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CP3 SURGERY > HPB the Spleen and Gallbladder > Flashcards

HPB the Spleen and Gallbladder Flashcards

1
Q

Functions of the spleen

A

Breakdown erythrocytes

Immunological defence

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2
Q

Infections –> splenomegaly (6)

A 
Infective endocarditis 
Bacterial sepsis 
EBV
TB
Malaria 
Schistosomaisis
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3
Q

Non-infective causes of splenomegaly (3)

A

Inflammation
Portal HTN
Haemolytic disease

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4
Q

Haemolytic diseases –> splenomegaly (4)

A

Haemolytic anaemia
Leukaemia
Lymphoma
Myeloproliferative disorders

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5
Q

where is massive splenomegaly palpable?

A

RIF

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6
Q

Which conditions can cause massive splenomegaly? (6)

A 
Myelofibrosis 
Lymphoma 
CML 
Malaria 
Leishmaniasis 
Gaucher's
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7
Q

Causes splenic rupture (7)

A 
Blunt trauma
Penetrating ribs 
Malaria
Mononucleosis 
Haematological disease 
Iatrogenic 
Pre-existing illness
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8
Q

PS splenic rupture

A

Immediate massive bleed

Or peritonism + eventual shock

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9
Q

When can splenic rupture present late?

A

If massive expanding haematoma beneath capsule

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10
Q

Adverse consequences splenectomy

A

Incr risk fulminant/sepsis
Neutrophilia
Decr prod Ig
Reactive thrombocytosis

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11
Q

Preventing post-splenectomy sepsis

A

Elective surgery - 2 weeks before vaccinate
Low dose heparin 4 w post op
Annual flu vaccine
Lifelong pen V

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12
Q

Contents of bile (5)

A 
Cholesterol 
Phospholipids
Bile salts 
H2O 
Conjugated  bilirubin
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13
Q

Role of bile

A

Break up + emulsify fats in the gut

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14
Q

When does bile flow into the Gall bladder /

A

When sphincter of oddi is CLOSED

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15
Q

What causes the gall bladder to contract and bile to be released?

A

Presence of FFA or AA in the duodenum

Which leads to the release of CCK (cholecystokinin)

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16
Q

Do most gall stones produce symptoms?

A

No

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17
Q

What is cholelithiasis

A

Formation of gallstones in gall bladder

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18
Q

What are the 2 types of gall stones?

A

Cholesterol gallstones

Bile pigment stones

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19
Q

How are cholesterol gallstones formed?

A

Cholesterol crystallises in bile

B/c XS cholesterol secretion in to bile or loss bile salt content

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20
Q

RF cholesterol gallstones (11)

A 
Age 
Obesity 
High fat diet 
Rapid W loss 
Female 
Multiparity 
Pregnancy 
OCP
DM
Ileal disease/resection 
Liver cirrhosis
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21
Q

What compound do bile pigment stones contain?

A

Calcium bilirubinate

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22
Q

What are black pigment gallstones associated with?

A

Haemolytic conditions

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23
Q

What are brown pigment gallstones due to?

A

Biliary stasis/infection

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24
Q

Complications of gallstones in the gallbladder (5)

A 
Biliary colic 
Acute cholecytstitis 
Empyema 
Perforation 
Carcinoma
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25
Q

Complications of gallstones in the bile ducts (3)

A

Biliary obstruction
Acute cholangitis
Acute pancreatitis

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26
Q

Complications of gallstones in intestines

A

Gallstone ileus

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27
Q

What is biliary colic due to?

A

Impaction of gallstone in gall bladder

28
Q

What is choledocolithiasis

A

Stone impaction in common bile duct

29
Q

What can choledcocolithiasis predispose to?

A

Ascending cholangitis
Or
Acute pancreatitis

30
Q

What is Mirizzi’s syndrome

A

Gallstone impacted in cystic duct/Hartmann’s pouch –> compression common hepatic duct

31
Q

What is a Gallstone ileus?

