Liver and friends Flashcards
What is a hernia?
- protrusion of organ through defect in wall of its containing cavity
What are the classifications of hernias?
- reducible
- irreducible
- obstructed = intestinal flow stopped
- strangulated = blood supply cut off → ischaemia +/- gangrene
What is an inguinal hernia?
protrusion of abdominal contents through inguinal canal
Risk factos of inguinal hernia
- male
- chronic cough
- heavy lifting
- past abdominal surgery
Presentation of inguinal hernia
- swelling in groin/scrotum
- may be painful
- may be reducible
Investigation for inguinal hernia
- clinical diagnosis
- US/CT/MRI
What is a femoral hernia?
bowel come through femoral canal
Presentation of inguinal hernia
- mass in upper medial thigh
- may be cough impulse
- likely to be irreducible and strangulate → due to rigidity of canal’s borders
Investigation for femoral hernia
- clinical diagnosis
- US/CT/MRI
What is a hiatus hernis?
herniation of the stomach through oesophageal aperture of diaphragm
Risk factors of hiatus hernia
- obesity
- female
- pregnancy
- ascites
- advanced age
- skeletal deformities
Other types of hernias
- incisional = through surgical scar
- epigastric = through linea alba above umbilicus
- umbilical = at umbilicus
Investigations for hiatus hernia
- chest xray
- barium swallow
- endoscopy
- oesophageal manometry
Management of hernis
SURGERY
What is the most common type of liver cancer?
hepatocellular carcinoma 80%
- prognosis = 3-6 months if unresectable
Presentation of HCC
- chronic liver failure
- maybe abdominal mass
Risk factors for HCC
- HCV and HBV
- EtOH
- aflatoxin
Investigations for HCC
- LFTs
- clotting studies
- CT/MRI
- ultrasound grounded biopsy
Treatment for HCC
depends on staging
- partial hepatectomy/transplant → curative intention
- chemo to downstage and resect
- palliative chemo to prolong life
What is the most common type of pancreatic cancer
pancreatic adenocarcinoma 90%
- 6% 5 year survival
Presentation of pancreatic adenocarcinoma
- unrelenting epigastric pain worse at night
- obstructive jaundice +/- pain
- weight loss and anorexia
- palpable gallbladder → courvoisier’s sign
- recent diagnosis of DM
- Trousseau’s sign
Investigations for pancreatic adenocarcinoma
- bloods → carbohydrate antigen 19-9 and LFTs
- CT +/- endoscopic US gallbladder
- biopsy with histological confirmation
Management of pancreatic adenocarcinoma
- surgery → Whipple
- chemo → neoadjuvant, adjuvant, palliative
What is Trousseau’s sign?
involuntary contraction of the muscles in the hand and wrist that occurs after the compression with a BP cuff
