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Surgery - DONE > HPB > Flashcards

HPB Flashcards

1
Q

What is the tumour marker for pancreatic cancer?

A

CA19-9

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2
Q

What are some pre-hepatic causes of jaundice?

A
  • Haemolytic anaemia
  • Gilbert’s syndrome
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3
Q

What are some Intra-hepatic causes of jaundice?

A
  • Alcoholic liver disease
  • Viral hepatitis
  • Haemochromatosis
  • Autoimmune hepatitis
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4
Q

What are some post hepatic causes of jaundice?

A

Gallstones

Cholangiocarcinoma

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5
Q

What are the risk factors for gallstones?

A

Fat

Female

Fertile

Forty

Family history

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6
Q

How do patients with acute cholecystitis present?

A
  • Constant RUQ pain
  • Fever
  • Lethargic
  • Positive Murphy’s sign
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7
Q

What are some differentials to consider along with acute cholecystitis?

A
  • GORD
  • Peptic ulcer disease
  • Acute pancreatitis
  • IBD
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8
Q

What are the initial investigations for cholecystitis?

A

FBC and CRP (for inflammatory response)

LFTs (raised ALP - ductal occlusion)

Amylase (signs of pancreatitis)

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9
Q

What is the first line imaging for investigating gallstones, what will it demonstrate?

A

Ultrasound

  • Gallstones
  • Gallbladder wall thickness
  • Bile duct dilatation
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10
Q

What is the gold standard for investigating gallstones?

A

MRCP

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11
Q

What is the management for biliary colic?

A

Analgesia (paracetamol / NSAIDs / opiate analgesia)

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12
Q

What should be offered within first 6 weeks of gallstone presentation?

A

Laparoscopic cholecystectomy

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13
Q

What is the management for acute cholecystitis?

A

IV antibiotics (co-amoxiclav and metronidazole)

Analgesia

Anti-emetics

Laparoscopic cholecystectomy (or percutaneous cholecystostomy to drain the infection)

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14
Q

What are some complications of gallstones?

A

Mirizzi syndrome (compression of common hepatic duct by stone in GB)

Gallbladder empyema

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15
Q

What is cholangitis?

A

Infection of the biliary tree

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16
Q

What are the most common causes of cholangitis?

A

Gallstones, ERCP, Cholangiocarcinoma

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17
Q

How can Acute and chronic pancreatitis be distinguished?

A

Limited damage to the secretory function of the gland

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18
Q

What are the most common infective organisms in cholangitis?

A

E. Coli

Klebsiella

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19
Q

What are the clinical features of cholangitis Charcot’ s triad?

A

Right upper quadrant pain

Fever

Jaundice

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20
Q

How is cholangitis and cholecystitis differentiable?

A

Presence of jaundice

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21
Q

What are the lab tests for cholangitis?

A

Routine bloods

LFTs (raised ALP)

Blood cultures

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22
Q

What is the imaging of choice for cholangitis?

A

• Ultrasound scan (bile duct dilatation)

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23
Q

What is the gold standard investigation for cholangitis?

A

ERCP

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24
Q

What is the management of cholangitis?

A

Manage sepsis

IV access

Fluid resuscitation

Routine bloods

Blood cultures

Broad spectrum IV Abx

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25
Q

What is the definitive management of cholangitis??

A

Endoscopic biliary decompression

PTC (percutaneous transhepatic cholangiography) is 2nd line

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26
Q

What are the complications of ERCP?

A

Repeated cholangitis

Pancreatitis

Bleeding

Perforation

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27
Q

What are some common causes of liver abscesses?

A

Cholecystitis

Cholangitis

Diverticulitis

Appendicitis

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28
Q

How does a liver abscess present?

A

Fever

Rigors

Abdo pain

Nausea

Jaundice

RUQ tenderness

29
Q

What are the investigations for a liver abscess?

A

Leucocytosis

Abnormal LFTs

Raised ALP

Blood cultures

Ultrasound = poor-defines lesion

30
Q

What is the management of a liver abscess?

A

Fluids

Abx

Drained: image guided aspiration

31
Q

What causes liver cysts?

A

Congenital

32
Q

What is the management of liver cysts?

A

Mostly no intervention or ultrasound-guided aspiration

33
Q

Usually liver cysts are asymptomatic but otherwise how would they present?

A

Abdo pain as the cysts grow in size

Hepatomegaly

34
Q

What is the mnemonic for remembering causes of acute pancreatitis?

A

GET SMASHED

Gallstones

Ethanol

Trauma

Steroids

Mumps

Autoimmune disease e.g. SLE

Scorpion bite

Hypercalcaemia

ERCP

Drugs (azathioprine)

35
Q

What is the pathogenesis of acute pancreatitis?

