Pancreatic/Hepatic Surgery Flashcards
What is biliary disease progression?
Cholethiasis –> biliary colic –> acute cholecystitis
Choledocholitiasis –> ascending cholangitis or gallstone pancreatitis
How does cholelithiasis present?
Presents as nausea, vomiting, RUQ pain without fever, only 15-20% are symptomatic
IN pregnancy: manage non-op i possible; elective lap chole can be done after delivery
What is biliary colic?
Fatty meal –> CCK release –> gall bladder contraction against non-lodged stone resulting in transient RUQ pain for <6 hours; labs are usually normal if episode has passed
How does cholecystitis present?
Presents as fever, WBC>15, RUQ pain >6 hours; MC bacteria are E. coli, bacteroides fragilis, Klebsiella, enterococcus
How do you manage cholecystitis?
Dx abdominal u/s, order CBC and LFTs, tx lap chole within 72 hours
- elderly patients respond to sepsis with hypothermia and decreased WBC
- tx with cipro and metronidazole to cover GNR and anaerobes
What are the indications for a cholecystecomy?
Symptomatic cholethiasis, acute cholecystitis, and cholangitis; do not operate on asymptomatic stones
What are the complications of a cholecystectomy?
Nicking the CBD (jaundice) or right hepatic artery (hepatitis)
How does a post-op biliary leak present?
Presents as Charcot’s triad; get an U/S and HIDA scan –> tx biliary drainage and temporary stent during ERCP
How does choledocholithiasis present?
Presents as transient jaundice and an increase in alk phos; dx U/S shows dilated bile ducts +/- ERCP, tx lap chole with CBD exploration
How does acute cholangitis present?
Presents as Charcot’s triad (jaundice, fever, RUQ pain) or Reynold’s pentad (shock, AMS) due to choledocolithiasis
How do you manage acute cholangitis?
IVF, antibiotics, and U/S –> ERCP to compress biliary tree –> finally, lap chole with CBD exploration
How do you manage gall bladder polyps?
2cm take it out due to risk of adenocarcinoma
How does gall bladder adenocarcinoma present?
Presents as a mass in GB fossa; dx with CT scan, tx with open chole + hilar LN resection + liver resection with negative margins
What is porcelain gall bladder?
Dystrophic calcification of gall bladder, has 50% risk of adenocarcinoma, take it out
What is jaundice?
Elevated bilirubin and yellowing of skin
Three types: hemolytic, obstructive, and hepatocellular