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YEAR 6 > SURG: Upper GI & Hepatobiliary > Flashcards

SURG: Upper GI & Hepatobiliary Flashcards

1
Q

Mirizzi Syndrome?

A

A gallstone impacted in the distal cystic duct causing extrinsic compression of the common bile duct

> > Deranged LFTs

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2
Q

Complications of acute cholecystitis?

A
  • gangrenous cholecystitis
  • perforation - may result in pericholecystic abscess or peritonitis
  • cholecystoenteric fistula - results in air in the biliary tree (pneumobilia) > if a gallstone passes through the fistula may result in gallstone ileus
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3
Q

Grey-Turner’s sign?

A

bruising of the flanks

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4
Q

Cullen’s sign?

A

peri-umbilical bruising

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5
Q

Investigations for acute pancreatitis?

A
  • LIPASE
  • Amylase
  • If inconclusive - CT abdomen with contrast
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6
Q

Severity scores for acute pancreatitis?

A
  • Ranson score
  • Glasgow score
  • APACHE II
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7
Q

Complications of acute pancreatitis?

A
  • Pancreatic necrosis - surgical or radiological drainage or aspiration indicated if any suspicion of infection and drains placed with IV antibiotics commenced ASAP
  • Pancreatic abscess - transgastric drainage or endoscopic drainage
  • Pseudocyst formation - drainage (endoscopically/surgically) not indicated unless significant pressure symptoms as likely to resolve over time
  • Ascites - multiple large bore ascitic drains placed and left in until no further fluid produced
  • Retroperitoneal haemorrhage - CT angiography to identify source of bleeding then radiological embolisation
  • ARDS
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8
Q

Features indicating severe pancreatitis?

A
  • age > 55 years
  • hypocalcaemia
  • hyperglycaemia
  • hypoxia
  • neutrophilia
  • elevated LDH and AST
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9
Q

Charcot’s triad?

A

> > Ascending cholangitis

  • Fever
  • Jaundice
  • RUQ pain
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10
Q

Reynold’s pentad?

A

> > Ascending cholangitis

  • Fever
  • Jaundice
  • RUQ pain
  • +Septic shock
  • +Mental confusion
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11
Q

Most common organism implicated in ascending cholangitis?

A

E coli

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12
Q

Causes of ascending cholangitis?

A

> > Biliary obstruction

  • Gallstones
  • Strictures
  • Malignant obstruction
  • Parasitic infection
  • Biliary stents / drainage procedures
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13
Q

Management of ascending cholangitis?

A
  • Broad spectrum IV antibiotics - piperacillin / tazobactam (gentamicin + metronidazole if pen allergic)
  • IV fluids / correct electrolyte imbalances / analgesia
  • Biliary decompression - ERCP ± sphincterotomy after 24-48hrs (preferred over surgery)
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14
Q

Boerhaaves’s Syndrome?

A

spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting

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15
Q

Diagnosis of Boerhaaves’s Syndrome?

A

CT contrast swallow

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16
Q

Management of Boerhaaves’s Syndrome?

A
  • Thoracotomy and lavage, if <12 hours after onset then primary repair is usually feasible
  • Surgery delayed beyond 12 hours is best managed by insertion of a T tube to create a controlled fistula between oesophagus and skin
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17
Q

Main risk factor for cholangiocarcinoma?

A

PSC

18
Q

Lymphadenopathy seen in cholangiocarcinoma?

A
  • Periumbilical lymphadenopathy (Sister Mary Joseph nodes)
  • Left supraclavicular adenopathy (Virchow node)
19
Q

Marker raised in cholangiocarcinoma?

A

CA 19-9

20
Q

Management of cholangiocarcinoma?

A
  • Only surgery is currative - not always possible
  • Adjunct with chemo or radio to prevent recurrence
  • Pemigatinib - patients with previously treated, unresectable locally advanced or metastatic cholangiocarcinoma with certain gene mutations

Palliative:

  • Stenting - ERCP/surgery used to stent bile duct relieving obstructive symptoms
  • Chemo/radiotherapy - reduce symptoms, Gemcitabine and Cisplatin most commonly used
21
Q

Features of chronic pancreatitis?

