Surgery A - Upper GI and hepatobiliary disorders Flashcards
55 y/o female
pc: becomes unwell following dinner, constant pain tummy, appears flushed
hpc: refereed to SAU, 6hr hx upper abdo pain 3 days ago.
pmh: high cholesterol, BMI 32
Obs: 100bpm
possible differential diagnosis?
- biliary colic
- cholecystitis
- pancreatic
- MI
- chest infection
- peptic ulcer disease
- MSK causes?
most likely cholecystitis
what is acute cholecystitis?
- acute inflammation of gall bladder
- primary complication of cholelithiasis
- cholelithiasis is the formation of gall stones
main presenting symptom of cholecystitis is:
- pain in RUQ
- may radiate to shoulder
other features: fever, nausea, vomiting, t.cardia, RUQ tenderness, Murphy’s sign, raised inflammatory markers
what is Murphy’s sign and what is it suggestive of:
- suggestive of acute cholecystitis
- place hand in RUQ, apply pressure
- ask patient to take deep breath
- gall bladder moves down in inspiration
- comes into contact with hand
- stimulation of inflamed gallbladder results in acute pain
- sudden stopping of inspiration
first investigation for suspected acute cholecystitis?
- abdominal USS
- thickened gallbladder wall
- stones or sludge In gallbladder
- fluid around the gall bladder
if common bile duct stone is suspected but not seen on USS, what might be done?
MRCP
- can help visualise biliary tree in more detail
management of cholecystitis?
conservative
- NBM
- IV fluids
- antibiotics
- NG if required for vomiting
surgical
- ERCP to remove stones trapped in CBD
- cholecystectomy
complications of acute cholecystitis?
- sepsis
- gallbladder empyema (infected tissue and pus collecting in gall bladder)
- gangrenous gallbladder
- perforation
68 y/o male
pc: 5 day hx generally unwell. currently having rigorous, looks sweaty and pale, upper abdo pain
pmh: pancreatitis secondary to gall stones , laparoscopic cholecystectomy 3 years ago
Obs: 90/65mmHg, 110bpm, urinary catheter, urine very dark, looking a bit jaundice and itchy
some differentials:
- sepsis?
- cholangitis
- obstructive jaundice
- pancreatitis
- MI
- upper GI perforation
most likely
- biliary stones with cholangitis
right iliac fossa pain possible differentiations
- appendicitis
- Crohn’s
- ectopic pregnancy
left iliac fossa pain possible differentials
- diverticulitis
- ectopic pregnancy
epigastric pain possible differentials?
- oesophagitis
- gastritis
right upper quadrant possible differentials?
- cholecystitis
- hepatitis
flank pain possible differentials?
- renal colic
- pyelonephritis
suprapubic pain possible differential
UTI
