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Y4 Gen Surg > Hepatobiliary surgery > Flashcards

Hepatobiliary surgery Flashcards

1
Q

what are gallstones made up of?

A

phospholipids - lecithin
bile pigments
cholesterol

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2
Q

what causes gallstones ?

A

lithogenic bile
binary sepsis
gall bladder hypo motility (pregnancy, OCP, TPN, fasting)

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3
Q

what are the three types of gall stones ?

A

cholesterol

pigment

mixed

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4
Q

what are pigment gall stones made of?

A

calcium bilirubinate

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5
Q

what do cholesterol gall stones look like?

A

large, solitary

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6
Q

what do pigment gall stones look like?

A

small, black, gritty, fragile

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7
Q

what are pigment stones associated with ?

A

haemolysis

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8
Q

what is the major component of mixed stones?

A

cholesterol

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9
Q

what are gall bladder stones complications ?

A 
biliary colic 
acute cholecystitis 
chronic cholecysitis 
mucocele 
carcinoma 
mirizzis syndrome (common bile duct obstruction)
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10
Q

what are common bile duct gall stone complications ?

A

obstructive jaundice
pancreatitis
cholangitis

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11
Q

what are gut gall stones complications ?

A

gallstone ileus

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12
Q

what urine tests should be done for biliary colic?

A

bilirubin, urobilinogen, Hb

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13
Q

what blood tests should be done for biliary colic ?

A

FBC, U&E, amylase, LFT, clotting, CRP, group and save

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14
Q

what will stones look like on US?

A

acoustic shadow

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15
Q

what imaging can be done for biliary colic?

A

AXR, US, cholescintigraphy, MRCP

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16
Q

what is boas sign?

A

Hyperaesthesia below the right scapula

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17
Q

what is murphys sign?

A

2 fingers over the GB and ask pt. to breath in

􏰁 → pain and breath catch. Must be –ve on the L

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18
Q

what is the management of acute cholecystitis ?

A

NBM
􏰁 Fluid resuscitation
􏰁 Analgesia: paracetamol, diclofenac, codeine 􏰁 Abx: cefuroxime and metronidazole

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19
Q

in what condition is boas sign and murphys sign seen?

A

acute cholecystitis

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20
Q

what is DD for chronic cholecysitis?

A

PUD
􏰀 IBS
􏰀 Hiatus hernia
􏰀 Chronic pancreatitis

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21
Q

what is the surgical treatment for chronic cholecysitis ?

A

Elective cholecystectomy

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22
Q

what is a calcified gall bladder called?

A

porcelain gall bladder

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23
Q

what is Riglers triad?

A

Pneumobiliia

􏰁 Small bowel obstruction 􏰁 Gallstone in RLQ

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24
Q

where is jaundice seen first ?

A

tongue frenulum

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25
Q

what happens to INR during obstructive jaundice?

A

increases due to low Vit K as bile can’t get through to break down fat and Vit K

26
Q

what immune antibodies should be checked with obstructive jaundice?

A

anti mitochondrial antibodies
ANCE
ANA

27
Q

what antibodies are found with coeliac disease?

A

anti endomysal

anti transglutaminase

28
Q

what does Pneumobilia on AXR suggest?

A

gas forming infection

29
Q

what is the conservative management of obstructive jaundice?

A

Monitor LFTs: passage of stone may → resolution 􏰁 Vitamins ADEK
􏰁 Analgesia
􏰁 Cholestyramine

30
Q

what are the two signs seen in ascending cholangitis ?

A

charcots triad

raynaulds pentad

31
Q

what is charcots triad?

A

ever/rigors, RUQ pain, jaundice

32
Q

what is raynaulds pentad?

A

Charcot’s triad + shock + confusion

33
Q

what antibiotics should be given for ascending cholangitis ?

A

cef and met

34
Q

what is the most common type of pancreatic cancer?

A

ductal adenocarcinoma

35
Q

what surgery can be for pancreatic cancer?

A

Whipple’s pancreaticoduodenectomy

􏰁 Distal pancreatectomy

36
Q

state some DD of acute pancreatitis ?

A

Perforated DU
􏰀 Mesenteric infarction
􏰀 MI

37
Q

is amylase and lipase increased or decreased with acute pancreatitis ?

A

increased

returns to normal by day 6

38
Q

is Ca increased or decreased with acute pancreatitis ?

A

decreased

39
Q

is Glc increased or decreased with acute pancreatitis ?

A

increased

40
Q

what are some complications of acute pancreatitis ?

A 
ARDs
shock 
renal failure 
DIC 
increased Glc 
hypo/hyper calcium 
alcohol withdrawal
41
Q

what are the indications of laparotomy with acute pancreatitis ?

A

Infected pancreatic necrosis 􏰀 Pseudocyst or abscess

􏰀 Unsure Dx

42
Q

state some late complications of acute pancreatitis?

A

necrosis, infection, abscess
bleeding
thrombosis
fistula formation

43
Q

state some causes of chronic pancreatitis

A

alcohol

genetics - CF, haemochromatosis

44
Q

how is chronic pancreatitis is relieved ?

A

sitting back

45
Q

what is the presentation of chronic pancreatitis ?

A 
epigastric pain 
steatorrhoea 
weight loss 
DM - polyuria/dipsia 
epigastric mass (pseudocyst)
46
Q

is faecal elastase increased or decreased with chronic pancreatitis?

A

decreased

47
Q

what could be seen on CT or XR of chronic pancreatitis?

A

calcifications

48
Q

what clinical sign would splenic vein thrombosis have?

A

splenomegaly

49
Q

what are complications of chronic pancreatitis ?

A 
Pseudocyst
􏰀 DM
􏰀 Pancreatic Ca
􏰀 Pancreatic swelling → biliary obstruction
􏰀 Splenic vein thrombosis → splenomegaly
50
Q

what causes WDHA syndrome ?

A

vasoactive intestinal peptide (VIPoma) causing

  • watery diarrhoea
  • hypokalaemia
  • achlorhydria
  • acidosis
51
Q

what are the features of somatostatinoma ?

A

DM
steatorrhoea
gall stones

52
Q

what is Meckel’s diverticulum?

A

congenital outpouching in the lower part of the small intestine

53
Q

what are risk factors for cholangiocarcinomas?

A

PSC (primary sclerosing cholangitis)
UC
Choledocholithiasis
Hep B/C

54
Q

what is the presentation of cholangiocarcinomas?

A

progressive painless obstructive jaundice
steatorrhoea
weight loss

55
Q

what tumour marker might be present with cholangiocarcinoma ?

A

CA 19-9

56
Q

what cancers could CA19-9 indicate?

A

cholangiocarcinomas
pancreatic
CRC

57
Q

what is the management of cholangiocarcinoma ?

A

poor prognosis

palliative stenting by ERCP

58
Q

what is hydatid cyst?

A

calcified cyst of liver

59
Q

what causes hydatid cyst?

A

Zoonotic infection by Echinococcus granulosus

􏰀 Occurs in sheep-rearing communities

60
Q

what is the treatment for hydatid cyst?

A

albendazole

Y4 Gen Surg (7 decks)

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