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MD2 Surgery and Anaesthesia > Upper Abdominal Pain > Flashcards

Upper Abdominal Pain Flashcards

1
Q

Where is Hartmann’s pouch, and what is its relevance?

A

In gallbladder

Can get stone stuck in there > acute cholecystitis

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2
Q

What is inside Calot’s triangle?

A

Cystic artery

Cystic node

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3
Q

What is the venous drainage of the gallbladder?

A

Drained directly into liver via series of small veins

Therefore, cancer of gallbladder goes straight to liver

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4
Q

What is the clinical presentation of biliary colic?

A 
Episodic
In epigastrium and right subcostal to right infrascapular
After fatty meals - 30 min-2 hours
Lasts at least 15 min
Associated nausea
Usually abdominal exam normal
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5
Q

Why does biliary colic occur after fatty meals?

A

CCK released > gallbladder contracts > stone obstructs opening

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6
Q

Why can you sometimes get left-sided pain with gallstones?

A

Embryologically, gallbladder central organ, so pain can be either side

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7
Q

What is the gold standard for diagnosis of gallstones?

A

Ultrasound

Seen as acoustic shadow behind stone

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8
Q

What is the normal diameter of the bile duct?

A

Usually 3-4 mm

Dilates to 8-10 mm after cholecystectomy

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9
Q

What are cholestatic symptoms?

A

Jaundice
Dark urine
Pale stools

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10
Q

What is the clinical presentation of pancreatitis?

A 
Sudden onset
Severe epigastric pain radiating to back
Nausea and vomiting
Unwell
Lying very still
Raised lipase
Deranged LFTs
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11
Q

Why can breath sounds be reduced at the bases in acute pancreatitis?

A

Big breath > diaphragm impinges on pancreas

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12
Q

What is the relationship between deranged serum calcium and pancreatitis?

A

Hyper-calcaemia rare cause of pancreatitis

Pancreatitis can cause hypocalcaemia

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13
Q

What are hypoxia and acidosis in acute pancreatitis markers of?

A

Severe pancreatitis

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14
Q

Why is an erect chest x-ray done whilst investigating upper abdominal pain?

A

?Free gas under diaphragm

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15
Q

Why are patients with their first bout of pancreatitis often sent to ICU?

A

Usually most severe episode

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16
Q

What are the four most common causes of acute pancreatitis?

A

Idiopathic
Gallstones
Ethanol
Trauma

17
Q

What is LDH in acute pancreatitis a marker of?

A

Severity

18
Q

Why is CT performed in acute pancreatitis?

A

Usually not needed to make diagnosis

Performed at weekly intervals in severe pancreatitis to demonstrate complications

19
Q

What is a complication of ERCP?

A

Iatrogenic pancreatitis

20
Q

What is the Ranson scoring system used for?

A

Assessing severity of pancreatitis

21
Q

What is the management for mild pancreatitis?

A

Fasting
Analgesia
Gallstone pancreatitis
- Laparoscopic cholecystectomy + operative cholangiogram once pancreatitis resolved

22
Q

What is the management for severe pancreatitis?

A 
Supportive care
- Admit to ICU
- Fluid resuscitation
- O2 +/- ventilation
- Inotropes
- Haemofiltration
- Analgesia
Specific measures
- ERCP
- Abx
- Nutrition
Treat complications
23
Q

What are the complications of severe pancreatitis, and how are they treated?

A 
Infected necrosis
- