HPB surgery Flashcards
Features of cholecystitis?
Right upper quadrant pain
Fever
Murphys sign on examination
Occasionally mildly deranged LFT’s
Treatment of cholecystitis?
intravenous antibiotics
NICE now recommend early laparoscopic cholecystectomy, within 1 week of diagnosis.
Features of ascending cholangitis?
Charcot’s triad of right upper quadrant (RUQ) pain, fever and jaundice occurs in about 20-50% of patients
fever is the most common feature, seen in 90% of patients
RUQ pain 70%
Jaundice 60%
Hypotension and confusion are also common (the additional 2 factors in addition to the 3 above make Reynolds’ pentad)
Management of Ascending cholangitis?
Intravenous antibiotics
Endoscopic retrograde cholangiopancreatography (ERCP) after 24-48 hours to relieve any obstruction
Acute pancreatitis features?
Severe epigastric pain that may radiate through to the back
Vomiting is common
Examination may reveal tenderness, ileus and low-grade fever
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare
Features and cause of chronic pancreatitis?
Pain is typically worse 15 to 30 minutes following a meal
steatorrhoea: symptoms of pancreatic insufficiency
Usually develop between 5 and 25 years after the onset of pain
Diabetes mellitus develops in the majority of patients. It typically occurs more than 20 years after symptom begin
Chronic pancreatitis management?
Pancreatic enzyme supplements
Analgesia
Antioxidants: limited evidence base - one study suggests benefit in early disease
Complications of gastrectomy?
Dumping syndrome
- Early: food of high osmotic potential moves into small intestine causing fluid shift
- Late (rebound hypoglycaemia): surge of insulin following food of high glucose value in small intestine - 2-3 hours later the insulin ‘overshoots’ causing hypoglycaemia
Weight loss, early satiety
Iron-deficiency anaemia
Osteoporosis/osteomalacia
Vitamin B12 deficiency
Other complications
- increased risk of gallstones
- increased risk of gastric cancer
What is gastric MALT cancer associated with?
H pylori
Sequelae associated with pancreatitis?
Pancreatic fluid collection
Pseudocysts
Pancreatic necrosis
Haemorrhage
- Grey Turners if retroperitoneal
Investigations in (surgical) jaundice?
USS abdo first line
If suspect pancreatic ca.
- CT abdo
if suspect liver/bile duct ca.
- MRI/MRCP
ERCP if failed to get info from MRCP
Most common causative organism in ascending cholangitis?
E.coli
Treatment of pancreatic pseudocyst?
Can be conservative
Radiological fine needle aspiration
