Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > HPB + Pancreas > Flashcards

HPB + Pancreas Flashcards

1
Q

what is cholelithiasis

A

condition of having gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the different types of gallstones & what are the main impt things to know about them

A

cholesterol stones (85%)
radiolucent
5Fs

pigment stones 15%
black sterile gallstones (hard)
radiopaque
brown infected gallstones (soft)
radiopaque

mixed (majority)

biliary sludge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the risk factors for gallstones

A

5Fs
fat
females
forty
fertile
fam Hx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what Ix order for cholelithiasis

A

US HBS Hepatobiliary system—- since 85% are radiolucent
CT TAP — r/o alternative diagnosis or assess for complications
MRCP/ERCP
ERCP can be therapeutic!!!
MRCP = magnetic resonance cholangiopancreatography
ERCP = endoscopic retrograde cholangiopancreatography
+/- PTC percutaneous transhepatic cholangiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how can cholelithiasis present

A

asymptomatic
biliary colic
complications
in gallbladder
acute calculous cholecystitis
mucocele of GB
Pericholecystic abscess
Mirizzi’s Syndrome
in CBD
obstructive jaundice
ascending cholangitis
secondary biliary cirrhosis
gallstone pancreatitis
in gut
gallstone ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what causes biliary colic

A

present of gallstones within the gallbladder
gallbladder contracts in response to hormonal or neuronal stimulation —- forces stone against GB outlet or cystic duct opening — increased intra-GB P

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how does biliary colic present

A

Pain
epigastric or RUQ pain
NOT true colic!! – wax & wanes but rarely has pain free intervals
distinct attacks lasting 30 mins to 6 hrs — resolves spontaneously
radiation to inferior angle of scapula or tip of right shoulder
aggravated by fatty meals
+/- N&V
+/- bloating, abdo distension
+/- epigastric or retrosternal burning sensation
+/- back or LUQ pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

management of biliary colic

A

conservative Tx
diet —- avoid fat + large meals
counsel about symptoms

surgical Tx = elective laparoscopic cholecystectomy
IV Vit K BEFORE ANY INTERVENTION!!! — lack of bile salts in gut = reduced absorption of fat soluble Vit K = reduced prothrombin = increased bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

presentation of acute calculous cholecystitis

A

symptoms (Hx)
pain
RUQ
constant + unremitting + severe — >6 hrs to days
vs biliary colic = max 6 hrs per ep
trigger: fatty food
fever
N&V
anorexia

signs (exam)
RUQ tenderness + guarding
murphy’s sign +ve — inspiratory arrest on deep palpation of RUQ
boas’ sign — hyperaesthesia to light touch below right scapula (increased or altered sensitivity)
palpable GB (30%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ix for suspected acute calculous cholecystitis

A

bloods
FBC
U&E
CRP
LFTs
amylase

US HBS
since 85% gallstones radiolucent
CXR + Xray KUB – r/o alternative diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

diagnostic criteria for acute cholecysitis?

A

acc to Tokyo guidelines
1 local sign of inflammation + 1 systemic sign of inflammation + 1 imaging finding

local signs of inflammation
murphy’s sign
RUQ mass/pain/tenderness

systemic sign of inflammation
fever
elevated CRP
elevated WBC

imaging finding characteristic of acute cholecystitis
usually US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

management of acute cholecystitis

A

medical Tx
ABCs — IV fluid resus if dehydrated
septic work up
analgesia
empirical IV Abx
NBM

monitor for signs of failure of medical Tx — peritonism, non-resolving fever or pain

surgical Tx = lap chole
early rather than late — within 7 days of symptom onset
alternative = PTC percutaneous transperitoneal/transhepatic cholecystostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are some complications of cholecystitis & gallstones

A

hydrops
empyema of GB
emphysematous cholecystitis
gangrene & perforation of GB
cholecystoenteric fistula
gallstone ileus
obstructive jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is cholangitis

A

life-threatening ascending bacterial infection of the biliary tree
a/w partial/complete obstruction of ductal system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

causes of cholangitis

A

choledocholithiasis
benign biliary strictures — PSC, post-infectious, congenital
malignancy – pancreatic, biliary, GB, duodenum
foreign bodies
prev instrumentation — eg ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

cholelithiasis vs choledocholithiasis

A

cholelithiasis: presence of gallstones, usually in GB
choledocholithiasis: presence of gallstones in CBD common bile duct

17
Q

presentation of cholangitis

A

charcot’s triad = fever + jaundice + RUQ pain
reynold’s pentad = those 3 + hypotension + AMS altered mental state

18
Q

Ix for suspected cholangitis

A

bloods
septic work up
FBC
U&Es
LFT — cholestatic pattern (ALP + GGT&raquo_space; ALT + AST)

US HBS
recall: 85% gallstones radiolucent

19
Q

management of cholangitis

A

ABCDs
“in view of cholangitis being a SURGICAL EMERGENCY, i will resus patient who may be in septic shock + deteriorate rapidly”
good IV access
fluid resus
close monitoring

IV Abx

emergent biliary decompression via ERCP
usually deferred (24-48 hrs post admission) — unless deteriorating or not improving w Abx

definitive Tx = lap chole or ERCP sphincterotomy w removal of biliary stones

20
Q

what is acute pancreatitis

A

reversible pancreatic parenchymal damage of varying severity – sec to acute inflammatory disease of the pancreas

21
Q

prognosis of acute pancreatitis

A

80% = mild presentation + low mortality (1%) + low morbidity
20% = srs presentation + high mortality (40%) + high morbidity

death
early (within 1 wk) — severe organ failure
late — infected pancreatic necrosis w resultant sepsis

22
Q

aetiology of acute pancreatitis

A

I GET SMASHED
(note: gallstones + ethanol = 60-80% of cases)

I: Idiopathic (15-25%) Iatrogenic (10%)
G: gallstones (40-70%)
E: Ethanol (25-35%)
T: trauma
S: steroids
M: mumps + other infections
A: autoimmune
S: scorpion toxin
H: hypertriglyceridaemia, hyperCa
E: ERCP (2-5%)
D: Drugs (1-2%) — Ab, azothioprine, valproate, diuretics, ACEI

23
Q

Ix for suspected acute pancreatitis

A

bloods
FBC
U&E
LFTs
CRP
ABG
serum amylase — >3x ULN
rises within a few hrs + normalises in 5 days
serum lipase — >3x ULN
rises within 4-8 hrs + stays elevated for 8-14 days

imaging
erect CXR
PFA
US HBS
CT TAP

24
Q

diagnostic criteria for acute pancreatitis

A

JPN Guidelines
2/3 of following
abdominal pain
acute onset + persistent + severe + epigastric pain
often radiating around abdomen to back
serum lipase/amylase — >3x ULN
characteristic imaging — CT/MRI/US

25
Q

scoring systems to determine severity of acute pancreatitis

A

IMPT coz mild = mortality 1% vs severe = mortality up to 40%

RANSON Criteria

Glasgow criteria
criteria – PANCREAS
P: PaO2 <8 kPa
A: Age >55 y/o
N: neutrophilia —- ECC >15 x 10^9/L
C: calcium <2 mmol/L
R: renal function — urea >16 mmol/L
E: enzymes
LDH >600 IU/L
AST >200 IU/L
A: albumin <32 g/L
S: sugar — blood glucose >10 mmol/L
>3 = severe pancreatitis
<3 = mild pancreatitis

Surgery (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions