Surgical Jaundice Flashcards
What is surgical jaundice
Any jaundice amenable / correctable by surgical intervention
Main cause of surgical jaundice
Extrahepatic biliary obstruction
What are some congenital dx of gallbladder and bile ducts leading to surgical jaundice
Extrahepatic biliary atresia
Choledochal cyst
Cholelithiasis
What is biliary atresia
Abnormal narrowing of common Bile duct or left hepatic duct
Clinical feature of biliary atresia
Jaundice at birth or by end of first week and deepens later
Bile stained méconium
Pale stool
Dark urine
Pruritus
Clubbing
Skin xanthomas
What is choledochal cyst
Congenital dilatations of intra / Extrahepatic biliary system
Symptoms and signs of choledochal cyst
Jaundice
Fever
BDOMINAL PAIN
RIGHT upper quadrant mass
Investigation choledochal cyst
Ultrasonography
MRI
Ct scan
Treatment of choledochal cyst
Radical excision of the cyst and reconstruction of biliary tract
Most common biliary pathology leading to surgical jaundice
Cholelithiasis
3 types of gallston3s
Cholesterol stones
Pigment stones ( brown or black. )
Mixed stones
Cholelithiasis risk factors
Obesity
High calorie diet
Abnormal gastric emptying
Components of black pigment stone in Cholelithiasis
Insoluble bilirubin
Pigment polymer
Calcium phosphatase and calcium carbonate
Main causes of black pigment stone
Hemolytic disease like Hereditary spherocytosis or sickle cell anemia
Component of brown pigment stones
Calcium bilirubinate
Calcium palmitate
Calcium stearate
Cholesterol
Causes of brown pigment
Bile stasis
infected bile
Clinical features of gallstone
Right upper quadrant or epigastric pain
Dyspepsia
flatulence
food intolerance fatty food
altered bowel habits
Common differential diagnosis of Cholelithiasis
Acute appendicitis
perforated gastric ulcer
Acute pancreatitis
Complication of gallstones
Biliary colic
acute cholecystitis
Chronic cholecystitis
Empyema of gallbladder
Mucocele
biliary obstruction
acute cholangitis
acute pancreatitis
intestinal obstruction
gallstone Ileus
What Is cholecystitis
Inflammation of the gallbladder occurring mostly during obstruction of cystic duct from cholelithiasis
Risk factors of calculus cholecystitis
Increasing age
obesity
drugs
pregnancy
Risk factor associated with acalculous cholecystitis
Biliary stasis
debilitation
major surgery
severe trauma
sepsis
long-term total parenteral nutrition
prolonged fasting
diabetes mellitus
Clinical features of acute cholecystitis
Acute upper abdominal pain starting in the epigastric region and going to the right upper quadrant which may radiate to shoulder , colicky
fever
Tachycardia
guarding
rebound tenderness
jaundice not common
Complications of acute cholecystitis
Perforation
gangrene
peritonitis
What Is cholangitis
Infection of the biliary tract
Clinical presentation of cholangitis
Jaundice
right upper quadrant pain
fever with chills and Rigor
What is sclerosing cholangitis
Idiopathic fibrosing inflammatory condition. Of the biliary tree affecting intra and extra hepatic ducts
Risk factor of sclerosing cholangitis
Inflammatory bowel disease - UC
Hypergammaglobulinaemia
Clinical presentation of sclerosing cholangitis
RUQ discomfort
Jaundice
Pruritus
Weight loss
Fever
‘Fatigue
Investigations in idiopathic cholangitis
LFT
Ultrasonography
Cholangiography
ERCP
Treatment of idiopathic cholangitis
Vit K
Steroids
Immunosuppressants
Endoscopic stenting
Causes of stricture of bile duct
Congenital in biliary atresia
Bile duct injury during surgery
Inflammation ( stones, cholangitis , pancreatitis , sclerosing cholangitis )
Trauma
Idiopathic
Main benign tumors of the bile duct
Papilloma
Adenoma
Main malignancy tumor of biliary duct
Adenocarcinoma
Clinical features of malignant tumors of biliary tree
Jaundice
Abdominal pain
Early satiety
Weight loss
Investigation of tumors of biliary tree
Biochemical - bilirubin high , high phosphatase , high GG transaminase
Tumor marker - CA 19-9
Ultrasonography
Percutaneous transhepatic cholangiography
Percutaneous drainage for cytology
Treatment of tumor of biliary tree
Resection
Prognosis of biliary tree tumor
18 months medians survival with 20% S5y
Form of bilirubin elevted in prehepatic jaundice
Unconjugated bilirubin
Form of bilirubin elevated in hepatic jaundice
Both conjugated and Unconjugated
Form of bilirubin elevated in post hepatic jaundice
Conjugated
Urine color in different form of jaundice
Pre hepatic - normal
Hepatic / post hepatic - dark
Stool color in different form of jaundice
Pre hepatic / hepatic - normal
Post hepatic - steatorrhea
Pruritus presence in different form of jaundice
Pre hepatic / hepatic - not present
Post hepatic - present
What is Gilbert’s syndrome
Hereditary conditions with mild jaundice due to low levels of bilirubin processin enzymes in the liver
Investigation in obstructive jaundice
FBC
Electrolytes, urea, creat
LFT
Bilirubin
Urinalysis - bilirubin , urobilinogen
Faecal occult blood test
Coagulation profile
Hepatitis serology
Imaging of choice in obstructive jaundice
Magnetic resonance cholangiopancreatography MRCP
