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304: GI > Pancreas, biliary and liver > Flashcards

Pancreas, biliary and liver Flashcards

1
Q

Acute cholecystitis
- Definition
- Causes

A

Inflammation of the gallbladder

Causes
- Gallstones: blocks bile flow, thickens bile in gallbladder, leading to bacteria infection. Stone is mainly of cholesterol.
- Without stones: vascuilitis,, chemo, trauma

Bacteria
- Gut bacteria: E.coli, bacteriodes

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2
Q

Complications of gallstones/ acute cholecystitis

A

Empyema/ mucocele

GB perforation
- Can escalate to peritonitis

GS ileus: stone obstructs bowel

Pancreatitis

Fistula- with bowel

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3
Q

Ascending cholangitis
- Definition
- Causes
- Symptoms

A

Inflammation of bile duct, typically caused by infection ascending from duodenum.

Causes
- Gallstones
- Strictures
- Malignancy
- ECRP

Symptoms
- Charcot’s triad: jaundice, abdominal pain, fever.

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4
Q

Surgery for gallstones, biliary colic

A

Surgery best done within 48 hrs of cholecystitis/ biliary colic

  1. Laparoscopic cholecystectomy + Antibiotics
  2. Biliary stones = ERCP.
    + Lap chole +
    - If cholangitis= antibiotics
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5
Q

Cholecystectomy complications

A

Early
- Bleeding
- Bile duct injury
- Bile leak

Long term
- Adhesions

Post-surgery due to lack of bile
- Steatorrhea
- Abdominal discomfort

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6
Q

ERCP complications

A

Bleeding

Pancreatitis

Perforation

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7
Q

Gallstones risk factors
- 5 Fs

A

Female
Fertile (pregnant)
Fat
Fair (Caucasian)
Fifty (Age >50)

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8
Q

Causes of pancreatitis
I GET SMASHED

A

Idiopathic

Gallstones (common)
Ethanol (common)
Trauma

Steroids
Mumps
Autoimmune
Scorpion toxin
Hypertryglyceridaemia/ Hypothermia/ Hypocalcaemia
ERCP
Drugs

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9
Q

Management of pancreatitis

A

Initial
1. Large IV access: Fluids
2. Analagesia
3. O2 if needed
4. NBM, NGT?

Further

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10
Q

Complications of pancreatitis

A

Hypovolaemic shock

Haemorrhagic pancreatitis

Pseudocyst
- Made of pancreatic fluid

Infected necrosis

ARDS, SIRS

T2DM

Chronic pancreatitis

Multiorgan failure

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11
Q

Pneumoperitoneum

A

Air in the peritoneal cavity, can be within the abdominal cavity.

Causes
- Perforated duodenal/ peptic ulcer
- Bowel perf/ obstruction
- Post operation

Diagnosis
- Erect CXR
- CT (more information)

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12
Q

Murphy’s sign

A

Pressing on RUQ, asking Pt to breathe in.
- If painful= positive
- Cause= acute cholecystitis

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13
Q

GS ileus

A

Big stone gallstone enters the bowel and gets trapped in the ileocaecal junction.

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14
Q

Cholangiocarcinoma

A

Malignancy of bile duct

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15
Q

Pancreatic cancer categories

A

Adenocarcinoma
- Most common
- Exocrine tumour

Neoendocrine
- From endocrine source: insulinoma, glucagonoma etc

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16
Q

Tumour markers for pancreatic cancer

A

CA19-)
- Carbohydrate antigen 19.9
- Sensitivity= 80%, specificity 73%

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17
Q

Whipple’s surgery

A

Removal
- Gallbladder
- Antrum of stomach
- Head of pancreas
- Curve of duodenum

Bypasses food from stomach to jejunum

Jejunum loop attached to cystic duct to drain bile.

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18
Q

Prehepatic causes of jaundice

A

Haemolytic anaemia causes
- SCD
- Hereditary spherocytosis
- Autoimmune
- Transfusion reaction
- Drug toxicity

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19
Q

Hepatic causes of jaundice

A

Unconjugated hyperbilirubinaemia
- Gilbert’s syndrome
- Crigler Najjar

Conjugated
- Alcohol, chronic hepatatis
- Viral infection: Hepm EBV, BMV
- Bacterial infection: abscess
- Drugs: paracetamol, antibiotics

20
Q

Post-hepatic jaundice causes

A

Biliary obstruction
- Gallstone
- Pancreatic cancer
- Stricture
- Blood clot

Cholangiocarcinoma
Sclerosing cholangitis

21
Q

Investigations for jaundice

A

Blood
- Reticulocyte count (haemolytic)
- Clotting (hepatic)
- Hepatitis screen: Hep A, B, C, CMV, EBV
- ASM ab, AMA
- LFTs

Imaging
- USS
- MRCP

Liver biopsy

22
Q

Gallstones types
- 3

A

Most common
- Mixed

Cholesterol
- Often large and solitary

Pure pigment (bile salts)
- Black (haemolytic disease)
- Brown (Chronic cholangiitis, biliary parasites)

23
Q

Features of Acute cholecystitis

A

Biliary colic
- RUQ intermittent pain.
- With nausea/ vomtting
- Murphy’s sign= tenderness on gallbladder on inspiration

24
Q

Gold standard bile stone investigation

A

USS

MRCP
- if US is inconclusive

25
Q

Chronic pancreatitis
- Description
- Pathology

A

Irreversible destruction of pancreatic parenchyma

Pathology
- May be global or focal
- In chronic alcohol disease= head most affected
- Chronic inflammatory changes causing; glandular atrophy, duct ectasia, microcalcification, intraductal stone

