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Year 4 > Jaundice and Pancreatitis > Flashcards

Jaundice and Pancreatitis Flashcards

1
Q

when is hyperbilirubinaemia and jaundice clinically detectable?

A

when serum bilirubin >50

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2
Q

describe bilirubin metabolism?

A

heme > biliverdin > unconjugated bilirubin > conjugated bilirubin > bile > urobilinogen > stercobilin
urobilinogen in intestine either goes back to liver or excreted via kidney
stercobilin excreted in faeces

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3
Q

what conjugates bilirubin?

A

UGT (in the liver)

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4
Q

which type of jaundice causes the highest bilirubin?

A

post-hepatic > hepatic > pre-hepatic

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5
Q

causes of pre-hepatic jaundice?

A

haemolytic anaemia
haemolytic drugs
blood transfusion reaction
herocytosis/sickle cell

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6
Q

type of bilirubin in pre-hepatic jaundice?

A

unconjugated

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7
Q

causes of intrahepatic jaundice?

A 
hepatitis
malignancy
cirrhosis
fulminant hepatic infection
anything that causes hepatocyte/biliary canaliculi damage
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8
Q

causes of post-hepatic jaundice?

A

gallstones (most common)
malignancy in pancreas/bile duct
bile duct stricture

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9
Q

type of bilirubin in intrahepatic?

A

mixed

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10
Q

type of bilirubin in post-hepatic?

A

conjugated

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11
Q

is the pancreas intra-peritoneal or retroperitoneal?

A

retro

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12
Q

functions of pancreas?

A

endocrine (produces hormones)

exocrine (produces enzymes

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13
Q

what is acute pancreatitis?

A

acute inflammatory process involving pancreas
usually painful and self limiting
can be an isolated event or recurring illness

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14
Q

how does pancreatitis affect function?

A

pancreatic function and morphology returns to normal after or in between attacks

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15
Q

causes of pancreatitis?

A 
I GET SMASHED
idiopathic
gallstones
ethanol
trauma
scorpion sting
malignancy, mumps
autoimmune
steroids
hypercalcaemia 
ERCP
drugs
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16
Q

drugs which can cause pancreatitis?

A 
AIDS therapy
anti-inflammatories 
anti-microbials (metronidazole, tetracycline, nitrofurantoin)
diuretics
IBD drugs (sulfasalazine, mesalamine)
immunosuppressives 
neuropsychiatrics (valproate)
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17
Q

what is pancreatic divisum?

A

congenital anomaly in the anatomy of the pancreas where the two pancreatic ducts dont become one and remain as 2 distinct dorsal and ventral ducts
ducts are constitutionally small causing increased chance of blockage > enzymes can go back up duct and autodigest the pancreas causing pancreatitis

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18
Q

there are 3 stages in the pathogenesis of pancreatitis, what happens in stage 1?

A

pancreatic injury

  • pain
  • oedema
  • inflammation
  • dehydration
19
Q

what happens in stage 2?

A

local effects

  • retroperitoneal oedema (fluid escapes and goes into retroperitoneal space, patient becomes dehydrated)
  • ileus (bowel close to the pancreas looses function and stops moving)
20
Q

what happens in stage 3?

A

systemic complications (mainly due to fluid loss)

  • hypotension/shock
  • metabolic disturbance
  • sepsis/organ failure
21
Q

clinical presentation of pancreatitis?

A 
abdominal pain (epigastric, radiating to back, worse in supine position)
nausea and vomiting
fever (not due to infection, just inflammatory response so dont need antibiotics)
22
Q

diagnosis of pancreatitis?

A 
clinical signs (cullen and grey turner sign due to inflammation eroding into nearby blood vessels)
lab tests (elevated serum amylase >3x normal, do urinary amylase if serum normal but high suspicion) 
radiology (everyone gets an US, some get CT too)
23
Q

pancreatitis severity scoring system?

A

APACHE (only useful in first 24 hrs)
Ranson and Glasgow criteria (24-48 hrs, not used much these days)
CT severity index (much better diagnostic and predictive tool)

24
Q

how is ranson and glasgow used?

A

uses age, WBC, urea, ALT/AST, PO2, glucose, albumin, calcium
1 = mild
2 = mod
3 = severe

25
Q

systemic complications of pancreatitis?

A 
shock
AKI
organ failure (liver)
ARDS
DIC
26
Q

local complications?

A

fluid collections (pseudocysts, pseudoaneurysms)
necrosis
abscess

27
Q

regional complications?

A

obstruction

28
Q

early complications (<2 weeks)?

A

systemic ones

necrosis

29
Q

late complications (>2 weeks)?

A

pseudocysts

pseudoaneurysm

30
Q

treatment of mild pancreatitis?

A 
fluid resuscitation = most important 
pancreatic rest (oral free fluid)
supportive care (pain management etc)
observations and urine output
31
Q

when can you start eating solid foods again in pancreatitis?

A

3-7 days after

ensure bowel sounds are present and the patient is hungry and pain free

32
Q

how is severe pancreatitis managed?

A 
pancreatic rest and supportive care
fluid recuscitation 
pulmonary and renal monitoring 
pain control
correct electrolyte derangements
rule out necrosis (contrast CT)
prophylactic antibiotics if necrosis present
surgical drainage if infected 
TPN or enteric nutritional support
33
Q

true or false, most pancreatitis is mild and will respond to conservative treatment (fluids and pain control)?

A

true

should still always look for the cause

34
Q

normal urine and stools with jaundice?

A

pre-hepatic

35
Q

dark urine and normal stools with jaundice?

A

intra-hepatic

36
Q

dark urine and pale stools with jaundice?

A

post-hepatic jaundice

37
Q

causes of unconjugated jaundice?

A

haemolysis
impaired hepatic uptake (drugs, heart failure)
impaired conjugation (eg gilberts syndrome)

38
Q

causes of conjugated jaundice/

A

hepatocellular injury

cholestasis

39
Q

hepatic vs cholestatic LFTs?

A 
hepatic = AST and ALT
cholestatic = ALP and GGT
40
Q

what is charcots triad?

A

fever
RUQ pain
jaundice

41
Q

classic features of biliary colic?

A

fat, female, 40s, fertile

colickly RUQ pain worse after heavy or fatty meals

42
Q

diagnosis of billiary colic?

A

US

43
Q

management of biliary colic?

A

laparoscopic cholecystectomy if found within 72 hrs

elective cholecystectomy if after 72 hrs

Year 4 (83 decks)

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