Hepatobiliary surgery

Question 1

What are some complications of Acute cholecystitis?

Answer 1

Empyema
Perforation
Sepsis
Chronic cholecystitis

Question 2

What are the clinical signs for Acute cholecystitis?

Answer 2

Murphy’s sign

Boa’s sign - Hyperaesthesia at the right scapula

Question 3

How is an empyema managed?

Answer 3

IV antibiotics

Percutaneous drainage

Question 4

If there is cholangitis secondary to a stone in the bile duct, how should it be managed?

Answer 4

ERCP with sphincterotomy and stone extraction

Question 5

How is Ascending cholangitis managed?

Answer 5

IV antibiotics and Sepsis 6

ERCP

Question 6

What is it called when there is blockage to the gallbladder by a stone but no infection

Answer 6

Mucocele

Question 7

In obstructive jaundice what would you expect to see in the urine?

Answer 7

Bilirubin

Decreased Urobilinogen
- nothing is getting down to the bowel to be converted

Question 8

What investigations do you want to do into obstructive jaundice?

Answer 8

Blood:

• FBC - WWC - cholangitis?
• CRP - Cholangitis?
• LFTs
• Coagulation
• G&S - if suspect ERCP will be needed

Orifices:
- urine analysis

X-rays:

• US sound of abdomen
• US of liver
• MRCP
• ERCP

Question 9

What are the clinical findings of acute pancreatitis?

Answer 9

Tachycardia 
Tachypnea 
Severe epigastric tenderness 
Absent bowel sounds - ileus 
Shock - hypovolemia - 3rd spacing  
Jaundice 
Grey Turner's sign - Ecchymosis 
Cullen's sign - ecchymosis

Question 10

What investigations do you want into acute pancreatitis?

Answer 10

Bloods:

• FBC
• Amylase - 3x normal diagnostic
• U&Es - AKI?
• LFTs - Albumin/ Obstruction
• ABG - PaO2?
• Calcium
• Glucose

**think about glasgow score

Orifices:
- test for bilirubin

X-rays:

• CT - if diagnosis unsure
• US of gallbladder for stone removal
• MRCP
• ERCP

Question 11

How is a pancreatic pseudocyst treated?

Answer 11

Usually left as majority self resolve.
Following 6 weeks they may need to be drained.

Laparoscopic drainage into stomach

Question 12

What is the treatment of pancreatic necrosis?

Answer 12

Deterioration in patient.
diagnosed via CT and Fine needle aspiration

Necrosectomy is done

Question 13

What are the immediate complications following pancreatitis?

Answer 13

AKI/ Hypovolemic shock

ARDS

Hyperglycaemia

Hypocalcaemia

DIC

Question 14

What investigations would you want into chronic pancreatitis?

Answer 14

Bloods:

• Serum lipase
• Blood glucose
• LFTs

Imaging:

• CT abdomen
• ERCP - for structure abnormalities

Question 15

What is the treatment of chronic pancreatitis?

Answer 15

Alcohol abstinence

Analgesic
+/-
Coeliac block

Pancreatic Enzyme replacement
- creon supplements

ADEK vitamins

Diabetes treatment

Question 16

What is type of tumour that produces glucagon and what is the rash that is seen with it?

Answer 16

Glucagonoma

Necrolytic migratory erythema