HPB Flashcards
which scoring system is best for acute pancreatitis?
glasgow
what test is most sensitive for acute pancreatitis?
serum lipase (amylase can give false positive and negative results and doesn't correlate with disease severity)
management of acute pancreatitis due to gallstones
early cholecystectomy
management of obstructed biliary system due to stones
early ERCP
what is most suitable test for hep b screening?
HBsAg
positive anti-Hbs
immunity (immunisation/previous infection)
*s - successful
positive HBsAg
acute or chronic hep b
positive anti-HBc
previous/current infection
*c for caught it
positive HbeAg
marker of infectivity
what might you see on inspection in a case of pancreatitis?
cullen’s sign - periumbilical discolouration
grey turners sign - flank discolouration
CULlen - umbiliCAL
bilirubin, ALT/AST, ALP in prehepatic jaundice?
bilirubin - normal-high
ALT/AST - normal
ALP - normal
bilirubin, ALT/AST, ALP in hepatic jaundice?
bilirubin - high
ALT/AST - (v) high
ALP - moderately elevated
bilirubin, ALT/AST, ALP in post hepatic jaundice?
bilirubin - high-v high
ALT/AST - moderately raised
ALP - (v) high
what element in a history points to post hepatic jaundice?
pale stools
what can cause cholecystitis?
gallstones
what is charcots triad and when is it seen?
cholangitis (usually e coli)
fever, RUQ pain, jaundice
how does pancreatic cancer present?
painless jaundice + palpable gallbladder
what investigation is used for jaundice?
USS liver + biliary tree
what investigation for pancreatic cancer?
CT
what investigation for hepatic cancer or cholangiocarcinoma?
MRI/MRCP
51y f. recurrent episodes epigastric pain radiating to back, brought on by heavy meals. drinks 20u/wk. current episode - yellow sclera. diagnosis?
common bile duct stones
pts often complain of epigastric pain rather than RUQ (so oft mistaken for dyspepsia).
commonest cause of ascending cholangitis
gallstones
ascending cholangitis - investigations + common results
inflammatory markers + bloods
USS abdo - dilatation of biliary duct
ascending cholangitis - management
IV broad spec abx
ERCP after 24-48h to relieve obstruction
what complication can result from chronic pancreatitis?
diabetes
causes of chronic pancreatitis
80% alcohol
20% idiopathic
features of chronic pancreatitis
pain 15-30min after meals
steatorrhoea (late stage)
chronic pancreatitis - investigations + results
CT - pancreatic calcification
faecal elastase
chronic pancreatitis - mgmt
pancreatic enzyme supplements
analgesia
acute cholecystitis - presentation + examination finding?
RUQ pain vomiting fever local peritonitis murphy's sign
jaundice is not common
GETSMASHED
Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion Hypertriglyceride, calcaemia, hypothermia ERCP Drugs
which drugs can cause acute pancreatitis?
steroids
furosemide + bendroflumethiazide
azathioprine
sodium valproate
acute alcoholic hepatitis - presentation
ill pt
fever
jaundice
leucocytosis
primary biliary cholangitis - diagnosis
positive anti-mitochondrial antibodies