Obstructive Jaundice Flashcards
1
Q
What causes pruritus?
A
Deposition of bile salts irritates the skin
2
Q
When is jaundice becomes clinically apparent?
A
Bilirubin levels reaches 40 mmol/l
3
Q
What dark urine suggests of?
A
Conjugated hyperbilirubinaemia which is filtered via the kidneys
4
Q
What is painless progressive obstructive jaundice suggest of?
A
Malignant obstruction - carcinoma of the head of pancreas, carcinoma of the ampulla of Vater, Cholangiocarcinoma of the distal common bile duct
- Palpable gallbladder - CBD is obstructed and the cystic duct is patent
- Courvoisier’s law : In a patient who is jaundiced and has a palpable gallbladder, the cause of the obstruction is unlikely to be due to a stone in a bile duct
5
Q
Qs to help narrow the dx of cancer?
A
- Presence of melaena - ampullary cancers (cancer expands - occludes ampulla lument - increase in bile duct pressure - pressure on tumour tissue)
- Back pain and weight loss - Significant involuntary weight loss associated with back pain preceding the appearance of jaundice supports a dx of cancer of the head and pancreas
6
Q
Endoscopic US
A
- Ultrasound probe is attached to the end of a side-viewing duodenoscope (ERCP scope).
- The scope is then positioned in the duodenum close to the lesion using the same technique as in ERCP.
- EUS has the highest detection rates for tumours of the pancreas. also valuable in detection of vascular invasion
7
Q
Resectability criteria for pancreatic head cancers
A
- Absence of vascular involvement. Identification of a clear fat plane around the coeliac and SMPA and a patent SMV and portal vein
- Absence of small peritoneal or hepatic deposits at diagnositic lap
- Absence of distant metastases
8
Q
Whipple operation
A
- Removes head, neck and part of the body of the pancreas, distal one third of the stomach, duodenum, part of the CMD and gallbladder
- PPPD (pylorus-preserving pancreatoduodenectomy)
- Main cause of morbidity and mortality - pancreatic fistulae due to leaks from the pancreatojejunal anastomosis
