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CORE SURG > hepatobiliary surgery > Flashcards

hepatobiliary surgery Flashcards

1
Q

at what level of bilirubin is jaundice usually seen?

A

> 35 mmol/L

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2
Q

normal serum bilirubin?

A

3-17 mmol/L

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3
Q

causes of prehepatic jaundice?

A
  • autoimmune hemolytic anemia
  • drug toxicity
  • transfusion reaction
  • congenital - hereditary spherocytosis, sickle cell
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4
Q

causes of hepatic jaundice?

A
  • gilberts (unconj)
  • crigler-najjar (unconj)
  • viral hepatitis
  • alcoholic liver disease
  • toxic drug jaundice
  • metastatic disease
  • dubin johnsin
  • rotor
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5
Q

causes of post hepatic jaundice - intraluminal causes ?

A

choledocholithiasis

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6
Q

causes of post hepatic jaundice - mural causes ?

A
  • primary sclerosing cholangitis

- biliary stricture

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7
Q

causes of post hepatic jaundice - extrinsic causes ?

A
  • carcinoma of head of pancreas, ampulla of vater or bile duct
  • chronic pancreatitis
  • enlarged lymph nodes in porta hepatis
  • mirizzi syndrome
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8
Q

what is mirizzi syndrome?

A

-external biliary compression from a stone impacting the neck of the gallbladder

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9
Q

what is charcots triad?

A

Triad seen in ascending cholangitis?

  • RUQ pain
  • fever and rigors
  • jaundice
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10
Q

murphys sign suggests…

A

gallbladder inflammation

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11
Q

Courviousiers law

A

A painless, palpable gallbladder in a patient with jaundice is unlikely due to gallstone disease and may suggest malignant obstruction

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12
Q

what are the three components of bile?

A
  • cholesterol
  • bile salts
  • phospholipids
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13
Q

complications of acute cholecystitis?

A
  • empyema or abscess of gallbladder
  • perforation with peritinitis
  • gallstone ileus
  • jaundice due to compression of adjacent bile duct (Mirizzi)
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14
Q

what is chronic cholecystitis?

A

-attacks of RUQ and tenderness

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15
Q

management of chronic cholecystitis?

A

-analgesia and routine cholecystectomy

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16
Q

patho of a mucocele?

A

-when stones block the neck of the gallbladder and bile is reabsorbed but mucous is continued to be secrete leading to a large tense globular mass in the RUQ

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17
Q

treatment of ascending cholangitis?

A

-IV fluids, antibiotics and relieving the obstruction

18
Q

next ix after ultrasound for ascending cholangitis?

A

ERCP

19
Q

next investigation after ERCP for ascending cholangitis?

A

if stone is identified on ERCP -> MRCP or percutaneous cholangiography

20
Q

SEPSIS 6

A

TAKE 3:

  • lactate
  • blood cultures
  • urine output

GIVE 3:

  • oxygen
  • fluids
  • antibiotics
21
Q

Management of ascending cholangitis:

A
  • analgesia
  • IV fluids
  • antibiotics
  • oral intake restricted
  • THEN plan for either elective cholecystectomy, or perform during admission
22
Q

I GET SMASHED - aetiologies for pancreatitis?

A 
I-idiopathic
G-gallstones
E-ethanol/alcohol
T-trauma
S-steroids
M-mumps & other infections
A-autoimmune
S-spider/scorpion
H-hypertriglyceridemia
E-ERCP
Drugs and toxins
23
Q

severe pancreatitis can result in…

A

SIRS

24
Q

left flank bruising in pancreatitis =

A

grey-turners sign

25
Q

periumbilical bruising in pancreatitis =

A

cullens sign

26
Q

what is the name of the scale that determines MORTALITy of pancreatitis

A

ransons

27
Q

what is the name of the scale that determines the SEVERITY of pancreatitis

A

glasgow

28
Q

BEDSIDE investigations for pancreaittis

A

-ECG, urine dipstick

29
Q

Blood tests for someone with pancreatitis

A

-FBC, LFTS, ALK phos, coag, cross match, ca, blood glucose, amylase, electrolytes,CRP

ABGs

30
Q

why are lipase and urinary amylase sometimes useful for diagnosisng pancreatitis?

A

they remain elevated longer than serum amylase

31
Q

Imaging for suspected pancreatitis

A 
CXRAY - rule out free air under diagphram
Ultrasound for gallstones
Abdominal XRAY - 
CT
Endoscopic ultrasound
MRCP
32
Q

Local complications of pancreatitis

A
  • abscess
  • pseudocyst
  • necrosis/gangrene
  • splenic vein thrombosis/hemorhage
  • peripancreatic fluid collection
33
Q

what is a pseudocyst?

A

collection of fluid that does not have epithelial lining

34
Q

Systemic complications of pancreatitis

A
  • sepsis
  • arythmia
  • hypovolemia
  • renal failure
  • ARDS, pleural effusions, pneumonia
  • DIC
  • hyperglycemia
  • hypocalcemia
  • death
  • intestinal hemorhage/ileus
35
Q

Ix for CHRONIC pancreatitis

A
  • abdominal xray
  • abdominal ultrasound - pancreatic duct dilation
  • CT
  • MRCP
  • ERCP
  • endoscopic ultrasound combined with aspiration cytology/biopsies
  • fecal elastase to check endocrine function
36
Q

non-surgical management of chronic pancreatitis

A
  • stop offending agents (alcohol)
  • decrease fat in diet
  • creon
  • insulin (if necessary)
  • pain control
37
Q

surgical options for chronic pancreatitis (if medical therapy fails)?

A
  • pancreatoduodenectomy (whipples procedure)
  • partial or distal pancreatectomy
  • pancreaticojejunostomy
38
Q

most common type of pancreatic cancer

A

ductal adenocarcinoma

39
Q

tumour marker for pancreatic cancer?

A

CA-19-9

40
Q

most common endocrine tumour of the pancreas?

A

insulinoma

41
Q

90% of insulinomas are (benign/malignant)

A

benign

CORE SURG (14 decks)

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