Surgical Liver & Biliary Disease Flashcards
what is the normal liver span and weight ?
11 to 14 cm and 1.5 to 2 kg.
what is the blood supply of liver ?
- 80% portal vein
- 20% common hepatic artery
~75% of functional liver
parenchyma is located in which lobe ?
Right lobe.
What is the cause of portal hypertension ?
CLD
What are the complications of portal HTN ?
- GI bleeding (oesophageal /
gastric / rectal varices) - Ascites
- Spontaneous bacterial
peritonitis - Heart Failure
- Pulmonary HTN
- Hepatopulmonary syndrome
- Hepatorenal syndrome
What is the approach to Variceal Bleeding?
Start with ABC as it is an acute hemodynamiclally unstable presentation. Place 2 large bore IVs for fluid and blood transfusion. Give prophylactic anti-biotics and provide IV terlipression or octreotide, IV B-blocker. Endoscopic management can be band ligation or sclerotherpay.
what is the advantage of TIPSS in Variceal bleeding ?
Transjugular Intrahepatic Portosystemic Shunt can relieves portal pressure by bypassing liver.
What are the indications for TIPS ?
- Used in refractory/recurrent variceal bleeding
- Used in refractory ascites
What is the marker of cholestatic liver disease or biliary obstruction?
ALP
What are the biomarker of hepatocellular injury ?
Increase in ALT ,AST and ALT/AST ratio.
What is the marker of alcoholic liver injury ?
GGT
What are the indicators of compromise in liver synthetic function ?
Increase in PT or INR and decrease in albumin.
What is the hepatocellular injury pattern ?
> 10x increase in ALT with <3x increase in ALP =
hepatocellular injury
What is the cholestasis pattern ?
<10x increase in ALT with >3x increase in ALP =
cholestatsis
What are the cholestasis biomarkers ?
Raised ALP + GGT
Isolated increase in bilirubin indicates ?
Direct bilirubin = Dubin Johnson syndrome and Rotor syndrome.
Indirect bilirubin = Gilbert’s syndrome and Craygal Najar type 01 and 02.
What is the ALT, AST pattern in CLD ?
ALT>AST
What is the ALT, AST pattern in cirrhosis, and acute alcoholic hepatitis?
AST>ALT
What is the main surgical cause of Jaundice ?
Jaundice due to intra- or extra-hepatic organic obstruction to biliary outflow.
What is the commonest cause of obstructive surgical jaundice ?
extrahepatic obstruction due to gall stone.
What are the main etiologeis of surgical jaundice ?
- Malignancy
- Inflammation (pancreatitis)
- Merrizi’s syndrome
- Primary Sclerosing Cholangitis (PSC)
What forms ampula of Vater ?
Distal end of common bile duct and pancreatic duct.
What are the Five F’s of gallblader stone ?
“The 5* Fs” – Fat, 40, Fertile, Female, Family History, Fair
What is Mirizzi’s Syndrome?
stone in Hartman’s
pouch causing obstructive jaundice
What are the complications of galstone ?
- Gallstone Ileus is the main complication.
The uncommon ones are
*Fistula between gallbladder and duodenum
*Presents as sub-acute small bowel obstruction
What is the presentation and approach to Gallstone Pancreatitis?
The patients presents with severe RUQ + epigastric pain. The labs will show Raised LFTs, CRP and amylase. The management are
Aggressive supportive therapy
* Urgent ERCP + sphincterotomy
* Laparoscopic cholecystectomy
when resolves
What are the key symptom constellations in acute obstructive cholangitis?
*Charcot’s triad
* Reynolds pentad
What is the management of Ascending cholangitis?
- IV fluids and antibiotics broad-spectrum
- Emergency decompression of biliary system with ERCP
What is the presentation of Choledocholithiasis?
RUQ pain with obstructive jaundice. No fever.
What is the diagnsositic work-up and management of Choledocholithiasis?
- Initially diagnosed by USfollowed by MRCP.
- Requires urgent ERCP and
sphincterotomy - Laparoscopic Cholecystectomy
What is the presentation of Acute Cholecystitis?
- RUQ pain and Murphy’s sign +/- temperature.
- Bloods will show Normal LFTs, Raised CRP, +/- raised WBCs.
What is the management of Acute Cholecystitis?
- NPO and Analgesia
- Abdominal US and IV antibiotics
- IV fluids
- Laparoscopic Cholecystectomy
