Hepatobiliary Surgery Flashcards
Pre-Heaptic Causes of Jaundice
Increase bilirubin production (unconjugated hyperbilirubinemia)
- Haemolysis
- Ineffective erythropoiesis
- Resorption of hematoma
Hepatic causes of Jaundice
Post-Hepatic causes of Jaundice
Definition of Jaundice?
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
Clinical Presentation of Acute Cholangitis
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
What is Courvoisier sign/law?
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.
Laboratory Tests to investigate patient with suspected liver failure
Liver Antibody/Tumor Markers
Liver Imaging and their indication
Means of Intervention for Patient w/ Jaundice?
Prevalence of Gallstones in Adult Population?
10-15%
Pathogenesis of Gallstone Formation?
- 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%)
Epidemiology of Gallstones?
- 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.
Presentation/Differential of Gallstones
Imaging for Gallstones
Treatment of Acute Cholycyustitis?
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
Cholecystectomy Complications?
Complications of Gallstones
Mortality rate of Pancreatitis?
1% in mild pancreatitis to 20% in severe cases
Diagnosis of Acute Pancreatitis?
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)
Causes of Pancreatitis?
Gallstones and alcohol collectively account for 80% of acute pancreatitis cases
Classification of Pancreatitis?
Local Complications of Acute Pancreatitis?
Systemic Complications of Acute Pancreatitis?
Assessment of Severity of Acute Pancreatitis
Imaging for Acute Pancreatitis
Management of Pt w/ Acute Pancreatitis?
Initial Management:
- Fluid Resuscittation
- Pain Control
- Oxygen
- Provisional Nutirional Support
- Regular measurement of Vital Signs/ Urine Output
Acute vs. Chronic Pancreatitis?
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
Presentation of Chronic Pancreatitis
Laboratory Tests for Chronic Pancreatitis?
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
Imaging for Chronic Pancreatitis?
Presentation of Pancreatic Malignangy?
Surgical Therapy for Pancreatic Cancer
