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Clinical Surgery > Hepatobiliary Surgery > Flashcards

Hepatobiliary Surgery Flashcards

1
Q

Pre-Heaptic Causes of Jaundice

A

Increase bilirubin production (unconjugated hyperbilirubinemia)

  • Haemolysis
  • Ineffective erythropoiesis
  • Resorption of hematoma
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2
Q

Hepatic causes of Jaundice

A
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3
Q

Post-Hepatic causes of Jaundice

A
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4
Q

Definition of Jaundice?

A

Elevation of the serum bilirubin >15 μmol/L as a result of imbalance between production and clearance of bilirubin. It is clinically detectable when bilirubin is >35 μmol/L

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5
Q

Clinical Presentation of Acute Cholangitis

A

Charcot triad is the classic picture of acute cholangitis and comprises:

  • Jaundice
  • Abdominal pain
  • Rigors, and pyrexia.

Reynold Pentad: Hypotension and Confusion are often a feature of acute suppurative cholangitis in which the bile duct is filled with purulent bile under pressure

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6
Q

What is Courvoisier sign/law?

A

Courvoisier sign/law states that in a patient with painless jaundice and an enlarged or palpable gallbladder, the cause is unlikely to be gallstones. The presumed cause is an obstructing pancreatic or biliary neoplasm until proven otherwise.

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7
Q

Laboratory Tests to investigate patient with suspected liver failure

A
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8
Q

Liver Antibody/Tumor Markers

A
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9
Q

Liver Imaging and their indication

A
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10
Q

Means of Intervention for Patient w/ Jaundice?

A
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11
Q

Prevalence of Gallstones in Adult Population?

A

10-15%

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12
Q

Pathogenesis of Gallstone Formation?

A
  • Cholesterol supersaturation can result from excessive hepatic secretion of cholesterol or decreased hepatic secretion of bile salts for cholesterol absorption. (85%)
  • Gallbladder hypokinesia causing prolonged bile stasis is also associated with gallstone formation.
  • An increase in bilirubin load can lead to the development of black and brown gallstones. (10%)
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13
Q

Epidemiology of Gallstones?

A
  • Cholesterol stones account for more than 85% of gallstones in the Western population whereas brown-pigmented stones accounts for 10%.
  • Pigmented stones are more prevalent in Asia, as a result of more common hemolytic anemia, biliary parasites and Escherichia coli infection.
  • Age – The incidence of gallstones increases with age.
  • Gender – females > males (Ratio 2:1).
  • Pregnancy – is associated with up to 30% risk of developing biliary sludge/stones
  • Obesity – the incidence of gallstones is 25% in patients with severe obesity. Patients who undergo weight reduction treatments (e.g. bariatric surgery) are also at higher risk of developing gallstones.
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14
Q

Presentation/Differential of Gallstones

A
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15
Q

Imaging for Gallstones

A
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16
Q

Treatment of Acute Cholycyustitis?

A

Acute cholecystitis is initially treated with broad-spectrum antibiotics and analgesia.

Options for early (“hot gallbladder”) and delayed cholecystectomy (after 6 weeks).

For acute cholecystitis, early cholecystectomy (within 72 hours of symptom onset) can be considered

17
Q

Cholecystectomy Complications?

A
18
Q

Complications of Gallstones

A
19
Q

Mortality rate of Pancreatitis?

A

1% in mild pancreatitis to 20% in severe cases

20
Q

Diagnosis of Acute Pancreatitis?

A

Acute pancreatitis diagnosed according to Atlanta classification with at least 2 or more of the following:

  • abdo pain
  • elevated serum amylase/lipase greater than x3 normal upper limit
  • characteristic imaging(Contrast-enhanced CT)
21
Q

Causes of Pancreatitis?

A

Gallstones and alcohol collectively account for 80% of acute pancreatitis cases

22
Q

Classification of Pancreatitis?

A
23
Q

Local Complications of Acute Pancreatitis?

A
24
Q

Systemic Complications of Acute Pancreatitis?

A
25
Q

Assessment of Severity of Acute Pancreatitis

A
26
Q

Imaging for Acute Pancreatitis

A
27
Q

Management of Pt w/ Acute Pancreatitis?

A

Initial Management:

  • Fluid Resuscittation
  • Pain Control
  • Oxygen
  • Provisional Nutirional Support
  • Regular measurement of Vital Signs/ Urine Output
28
Q

Acute vs. Chronic Pancreatitis?

A

Acute: inflammation of the pancreas, specifically the glandular parenchyma. Diagnosis based on Atlanta classification – at least 2 or more of the following – abdo pain, elevated serum amylase/lipase greater than x3 normal upper limit, characteristic imaging

Chronic: characterized by chronic progressive pancreatic inflammation and scarring, irreversibly damaging the pancreas and resulting in loss of exocrine and endocrine function

29
Q

Presentation of Chronic Pancreatitis

A
30
Q

Laboratory Tests for Chronic Pancreatitis?

A

Baseline laboratory tests includes full blood count, urea & electrolytes, liver function test, blood glucose, HbA1c, and CRP.

Serum amylase is often normal or marginally raised in patients with chronic pancreatitis

Pancreatic exocrine dysfunction can be assessed indirectly by measurement of faecal elastase

31
Q

Imaging for Chronic Pancreatitis?

A
32
Q

Presentation of Pancreatic Malignangy?

A
33
Q

Surgical Therapy for Pancreatic Cancer

A

Clinical Surgery (20 decks)

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