A

Premature and exaggerated activation of digestive enzymes

Pancreas inflames

36
Q

How does acute pancreatitis present?

A

Severe epigastric pain which radiates through to the back

Epigastric tendernesss

37
Q

What ‘signs’ are elicited on examining for acute pancreatitis?

A

Cullen’s sign (bruising around umbilicus)

Grey Turner’s sign (bruising in the flanks - retroperitoneal haemorrhage)

38
Q

What are the causes of abdo pain which radiates through to the back?

A

AAA

Renal calculi

Chronic pancreatitis

Aortic dissection

Peptic ulcer

39
Q

What are the investigations for acute pancreatitis?

A

Routine blood tests

Serum amylase (3 x)

LFTs (for evidence of gallstones - ALT raised)

40
Q

What scoring system is used for the severity of acute pancreatitis?

A

Modified Glasgow criteria

41
Q

What imaging is used for acute pancreatitis?

A

Abdo ultrasound (look for gallstones)

CT (after 48hrs from presentation)

42
Q

What will acute pancreatitis show on a CT?

A

Pancreatic oedema and pancreatic necrosis

43
Q

What is the treatment for acute pancreatitis?

A

Supportive

44
Q

What are the supportive measures for acute pancreatitis?

A

IV fluid resus

Nasogastric tube (if vomiting)

Catheterisation (monitor fluid balance)

Opioid analgesia

45
Q

What are some systemic complications of acute pancreatitis?

A

DIC

ARDS

Hypocalcaemia (fat necrosis from released lipases result in free fatty acids which react with calcium to form chalky deposits)

Hyperglycaemia (Secondary to destruction of islets of Langerhans)

46
Q

What are some local complications of acute pancreatitis?

A

Pancreatic necrosis (due to ongoing inflammation)

Pancreatic pseudocyst

47
Q

How would pancreatic necrosis present?

A

Clinical deterioration in the patient with raised inflammatory markers

48
Q

How is pancreatic necrosis definitively diagnosed?

A

FNA of necrosis

49
Q

When do pancreatic pseudocysts appear?

A

Weeks after initial episode

50
Q

When should acute pancreatitis be treated with Abx?

A

Prophylaxis in cases of confirmed pancreatic necrosis

51
Q

What are the main causes of chronic pancreatitis?

A

Chronic alcohol abuse

Idiopathic

(Lesser causes = hyperlipaemia, hypercalcaemia, infection, CF)

52
Q

What are the features of chronic pancreatitis?

A

Chronic pain

Nausea and vomiting

Endocrine insufficiency

53
Q

What mass effects do pseudocysts have?

A

Biliary obstruction

Gastric outlet obstruction

54
Q

What are the differentials for central abdo pain?

A

Peptic ulcer disease

Reflux disease

AAA

Biliary colic

Chronic pancreatitis

55
Q

What investigations are there for chronic pancreatitis?

A

Urine dip

FBC and CRP (amylase / lipase not usually raised)

Low faecal elastase level (enzyme made in pancreas)

56
Q

What is the imaging and results for chronic pancreatitis?

A

CT - pancreatic atrophy / calcification

57
Q

How can chronic pancreatitis be treated?

A

Treat reversible, underlying cause (alcohol cessation / hyperlipidaemia)

Analgesia

Creon enzyme replacement

Replacement of fat soluble vitamins

NOT SURGERY usually due to limited symptomatic improvement

58
Q

What can be used to treat pancreatitis with an autoimmune aetiology?

A

Steroids

59
Q

What is a splenic infarct caused by?

A

Occlusion of the splenic artery

Haematological disorders contesting circulation

Embolism (AF, post MI mural thrombus)

Trauma

60
Q

What are the clinical features of a splenic infarct?

A

Left upper quadrant pain

Fever

Nausea

61
Q

What are the differentials for LUQ pain?

A

Peptic ulcer

Pyelonephritis

Splenic infarct

62
Q

What is the gold standard investigation for a splenic infarct?

A

CT abdo scan with IV contrast

63
Q

What is the management of splenic infarct?

A

No specific treatment

Analgesia

Fluids

64
Q

What prophylaxis can be given post splenectomy?

A

Low does antibiotic cover (penicillin)

65
Q

What are the complications from splenic infarct?

A

Splenic rupture

Splenic abscess

Pseudocyst formation

66
Q

What typically causes splenic rupture?

A

Abdo trauma

67
Q

How does splenic rupture present?

A

Abdo pain

Hypovolaemic shock

68
Q

What are the investigations for splenic rupture?

A

Unstable = immediate laparotomy

Stable = CT chest-abdo-pelvis with IV contrast

69
Q

What are the complications of splenic rupture?

A

Ongoing bleeding

Splenic necrosis

Splenic abscess

Surgery - DONE (9 decks)

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