26
Q

Causes of chronic pancreatitis

A

Reurrent pancreatitis

Secondary to pancreatic duct obstruction
- Cyst
- Tumours
- Structuures
- CF

AI diseasse
- PBC, PSC

Congenital

27
Q

Chronic pancreatitis presentation

A

Recurrent/ persistent abdominal pain

Signs of exocrine insuffiiciency
- malabsorption: weight loss, anorexia, steatorrhoea

Signs of endocrine insufficiency
- Dabetes

28
Q

Treatment of chronic pancreatitis

A

Preventative management of further damage
- no OH
- Anti-oxidant rich diet

Control symptoms
- Diet: less fat
- Exocrine enzyme supplement
- Control DM
- Analgesia

Surgical
- Treat reversible cause (tumour, stone, stricture)
- Severe: pancreatectomy

29
Q

Porto-systemic vascular anastomosis

A

Left gastric-Oesophageal veins

Superior rectal- inferior rectal veins

Umbilical vein- epigastric vein

30
Q

Investigationns into liver cirrhosis

A

LFTs, clotting
- AST, ALT

Congential screen
- Ferrtin (haemochromatosis)
- Ceruloplasmin (Wilson’s)
- Alpha-1 antitrypsin

Autoimmune screen (AIH)
- Anti-mitochondrial antibodies
- Anti-smooth muscle antibodies

Viral Hepatitis screen
- Hep A-E
- EBV, CMV

Imaging
- Abdominal ultrasoudn

Liver biopsy

31
Q

Pancreatic cancer
- Peak age
- Risk factors

A

Age: 60-70

Risk factor
- Smoking
- Age
- High fat diet
- DM
- Alcoholism
- Chronic pancreatitis

32
Q

Pancreatic cancer
- Pathology types

A

Majority= ductal adenocarcinoma
- Mainly affects the head (then body and tail respectively)

Mucinous cyst neoplasms

Islet cell tumours

33
Q

Carcinoma of head of pancreas
- Presentation

A

Obstructive jaundice
- Palpable gallbladder

Epigastric/ LUQ pain

General
- Nausea, vomitting
- Fatigue, malaise
- Anorexia

Mets
- Hepatomegaly

34
Q

Carcinoma of body and tail of pancreas
- Presentation

A

Most common
- Weight loss
- Back pain

Epigastriic mass

DM

35
Q

Pancreatic cancer investigations

A

Bloods
- Marker= CA 19-9 (70% specificity)
- Amylase
- U+Es
- Calcium
- Glucose

Imaging
- USS: transabdominal, endoscopic (better for smaller lesions)
- Doppler for portal vein and SMVessels
- ERCP if obstructive jaundice

36
Q

Management of pancreatic cancer
- Curative
- Palliative

A

Curative
- Whipple’s: pancreatoduodenectomy
- Total/ distal pancreatomy

Palliative
- Relief jaundice: bilary stenting, drainage via PTC/ surgery

  • Sugrical gastric bypass to relief duodenal obstruction
  • Pain: morphine, chemical ablation of celiac ganglia
37
Q

Commonest tumours that metastasize to the liver (5)

A

Pancreas

Bowel

Stomach

Breast

Oesophagus

38
Q

Hepatocellular cancer
- Risk factors

A

Cirrhosis

39
Q

Cholangocarcinoma
- Description
- Typical sites

A

Neoplasm of biliary tree
- Typically extrahepatic, diistal CBD/ common hepatic duct, confluence of hepatic ducts.

40
Q

Adenocarcinoma of gallbladder
- Associations
- Presentation

A

Associations
- UC
- PSC

Presentation
- Gallbladder mass
- Obstructive jaundice

41
Q

Classifications of acute pancreatitis

A

Oedematous
- Most common
- Simple/ associated with phlegmon formation

Severe/ necrotising
- May form pseudocyst (large peripancreatic fluid collection)

Haemorrhagic

42
Q

Acute pancreatitis
- Investigations

A

Bloods
- FBC
- U+E: Na, K
- LFT
- Serum amylase: >1000 is diagnostic
- Group + save

Abdominal US
- Rules our gallstone obstruction

CT
- Pancreatic oedema, loss of fat planes

43
Q

Glasgow Imrie criteria

A

Scoring criteria to assess the severity of acute pancreatitis.

PANCREAS:
P- PaO2 <8
A- Age >55
N- Neutrophils/ WCC >15
C- (Corrected) Calcium <2
R- Raised blood urea >16
E- Elevated enzymes (AST, LDH)
A-Albumin (hypo)
S- Blood glucose >10

44
Q

What is the 2 week referral indication of suspected pancreatic cancer

A

Age >40 with unexplained jaundice

45
Q

what is the urgent indication for CT/USS in suspected pancreatic cancer

A

> 60 with weight loss and:
- diarrhoea
- Back pain
- Abdominal pain
- Nausea
- Vomiting
- Constipation
- New diabetes

46
Q

What is the Cullen’s sign and which condition is it associated with?

A

Oedema + bruising around the umbilicus within 24-48 hours of acute abdominal pain
- Associated with acute pancreatitis

47
Q

What is the Grey-Turner’s sign and which condition is it associated with?

A

Bruising in the flanks (caused by retroperitoneal haemorrhage)
- Sign of acute pancreatitis

304: GI (20 decks)

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