A 
Abdominal pain radiating to the back 
Worse 15-20 minutes after eating 
Greasy, foul-smelling stools 
Nausea
Vomiting 
Weight loss
Loss of appetite
Jaundice 
Symptoms of diabetes
26
Q

Give 3 causes of chronic pancreatitis

A 
Excessive alcohol 
Autoimmune pancreatitis
Trauma 
Smoking 
Radiotherapy side effect
27
Q

How is chronic pancreatitis diagnosed?

A 
Stool sample (fecal elastase) 
Ultrasound 
CT scan 
MRCP 
X-ray (can see calcification of pancreas)
28
Q

How is chronic pancreatitis treated?

A 
Avoid alcohol 
Stop smoking 
Low fat diet 
Enzyme supplements 
Corticosteroids 
Pain relief
29
Q

Where in the pancreas does a cancer normally affect?

A

Head of the pancreas

30
Q

Why is the prognosis for pancreatic cancer so poor?

A

Diagnosed late due to vague symptoms and ability for the cancer to grow into the space without consequence

31
Q

Give 3 risk factors for developing pancreatic cancer

A 
Smoking 
Alcohol 
Previous cancer
Diet 
Previous radiotherapy 
Obesity 
Old age 
MEN 
BRCA2 gene
32
Q

Give 3 causes of pancreatic cancer

A

Chronic pancreatitis
Stomach ulcer
H. pylori
Hepatitis

33
Q

Give 3 symptoms of pancreatic cancer

A 
Dull epigastric pain radiating to the back 
Worse when lying down 
Jaundice 
Weight loss
Symptoms of diabetes 
Itching 
Nausea and vomiting 
Steatorrhoea 
Fever 
Indigestion
34
Q

How is pancreatic cancer diagnosed?

A

USS and CT

35
Q

How is pancreatic cancer treated?

A

Chemotherapy

Surgery –> total pancreatectomy, Whipple’s procedure

36
Q

What is liver cirrhosis?

A

Chronic scarring of the liver which prevents the liver from functioning normally

37
Q

Give 4 symptoms of liver cirrhosis

A

Fatigue, nausea, loss of appetite, loss of sex drive, jaundice, haematemesis, itchy skin, melaena, bruising, oedema, ascites

38
Q

Give 4 signs of liver cirrhosis

A 
Leukonychia 
Clubbing 
Palmar erythema 
Spider naevi 
Gynaecomastia 
Loss of body hair
39
Q

Give 3 causes of liver cirrhosis

A

Alcohol excess
Hepatitis
Non alcoholic fatty liver disease

40
Q

How is liver cirrhosis treated?

A

Stop drinking alcohol, treat hepatitis, treat cause
Cholestyramine, interferon alpha, spironolactone
Liver transplant

41
Q

What 5 factors does the Child-Pugh score take into consideration?

A 
Serum bilirubin 
Serum albumin 
Presence of ascites 
Encephalopathy 
INR

Phase 2- Periop (5 decks)

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