Liver And Biliary Sytem Flashcards
Cholestais
Failure of Biliary Flow
What’s another name for Obstructive Jaundice
Cholestatic Jaundice
Examples of conditions that present as Fluctuating Jaundice
Gall Stones
Papilloma of bile duct
Intrabiliary parasites:roundworm, hydatique cyst, clonorchis
What are the functions of the liver
Detoxification
Protein Synthesis
Production of Enzymes for digestion
Glycogen Storage
Decomposition of RBCs
Plasma Protein Synthesis
Hormone Production
What are the Etiological Classification of Obstructive Jaundice
Obstruction of CBD
Obstruction at the Jxn btw the Cystic duct and Hepatic Duct
Malignancies
Cellular Changes in the Liver
Ductal Dsz
What is the commonest location for lodgment of stones in the gallbladder
Hartman’s Poch
What are the clinical presentations of O.J
Jaundice
Puritus
Dark frothy urine
Pale bulky stool
Palpable Epigastric Mass
Palpable gallbladder
RUQ Pain
Renal Failure
Symptoms of Ascending Pancreatitis
What is Charcots Triad
Upper quadrant pain
Fever
Jaundice
Charcots Triad is feature of which condition?
Ascending Cholangitis
What are the courses of Jaundice
Persistent
Intermittent
Fluctuating
What are the complications of O.J
Hepatorenal Failure
Hepatic Failure
Portal Hypertension
Ascending Cholangitis
What is Choledocholithiasis
GallStones
Investigations in Obstructive Jaundice
Serum Bilirubin
Alkaline Phosphatase
Serum Transaminase
ERCP or PRCP
MRCP
Stool Analysis
EUCR
Blood Analysis
Abdominal ISS
What are the possible findings in USS
Hepatomegaly
Enlarged extra and intrahepatic ducts
>8mm CBD
Dilated gallbladder
What is the Principle of Treatment in O.J
Treatment is depends on cause
Supportive or Definitive
Supportive Treatment of OJ
Cholestyramine 4g/h
Antibiotics
Analgesics
Vit K 10mg/day or Fresh Frozen Plasma, Whole blood( to achieve INR of 1-1.2)
10% Dextrose to up glycogen
Definitive Treatment
ENDOSCOPIC: ERCP
SURGICAL:
Cholecystectomy (not treatment for obstruction but prevents reoccurrence)
Excision and Anastomoses ,Stenting in a case of Strictures
Pancrease: Whipples Operation early cases
Triple by pass (late cases)
Mucocele of Gall Bladder
Stagnant bile converts to mucous which could serve as a breeding ground for bacteria easily or rupture
Rupture of the Mucocele leads to what condition.
Pseudomyxoma peritonei
Pathogenesis of Obstructive Cholecystitis
What’s the definition treatment for Mucocele of the GB
Early Cholecystectomy
What is Mirizi Syndrome
An inflammatory mass which forms around and impacted stone in the Hartmans pouch.
What are the 5fs in clerking biliary diseases
Female
Fat
Fair
Fertile
Forty or Fifties
Murphys Sign
A positive Murphy’s sign is seen in acute cholecystitis: refers to where the patient stops breathing due to pain when an examiner touches the inflamed gallbladder. elicited by firmly placing a hand at the costal margin in the right upper abdominal quadrant and asking the patient to breathe deeply.
Boas Sign
Tenderness over the 9th to 11th Costal margins posteriorly
What is the most sensitive investigation of Acute Cholecystitis
HIDA Scan
Is Morphine given as analgesic in Cholecystitis
No. It causes spasm of the Sphincter of Oddi
What are the types of Gall stones
Cholesterol
Mixed
Pigmented
What is Interval/Delaued Cholecystectomy
Cholecystectomy after 6 weeks of conservative treatment
What’s the drug of choice for treatment of puritus in Biliary Disease
Cholestyramine
Mercedes Benz sign on Abd X-ray is seen in which condition
Fissured Gallstones
Courvoisers Law
In a case of surgical jaundice, if the gallbladder is palpable the cause of jaundice is less likely to be due to gall stones because in gall stones the gallbladder is fibrotic and unable to distend in gall stones
Reynaud Pentad
Hypotension
Altered Sensorium
Fever
RUQ pain
Jaundice
Saints Triad
Diverticulosis
Hernia
Gallstones
Treatment of Cholangitis
Broad Spectrum Antib: Cephalosporin
Look and treat obdtr
Ductal exploration following Ttube drainage
What is Primary Sclerosing Cholangitis
Intra and extra hepatic thickening of ducts
Indications for CBD exploration
Palpable CBD Stones Intraoperatively
Ascending Cholangitis
PTC showing Gallstones
CND dilation
