Hepatobiliary surgery Flashcards
Four risk factors for gallstones
Obesity
Female
Pregnancy
Forty
Typical presentation of gallstones
- Biliary colic :
- Severe, colicky epigastric or right upper quadrant pain
- Often triggered by meals (particularly high fat meals)
- Lasting between 30 minutes and 8 hours
- May be associated with nausea and vomiting
First line investigation for gallstones
USS
Definition of acute cholecystitis
Inflammation of the gallbladder due to gallstones
Features of acute cholecystitis
-> RUQ pain, might radiate to the shoulder
-> Fever
-> Murphys sign
What would be seen on abdo USS in cholecystitis
Thickened gallbladder wall
Stones or sludge in gallbladder
Fluid around the gallbladder
Definition of cholangitis
Infection and inflammation of the bile ducts
most common organisms causing cholangitis
- Escherichia coli
- Klebsiella species
- Enterococcus species
Presentation of acute cholangitis
CHARCOT’S TRIAD
- Fever
- RUQ pain
- Jaundice
Management of cholangitis
- Nil by mouth
- IV fluids
- Blood cultures
- IV antibiotics (as per local guidelines)
- ERCP (after 24-48 hrs to relieve any obstruction)
what is a cholangiocarcinoma and where is the most common site ?
- Cancer originating in the bile ducts
- Most common site : perihilar region
Main RF for cholangiocarcinoma
- PSC
key presenting feature of cholangiocarcinoma
Obstructive jaundice : dark urine, pale stools and generalised itching
what are 2 key differentials for painless jaundice
- Pancreatic cancer (more common)
- Cholangiocarcinoma
what is courvoisier’s law ?
A palpable gallbladder + jaundice = unlikely to be gallstones. Cause is usually cholangiocarcinoma or pancreatic cancer
Tumour marker for cholangiocarcinoma
CA 19-9
Common presentation of pancreatic cancer
- Painless obstructive jaundice
- New onset or rapid worsening of gycaemic control type 2 DM
when can someone be referred for a direct access CT abdomen for suspected pancreatic cancer ? (7)
Over 60 with weight loss + an additional symptoms :
- Diarrhoea
- Back pain
- Abdominal pain
- Nausea
- Vomiting
- Constipation
- New-onset diabetes
3 key causes of pancreatitis
Gallstones
Alcohol
Post-ERCP
Name 11 causes of pancreatitis
I GET SMASHED
I – Idiopathic
G – Gallstones
E – Ethanol
T – Trauma
S – Steroids
M – Mumps
A – Autoimmune
S – Scorpion sting
H – Hyperlipidaemia
E – ERCP
D – Drugs (furosemide, thiazide diuretics and azathioprine)
Presentation of acute pancreatitis
-> Severe epigastric pain
-> Radiating through to the back
-> Associated vomiting
-> Abdominal tenderness
-> Systemically unwell (e.g., low-grade fever and tachycardia)
What will most often be raised in acute pancreatitis ?
-> Amylase : more than 3x upper limit of normal
-> Lipase : more sensitive and specific that amylase
what is used to assess severity of pancreatitis ?
Glasgow score
0 or 1 – mild pancreatitis
2 – moderate pancreatitis
3 or more – severe pancreatitis
What criteria is used in the glasgow score for pancreatitis ?
P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)
Complications of acute pancreatitis (5)
- Peripancreatic fluid collections
- Pseudocysts
- Pancreatic necrosis
- Pancreatic abscess
- Haemorrhage
most common cause of chronic pancreatitis
Alcohol