A
  • pain is typically worse 15 to 30 minutes following a meal
  • steatorrhoea: symptoms of pancreatic insufficiency usually develop between 5 and 25 years after the onset of pain
  • diabetes mellitus develops in the majority of patients. It typically occurs more than 20 years after symptom begin
22
Q

Investigations for chronic pancreatitis?

A
  • AXR shows pancreatic calcification in 30% of cases
  • CT pancreas is preferred diagnostic test
  • faecal elastase may be used to assess exocrine function if imaging inconclusive
23
Q

Management of chronic pancreatitis?

A

pancreatic enzyme supplements
analgesia

24
Q

Malignant complication of H pylori infection?

A

Gastric MALT lymphoma

25
Q

Management of pancreatic cancer?

A
  • Whipple’s resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas
  • Adjuvant chemotherapy usually given following surgery
  • ERCP with stenting is often used for palliation
26
Q

Causes of perforated peptic ulcer?

A
  • NSAIDs
  • H pylori
  • Smoking
27
Q

Clinical features of perforated peptic ulcer?

A
  • Abdominal pain
  • Tachycardia
  • Rigid abdomen
  • Abdominal distension
  • Shoulder tip pain (Kehr’s sign)
28
Q

Investigations for peptic ulcer perforation?

A
  • Erect AXR - air under diaphragm
  • If unsure - CT - free gas / fluid within the peritoneal cavity
  • If unsure - CT with contrast
29
Q

Management of peptic ulcer perforation?

A
  • IV fluids
  • NBM + NGT
  • IV PPI
  • IV antibiotics
  • If stable / improving after resus = non-surgical
  • Unstable / ongoing sx = surgery (<2cm - closure of perforation, >2cm - resection of lesion with subsequent repair)
30
Q

Post-operative management of peptic ulcer perforation?

A

Upper endoscopy:

  • Identify cause of perforation (e.g. malignancy, biopsy for H pylori infection)
  • Identify whether ulcer is healing appropriate after initial management
  • Wai at least 2 weeks, ideally up to 8 weeks after perforation, to perform endoscopy as to allow for the original ulcer to heal appropriately

H pylori eradication:

  • After initial management and stabilisation, if a patient is H pylori positive and this is the likely cause of the ulceration and therefore perforation, eradication is necessary
  • Triple therapy with PPI and dual antibiotics (clarithromycin and amoxicillin) for 10-14 days
31
Q

Types of bariatric surgery?

A

Primarily restrictive operations:

  • Laparoscopic-adjustable gastric banding (LAGB) - normally first-line in patients with BMI of 30-39, produces less WL than malabsorptive or mixed procedures but fewer complications
  • Sleeve gastrectomy - stomach reduced to ~15% of its original size
  • Intragastric balloon - can be left in stomach for max 6 months

Primarily malabsorptive operations:

  • Biliopancreatic diversion with duodenal switch
  • Usually reserved for very obese patients (e.g. BMI >60)

Mixed operations:

  • Roux-en-Y gastric bypass surgery
32
Q

Drugs causing acute pancreatitis?

A
  • azathioprine
  • mesalazine
  • didanosine
  • bendroflumethiazide
  • furosemide
  • pentamidine
  • steroids
  • sodium valproate
33
Q

Bloods in biliary colic?

A

Normal

34
Q

Most common complication of ERCP?

A

Pancreatitis

35
Q

Anatomical site causing hepatobiliary pathology least associated with jaundice?

A

Cystic duct

36
Q

Ascending cholangitis on USS?

A

dilated intrahepatic and extrahepatic bile ducts and multiple hyperechoic spheres within the gallbladder

37
Q

Screen for cholangiocarcinoma in patients with PSC?

A

CA 19-9

38
Q

Complications of gastrectomy?

A
  • B12 deficiency > subacute degeneration of the spinal cord
  • Weight loss, early satiety
  • Iron-deficiency anaemia
  • Osteoporosis/osteomalacia
  • Dumping syndrome
39
Q

When to refer for bariatric surgery?

A
  • Without contraindications = BMI is greater than 50
  • Medical conditions affected by weight = BMI greater than 35
40
Q

useful test of exocrine function in chronic pancreatits?

A

Faecal elastase

41
Q

Absolute contraindications to laparoscopic surgery?

A
  • haemodynamic instability/shock
  • raised intracranial pressure
  • acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm)
  • uncorrected coagulopathy
42
Q
A

YEAR 6 (14 decks)

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