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7- Surgery > Surgical Jaundice > Flashcards

Surgical Jaundice Flashcards

1
Q

What is surgical jaundice

A

Any jaundice amenable / correctable by surgical intervention

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2
Q

Main cause of surgical jaundice

A

Extrahepatic biliary obstruction

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3
Q

What are some congenital dx of gallbladder and bile ducts leading to surgical jaundice

A

Extrahepatic biliary atresia
Choledochal cyst
Cholelithiasis

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4
Q

What is biliary atresia

A

Abnormal narrowing of common Bile duct or left hepatic duct

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5
Q

Clinical feature of biliary atresia

A

Jaundice at birth or by end of first week and deepens later
Bile stained méconium
Pale stool
Dark urine
Pruritus
Clubbing
Skin xanthomas

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6
Q

What is choledochal cyst

A

Congenital dilatations of intra / Extrahepatic biliary system

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7
Q

Symptoms and signs of choledochal cyst

A

Jaundice
Fever
BDOMINAL PAIN
RIGHT upper quadrant mass

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8
Q

Investigation choledochal cyst

A

Ultrasonography
MRI
Ct scan

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9
Q

Treatment of choledochal cyst

A

Radical excision of the cyst and reconstruction of biliary tract

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10
Q

Most common biliary pathology leading to surgical jaundice

A

Cholelithiasis

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11
Q

3 types of gallston3s

A

Cholesterol stones
Pigment stones ( brown or black. )
Mixed stones

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12
Q

Cholelithiasis risk factors

A

Obesity
High calorie diet
Abnormal gastric emptying

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13
Q

Components of black pigment stone in Cholelithiasis

A

Insoluble bilirubin
Pigment polymer
Calcium phosphatase and calcium carbonate

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14
Q

Main causes of black pigment stone

A

Hemolytic disease like Hereditary spherocytosis or sickle cell anemia

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15
Q

Component of brown pigment stones

A

Calcium bilirubinate
Calcium palmitate
Calcium stearate
Cholesterol

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16
Q

Causes of brown pigment

A

Bile stasis
infected bile

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17
Q

Clinical features of gallstone

A

Right upper quadrant or epigastric pain

Dyspepsia
flatulence
food intolerance fatty food
altered bowel habits

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18
Q

Common differential diagnosis of Cholelithiasis

A

Acute appendicitis
perforated gastric ulcer
Acute pancreatitis

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19
Q

Complication of gallstones

A

Biliary colic
acute cholecystitis
Chronic cholecystitis
Empyema of gallbladder
Mucocele
biliary obstruction
acute cholangitis
acute pancreatitis
intestinal obstruction
gallstone Ileus

20
Q

What Is cholecystitis

A

Inflammation of the gallbladder occurring mostly during obstruction of cystic duct from cholelithiasis

21
Q

Risk factors of calculus cholecystitis

A

Increasing age
obesity
drugs
pregnancy

22
Q

Risk factor associated with acalculous cholecystitis

A

Biliary stasis
debilitation
major surgery
severe trauma
sepsis
long-term total parenteral nutrition
prolonged fasting
diabetes mellitus

23
Q

Clinical features of acute cholecystitis

A

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

24
Q

Complications of acute cholecystitis

A

Perforation
gangrene
peritonitis

25
Q

What Is cholangitis

A

Infection of the biliary tract

26
Q

Clinical presentation of cholangitis

A

Jaundice
right upper quadrant pain
fever with chills and Rigor

27
Q

What is sclerosing cholangitis

A

Idiopathic fibrosing inflammatory condition. Of the biliary tree affecting intra and extra hepatic ducts

28
Q

Risk factor of sclerosing cholangitis

A

Inflammatory bowel disease - UC
Hypergammaglobulinaemia

29
Q

Clinical presentation of sclerosing cholangitis

A

RUQ discomfort
Jaundice
Pruritus
Weight loss
Fever
‘Fatigue

30
Q

Investigations in idiopathic cholangitis

A

LFT
Ultrasonography
Cholangiography
ERCP

31
Q

Treatment of idiopathic cholangitis

A

Vit K
Steroids
Immunosuppressants
Endoscopic stenting

32
Q

Causes of stricture of bile duct

A

Congenital in biliary atresia
Bile duct injury during surgery
Inflammation ( stones, cholangitis , pancreatitis , sclerosing cholangitis )
Trauma
Idiopathic

33
Q

Main benign tumors of the bile duct

A

Papilloma
Adenoma

34
Q

Main malignancy tumor of biliary duct

A

Adenocarcinoma

35
Q

Clinical features of malignant tumors of biliary tree

A

Jaundice
Abdominal pain
Early satiety
Weight loss

36
Q

Investigation of tumors of biliary tree

A

Biochemical - bilirubin high , high phosphatase , high GG transaminase

Tumor marker - CA 19-9

Ultrasonography

Percutaneous transhepatic cholangiography
Percutaneous drainage for cytology

37
Q

Treatment of tumor of biliary tree

A

Resection

38
Q

Prognosis of biliary tree tumor

A

18 months medians survival with 20% S5y

39
Q

Form of bilirubin elevted in prehepatic jaundice

A

Unconjugated bilirubin

40
Q

Form of bilirubin elevated in hepatic jaundice

A

Both conjugated and Unconjugated

41
Q

Form of bilirubin elevated in post hepatic jaundice

A

Conjugated

42
Q

Urine color in different form of jaundice

A

Pre hepatic - normal
Hepatic / post hepatic - dark

43
Q

Stool color in different form of jaundice

A

Pre hepatic / hepatic - normal
Post hepatic - steatorrhea

44
Q

Pruritus presence in different form of jaundice

A

Pre hepatic / hepatic - not present
Post hepatic - present

45
Q

What is Gilbert’s syndrome

A

Hereditary conditions with mild jaundice due to low levels of bilirubin processin enzymes in the liver

46
Q

Investigation in obstructive jaundice

A

FBC
Electrolytes, urea, creat
LFT
Bilirubin
Urinalysis - bilirubin , urobilinogen
Faecal occult blood test
Coagulation profile
Hepatitis serology

47
Q

Imaging of choice in obstructive jaundice

A

Magnetic resonance cholangiopancreatography MRCP

7- Surgery (13 decks)

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