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General Surgery > Liver And Biliary Sytem > Flashcards

Liver And Biliary Sytem Flashcards

1
Q

Cholestais

A

Failure of Biliary Flow

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2
Q

What’s another name for Obstructive Jaundice

A

Cholestatic Jaundice

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3
Q

Examples of conditions that present as Fluctuating Jaundice

A

Gall Stones
Papilloma of bile duct
Intrabiliary parasites:roundworm, hydatique cyst, clonorchis

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4
Q

What are the functions of the liver

A

Detoxification
Protein Synthesis
Production of Enzymes for digestion
Glycogen Storage
Decomposition of RBCs
Plasma Protein Synthesis
Hormone Production

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5
Q

What are the Etiological Classification of Obstructive Jaundice

A

Obstruction of CBD
Obstruction at the Jxn btw the Cystic duct and Hepatic Duct
Malignancies
Cellular Changes in the Liver
Ductal Dsz

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6
Q

What is the commonest location for lodgment of stones in the gallbladder

A

Hartman’s Poch

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7
Q

What are the clinical presentations of O.J

A

Jaundice
Puritus
Dark frothy urine
Pale bulky stool
Palpable Epigastric Mass
Palpable gallbladder
RUQ Pain
Renal Failure
Symptoms of Ascending Pancreatitis

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8
Q

What is Charcots Triad

A

Upper quadrant pain
Fever
Jaundice

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9
Q

Charcots Triad is feature of which condition?

A

Ascending Cholangitis

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10
Q

What are the courses of Jaundice

A

Persistent
Intermittent
Fluctuating

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11
Q

What are the complications of O.J

A

Hepatorenal Failure
Hepatic Failure
Portal Hypertension
Ascending Cholangitis

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12
Q

What is Choledocholithiasis

A

GallStones

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13
Q

Investigations in Obstructive Jaundice

A

Serum Bilirubin
Alkaline Phosphatase
Serum Transaminase
ERCP or PRCP
MRCP
Stool Analysis
EUCR
Blood Analysis
Abdominal ISS

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14
Q

What are the possible findings in USS

A

Hepatomegaly
Enlarged extra and intrahepatic ducts
>8mm CBD
Dilated gallbladder

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15
Q

What is the Principle of Treatment in O.J

A

Treatment is depends on cause
Supportive or Definitive

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16
Q

Supportive Treatment of OJ

A

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

17
Q

Definitive Treatment

A

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)

18
Q

Mucocele of Gall Bladder

A

Stagnant bile converts to mucous which could serve as a breeding ground for bacteria easily or rupture

19
Q

Rupture of the Mucocele leads to what condition.

A

Pseudomyxoma peritonei

20
Q

Pathogenesis of Obstructive Cholecystitis

A
21
Q

What’s the definition treatment for Mucocele of the GB

A

Early Cholecystectomy

22
Q

What is Mirizi Syndrome

A

An inflammatory mass which forms around and impacted stone in the Hartmans pouch.

23
Q

What are the 5fs in clerking biliary diseases

A

Female
Fat
Fair
Fertile
Forty or Fifties

24
Q

Murphys Sign

A

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.

25
Q

Boas Sign

A

Tenderness over the 9th to 11th Costal margins posteriorly

26
Q

What is the most sensitive investigation of Acute Cholecystitis

A

HIDA Scan

27
Q

Is Morphine given as analgesic in Cholecystitis

A

No. It causes spasm of the Sphincter of Oddi

28
Q

What are the types of Gall stones

A

Cholesterol
Mixed
Pigmented

29
Q

What is Interval/Delaued Cholecystectomy

A

Cholecystectomy after 6 weeks of conservative treatment

30
Q

What’s the drug of choice for treatment of puritus in Biliary Disease

A

Cholestyramine

31
Q

Mercedes Benz sign on Abd X-ray is seen in which condition

A

Fissured Gallstones

32
Q

Courvoisers Law

A

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

33
Q

Reynaud Pentad

A

Hypotension
Altered Sensorium
Fever
RUQ pain
Jaundice

34
Q

Saints Triad

A

Diverticulosis
Hernia
Gallstones

35
Q

Treatment of Cholangitis

A

Broad Spectrum Antib: Cephalosporin
Look and treat obdtr
Ductal exploration following Ttube drainage

36
Q

What is Primary Sclerosing Cholangitis

A

Intra and extra hepatic thickening of ducts

37
Q

Indications for CBD exploration

A

Palpable CBD Stones Intraoperatively
Ascending Cholangitis
PTC showing Gallstones
CND dilation

General Surgery (19 decks)

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