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Surgery > HPB > Flashcards

HPB Flashcards

1
Q

What is jaundice

A

Yellow discolouration of skin and sclera

Due to hyperbilirubinaemia

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2
Q

What is pre-hepatic jaundice

A

Excessive RBC breakdown

Overwhelm liver’s ability to conjugate bilirubin

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3
Q

What is hepatocellular jaundice

A

Dysfunction of hepatic cells

Get a mixed picture (conjugated and unconjugated bilirubin)

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4
Q

What is post-hepatic jaundice

A

Obstruction of biliary drainage

Bilirubin conjugated by liver

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5
Q

What investigations are needed for jaundice

A

Bilirubin, albumin, AST, ALT, ALP, gamma GT

Coagulation studies

FBC, U&Es

Liver screen

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6
Q

What investigations are needed for jaundice

A

Ultrasound abdomen (first line)

MRCP (visualise biliary tree)

Liver biopsy

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7
Q

What are the types of gallstones

A

Cholesterol

Pigment (bile)

Mixed (cholesterol and bile)

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8
Q

What are the risk factors for gallstones

A

Fat

Female

Fertile

Forty

Family history

Pregnancy

Oral contraception

Haemolytic anaemia

Malabsorption

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9
Q

What is biliary colic

A

Gallbladder neck impacted by gallstone

Pain due to contraction against blockage

No inflammation

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10
Q

How might biliary colic present

A

Sudden onset, dull, colicky RUQ pain

Can radiate to epigastric region or back

Brought on by eating fatty food

Nausea and vomiting

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11
Q

How might acute cholecystitis present

A

Constant RUQ pain

Radiation to epigastrium

Fever

Lethargy

Tender RUQ

Murphy’s sign: pressure to RUQ, inspire, positive if halt inspiration due to pain

Check for guarding

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12
Q

What are the differentials for biliary colic and acute cholecystitis

A

GORD

Peptic ulcer

Acute pancreatitis

Inflammatory bowel disease

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13
Q

What investigations are needed for biliary colic and acute cholecystitis

A

FBC, CRP, LFTs, amylase, urinalysis

Ultrasound (see gallstones or sludge, thick gallbladder wall, bile duct dilation)

MRCP (gold standard)

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14
Q

What is the management for biliary colic

A

Analgesia

Lifestyle advice

Laparoscopic cholecystectomy (high risk of recurrence, within 6 weeks)

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15
Q

What is the management for acute cholecystitis

A

IV antibiotics

Analgesia

Antiemetics

Laparoscopic cholecystectomy (within 1 week)

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16
Q

What are the complications of biliary colic and acute cholecystitis

A

Mirizzi syndrome: stone in Hartmann’s pouch, compression of common bile duct

Gallbladder emphysema: gallbladder fills with pus

Chronic cholecystitis: persistent inflammation of gallbladder wall

Bouveret’s syndrome: can get fistula between gallbladder and small bowel

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17
Q

What is cholangitis

A

Infection of biliary tree

High morbidity and mortality

Causes biliary outflow obstruction and biliary infection

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18
Q

What are the causes of cholangitis

A

Gallstones

Iatrogenic

Cholangiocarcinoma

Pancreatitis

Primary sclerosing cholangitis

Ischaemic cholangiopathy

Parasitic infection

Common organisms: E coli, klebsiella, enterococcus

19
Q

How might cholangitis present

A

RUQ pain

Fever

Jaundice

Pruritus

Pyrexia

Rigors

Charcot’s triad

Reynold’s pentad

20
Q

What is Charcot’s triad for cholangitis

A

Jaundice

Fever

RUQ pain

21
Q

What is Reynold’s pentad for cholangitis

A

Jaundice

Fever

RUQ pain

Hypotension

Confusion

22
Q

What investigations are needed for cholangitis

A

Routine bloods

Blood cultures

Ultrasound biliary tree

ERCP (gold standard)

23
Q

What is the management for cholangitis

A

Immediate: sepsis 6, IV fluids, routine bloods, blood cultures, broad spectrum IV antibiotics

Definitive: endoscopic biliary decompression, cholecystectomy

24
Q

What is cholangiocarcinoma

A

Cancer of biliary tree

95% adenocarcinomas

25
Q

What is Courvoisier’s law

A

If have jaundice and enlarged palpable gallbladder, strongly suspect malignancy of biliary tree or pancreas

26
Q

What is acute pancreatitis

A

Inflammation of pancreas

Scoring via Glasgow criteria

27
Q

What are the causes of pancreatitis

A

GET SMASHED

Gallstones

Ethanol

Trauma

Steroids

Mumps

Autoimmune disease

Scorpion venom

Hypercalcaemia

ERCP

Drugs (azathioprine, NSAIDs, diuretics)

28
Q

How might acute pancreatitis present

A

Severe epigastric pain

Radiates to back

Nausea and vomiting

Guarding

Haemodynamic instability

Cullen’s sign

Grey Turner’s sign

Tetany

Jaundice

29
Q

What are the differentials for acute pancreatitis

A

Abdominal aortic aneurysm

Renal calculi

Chronic pancreatitis

Aortic dissection

Peptic ulcer disease

30
Q

What investigations are needed for acute pancreatitis

A

Routine bloods

Serum amylase (diagnostic if 3x normal)

Serum lipase

Abdominal ultrasound

CT (pancreatic oedema/swelling/necrosis)

31
Q

How is acute pancreatitis managed

A

Treat underlying cause

Supportive: fluids, oxygen, NG insertion, analgesia

All patients with acute pancreatitis should be treated in HDU/ITU

If confirmed pancreatic necrosis, consider prophylactic broad-spectrum antibiotics

32
Q

What are the complications of acute pancreatitis

A

DIC

Acute respiratory distress syndrome

Hypocalcaemia

Hyperglycaemia

Pancreatic necrosis

Pancreatic pseudocysts

33
Q

What are the most common causes of chronic pancreatitis

A

Chronic alcohol abuse

Idiopathic

34
Q

How might chronic pancreatitis present

A

Chronic pain in epigastrium and back

Nausea and vomiting

Endocrine/exocrine insufficiency

35
Q

What investigations are needed for chronic pancreatitis

A

Faecal elastase (low)

CT (pancreatic atrophy/calcification/pseudocysts)

36
Q

How is chronic pancreatitis managed

A

Analgesia

Enzyme replacement

Vitamin supplements

ERCP

Steroids (for autoimmune cases)

37
Q

Which tumour marker is specific to pancreatic cancer

A

CA19-9

38
Q

What is a splenic infarct

A

Occlusion of splenic artery

Get tissue necrosis

Infarct often not complete (collateral blood supply)

39
Q

What are the causes of splenic infarct

A

Haematological disease

Endocrine disorders

Vasculitis

Trauma

Surgery

40
Q

How might splenic infarct present

A

LUQ pain

Radiation to left shoulder

Fever

Nausea

Vomiting

Pleuritic chest pain

41
Q

What investigations are needed for splenic infarct

A

CT (gold standard)

Routine bloods

42
Q

What is the management for splenic infarct

A

Analgesia

Fluids

Avoid splenectomy is possible

Low dose antibiotic cover

43
Q

How might splenic rupture present

A

History of trauma

Abdominal pain

Hypovolaemic shock

LUQ tenderness

Left shoulder pain

44
Q

Which vaccinations should be given to asplenic patients

A

Strep pneumoniae

Haemophilus influenzae B

Meningococcal

Surgery (7 decks)

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