UGI and Hepatobiliary Flashcards
Typical bacteria causing ascending cholangitis:
e.coli
Reynold’s pentad:
Charcot’s triad + hypotension and confusion
Management ascending cholangitis:
- IV antibiotics
- ERCP after 24-48 hours to relieve obstruction
4Fs risk factors for biliary colic:
- fat
- female
- fertile
- forty
(other: diabetes, Crohn’s, rapid weight loss, vibrates, COCP)
Features of cholangiocarcinoma:
- persistent biliary colic symptoms
- anorexia, jaundice, weight loss
- palpable mass in RUQ (Courvoisier sign)
- periumbilical lymphadenopathy (Sister Mary Joseph nodes)
- left supraclavicular adenopathy (Virchow node)
Main risk factor for cholangiocarcinoma:
primary sclerosing cholangitis
Causes of chronic pancreatitis:
- alcohol excess
- genetic: cystic fibrosis, haemachromatosis
- ductal obstruction: tumours, stones, structural abnormalities: pancreas divisor and annular pancreas
Investigation chronic pancreatitis:
- xray: pancreatic calcification
- CT more sensitive
- faecal elastase
Management chronic pancreatitis:
- pancreatic enzyme supplements
- analgesia
- antioxidants
What type of cancer are most gallbladder cancers?
adenocarcinomas
What is porcelain gallbladder?
- intramural gallbladder wall calcification
- result of chronic cholecystitis
Gallbladder cancer TNM staging:
T1 - invades lamina propria and/or muscular layer
T2 - tumour invades perimuscular connective tissue without involvement of visceral peritoneum or liver
T3 - invades visceral peritoneum and/or liver and/or adjacent organ
T4 - tumour invades vascular structures and/or invades 2 or more adjacent organs
When is gallbladder cancer resection contraindicated:
- metastatic disease
- malignant ascites
- vascular invasion
What is gastric MALT lymphoma?
- H pylori 95%
- good prognosis
- if low grade 80% respond to H pylori eradication
- paraproteinaemia may be present
Complications of laparoscopy:
- vasovagal reaction in response to abdominal distension
- extra peritoneal gas insufflation: surgical emphysema
- injury to gastro intestinal tract
- injury to blood vessels
Causes of bilious vomiting in neonates:
- duodenal atresia
- malrotation with volvulus
- jejunal/ileal atresia
- meconium ileus
- necrotising enterocolitis
Duodenal atresia:
- few hours after birth
- AXR shows double bubble sign
Malrotation with volvulus:
- 3-7 days post birth
- compromised circulation causes peritoneal signs and haemodynamic instability
- UGI contrast study shows DJ flexure more medial
- USS may show abnormal orientation of SMA and SMV
Jejunal/ileal atresia:
- within 24 hours of birth
- AXR: air fluid levels
Meconium ileus:
- first 24-48 hours
- abdominal distension and bilious vomiting
- air: fluid levels on AXR, sweat test to confirm cystic fibrosis
Necrotising enterocolitis:
- usually second week of life
- dilated bowel loops on AXR, pneumatosis and portal venous air
