Hepatobillary And Pancreas Flashcards
Investigations for chronic pancreatitis?
Abdo X-ray - calcification of pancreas
Ct is more sensitive
Functional: faecal elastase low means low exocrine function
What’s in the modified Glasgow score for pancreatitis severity?
P - pao2 <8 A - age >55 N - neutrophils >15 (wcc) C - calcium <2 R - renal - urea >16 E - enzymes - LDH >600, AST >200 A - albumin <32 S - sugar - CBG >10
3 or more plan for HDU/ITU - severe disease
What are the different types of gall stone?
Cholesterol- large, solitary (fat females)
Pigement stones - small black gritty (haemolysis)
Mixed stones - multiple (cholesterol)
Complications of gallstones by anatomy?
GB - cholecystitis (+ empyema), mirizzi syndrome, biliary colic, carcinoma, mucocele
CBD - cholangitis, obstructive jaundice, pancreatitis
Gut - gall stone ileus
Rx for ascending cholagitis
IV Abx - cef and met
1st- ERCP (after 24-48hrs to relieve ob)
2nd - open or lap stone removal with T tube drain
What are the post pancreatitis complications?
Peripancreatic fluid collection - may develop into pseudocysts or abscesses - however most will sponataneously resolve
pseudocysts - >4 weeks post acute panc, retrogastric, 50% resolve, but others need surgery (cystogastrostomy) or aspiration.
Pancreatic necrosis - sterile necrosis (mx conservstively), infected necrosis needs surgery (necrosectomy)
Abscess - often an infected pseudocyst, requires draining
Haemorrhage - see grey turners sign
Risk factors for cholangiocarcinoma?
PSC 1’
Developing world - liver flukes and typhoid
What liver cysts should NOT be aspirated and how are they investigated?
Hydatid cysts (echinococcus parasite - eosinophilia) because there can be anaphylaxis to the contents of the cyst or can cause seeding of daughter cysts into abdomen.
Do a CT abdomen next after US.
Diagnostic Ix for pancreatic cancer?
ERCP- as can visualise and take samples