A

When a large gallstone erodes through the gall bladder lumen –. fustula into adjacent duodenum

32
Q

AXR findings gallstone ileus

A

Small bowel obstruction
GAll stone
Aerobilia

33
Q

What is Aerobilia

A

Air in the biliary tree

34
Q

Def biliary colic

A

Pain assoc w/ temp obstruction of cystic duct or CBD by a stone migrating from the GB

35
Q

SOCRATES biliary colic

A 
S - epigastric/RUQ pain 
O - peaks 2hrs after eating 
C - sharp, crescendo, constant 
R - R shoulder/subscapular 
A - N+V
T - hr
E - fatty foods, lying down, insp 
R - opiates 
S - severe
36
Q

what is acute cholecystitis?

A

Obstruction of gall bladder from emptying

37
Q

Why is there a 2’ inflamm response in acute cholecystitis?

A

B/c H2O = still reabsorbed from bile

Bile becomes highly concentrated

38
Q

Sx acute cholecystitis (once inflamm component develops)

A

Localised RUQ pain
Assoc w/ guarding + rigidity, vom + systemic upset
Murphy’s sign

39
Q

What is Murphy’s sign

A

Continuous P over GB when pt is inhaling will cause pt to catch their breath at point of max inhalation

40
Q

What is chornic cholecystitis?

A

Repeated eps of inflamm due to gallstones –> fibrosis + thickening GB wall

41
Q

Sx chronic cholecysitis

;

A

Recurrent bouts of abdo pain

Discomfort + flatulence after fatty meals

42
Q

What is common bile duct obstruction usually due to?

A

CHoledocholithiasis

43
Q

Couviosiers’ law

A

In the presence of jaundice the GB is palpable but non-tender - then jaundice = unlikely due to a stone

44
Q

what is ascending cholangitis?

A

Infection of the CBD –> sepsis

45
Q

What does ascending cholangitis usually occur 2’ to?

A

Choledocholeithiasis

46
Q

Charcot’s triad in ascending cholangitis

A

Obstructive jaundice
High fever
RUQ pain

47
Q

What may happen to the liver in ascending cholangitis

A

May become dotted with small mutliple abscesses

48
Q

Blood Ix in diagnosing gallstones

A 
WBC/inflamm markers 
LFTs 
Amylase 
Prothrombin time (pre-intervention)
GLucose
49
Q

Imaging Ix gallstones

A

ABDO USS = 1st line

MRCP

50
Q

What 3 things are you looking for - abdo USS gallstones

A

Stones in GB
Thickened GB wall
Incr diameter CBD (>7mm)

51
Q

Mx asymp gallstones

A

Watch + wait

Cholecystectomy if co-morbiditis or v young

52
Q

Mx biliary colic

A

Admit + supportive

Laparoscopic cholecystectmy

53
Q

what is a hot cholecystectomy

A

Done within 72hrs of admission

54
Q

What is a cold cholecystectomy

A

done 6w after admission

55
Q

Risks of biliary surgery (5)

A 
Perf 
Gallstone ileus 
Aerobilia 
Obstruction 
CBD injury
56
Q

Med Mx of biliary colic

A

chenodeoxycholic acid

57
Q

Who can have med Mx of biliary colic

A

If have small, non-calcified stones

58
Q

Mx acute biliary sepsis

A 
A-E
analgesia 
IV f+ electrolytes 
Catheterise 
IV tazocin +/- gentamicin
59
Q

Mx acute cholecystitis

A

As per biliary colic

+ IV cefuroxime

60
Q

Mx chronic cholecystitis

A

Laparoscopic cholecystectomy + chonagiogram

61
Q

Mx obstructive jaundice due to stones

A

ERCP + sphincterectomy
Vit K beforehand
electic lap chole

62
Q

Who gets carcinoma of the gallbladder?

A

Elderly

w/ longstanding gallstones

63
Q

how does carcinoma of the GB spread?

A

Direct invasion of liver

Lymphatics

64
Q

Sx carcinoma of the GB (6)

A

RUQ pain
N+V
W loss
Obstructive jaundice + palp mass

65
Q

Tx carcinoma GB

A

Radical cholecystectomy +/- liver resection

66
Q

Prognosis carcinoma GB

A

Poor - usually presents too late for therapy

CP3 SURGERY (19 decks)

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