Hepatobiliary surgery

Question 1

what are gallstones made up of?

Answer 1

phospholipids - lecithin
bile pigments
cholesterol

Question 2

what causes gallstones ?

Answer 2

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

Question 3

what are the three types of gall stones ?

Answer 3

cholesterol

pigment

mixed

Question 4

what are pigment gall stones made of?

Answer 4

calcium bilirubinate

Question 5

what do cholesterol gall stones look like?

Answer 5

large, solitary

Question 6

what do pigment gall stones look like?

Answer 6

small, black, gritty, fragile

Question 7

what are pigment stones associated with ?

Answer 7

haemolysis

Question 8

what is the major component of mixed stones?

Answer 8

cholesterol

Question 9

what are gall bladder stones complications ?

Answer 9

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

Question 10

what are common bile duct gall stone complications ?

Answer 10

obstructive jaundice
pancreatitis
cholangitis

Question 11

what are gut gall stones complications ?

Answer 11

gallstone ileus

Question 12

what urine tests should be done for biliary colic?

Answer 12

bilirubin, urobilinogen, Hb

Question 13

what blood tests should be done for biliary colic ?

Answer 13

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

Question 14

what will stones look like on US?

Answer 14

acoustic shadow

Question 15

what imaging can be done for biliary colic?

Answer 15

AXR, US, cholescintigraphy, MRCP

Question 16

what is boas sign?

Answer 16

Hyperaesthesia below the right scapula

Question 17

what is murphys sign?

Answer 17

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

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

Question 18

what is the management of acute cholecystitis ?

Answer 18

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

Question 19

in what condition is boas sign and murphys sign seen?

Answer 19

acute cholecystitis

Question 20

what is DD for chronic cholecysitis?

Answer 20

PUD
􏰀 IBS
􏰀 Hiatus hernia
􏰀 Chronic pancreatitis

Question 21

what is the surgical treatment for chronic cholecysitis ?

Answer 21

Elective cholecystectomy

Question 22

what is a calcified gall bladder called?

Answer 22

porcelain gall bladder

Question 23

what is Riglers triad?

Answer 23

Pneumobiliia

􏰁 Small bowel obstruction 􏰁 Gallstone in RLQ

Question 24

where is jaundice seen first ?

Answer 24

tongue frenulum

Question 25

what happens to INR during obstructive jaundice?

Answer 25

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

Question 26

what immune antibodies should be checked with obstructive jaundice?

Answer 26

anti mitochondrial antibodies ANCE ANA

Question 27

what antibodies are found with coeliac disease?

Answer 27

anti endomysal | anti transglutaminase

Question 28

what does Pneumobilia on AXR suggest?

Answer 28

gas forming infection

Question 29

what is the conservative management of obstructive jaundice?

Answer 29

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

Question 30

what are the two signs seen in ascending cholangitis ?

Answer 30

charcots triad | raynaulds pentad

Question 31

what is charcots triad?

Answer 31

ever/rigors, RUQ pain, jaundice

Question 32

what is raynaulds pentad?

Answer 32

Charcot’s triad + shock + confusion

Question 33

what antibiotics should be given for ascending cholangitis ?

Answer 33

cef and met

Question 34

what is the most common type of pancreatic cancer?

Answer 34

ductal adenocarcinoma

Question 35

what surgery can be for pancreatic cancer?

Answer 35

Whipple’s pancreaticoduodenectomy | 􏰁 Distal pancreatectomy

Question 36

state some DD of acute pancreatitis ?

Answer 36

Perforated DU 􏰀 Mesenteric infarction 􏰀 MI

Question 37

is amylase and lipase increased or decreased with acute pancreatitis ?

Answer 37

increased | returns to normal by day 6

Question 38

is Ca increased or decreased with acute pancreatitis ?

Answer 38

decreased

Question 39

is Glc increased or decreased with acute pancreatitis ?

Answer 39

increased

Question 40

what are some complications of acute pancreatitis ?

Answer 40

``` ARDs shock renal failure DIC increased Glc hypo/hyper calcium alcohol withdrawal ```

Question 41

what are the indications of laparotomy with acute pancreatitis ?

Answer 41

Infected pancreatic necrosis 􏰀 Pseudocyst or abscess | 􏰀 Unsure Dx

Question 42

state some late complications of acute pancreatitis?

Answer 42

necrosis, infection, abscess bleeding thrombosis fistula formation

Question 43

state some causes of chronic pancreatitis

Answer 43

alcohol | genetics - CF, haemochromatosis

Question 44

how is chronic pancreatitis is relieved ?

Answer 44

sitting back

Question 45

what is the presentation of chronic pancreatitis ?

Answer 45

``` epigastric pain steatorrhoea weight loss DM - polyuria/dipsia epigastric mass (pseudocyst) ```

Question 46

is faecal elastase increased or decreased with chronic pancreatitis?

Answer 46

decreased

Question 47

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

Answer 47

calcifications

Question 48

what clinical sign would splenic vein thrombosis have?

Answer 48

splenomegaly

Question 49

what are complications of chronic pancreatitis ?

Answer 49

``` Pseudocyst 􏰀 DM 􏰀 Pancreatic Ca 􏰀 Pancreatic swelling → biliary obstruction 􏰀 Splenic vein thrombosis → splenomegaly ```

Question 50

what causes WDHA syndrome ?

Answer 50

vasoactive intestinal peptide (VIPoma) causing - watery diarrhoea - hypokalaemia - achlorhydria - acidosis

Question 51

what are the features of somatostatinoma ?

Answer 51

DM steatorrhoea gall stones

Question 52

what is Meckel’s diverticulum?

Answer 52

congenital outpouching in the lower part of the small intestine

Question 53

what are risk factors for cholangiocarcinomas?

Answer 53

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

Question 54

what is the presentation of cholangiocarcinomas?

Answer 54

progressive painless obstructive jaundice steatorrhoea weight loss

Question 55

what tumour marker might be present with cholangiocarcinoma ?

Answer 55

CA 19-9

Question 56

what cancers could CA19-9 indicate?

Answer 56

cholangiocarcinomas pancreatic CRC

Question 57

what is the management of cholangiocarcinoma ?

Answer 57

poor prognosis | palliative stenting by ERCP

Question 58

what is hydatid cyst?

Answer 58

calcified cyst of liver

Question 59

what causes hydatid cyst?

Answer 59

Zoonotic infection by Echinococcus granulosus | 􏰀 Occurs in sheep-rearing communities

Question 60

what is the treatment for hydatid cyst?

Answer 60

albendazole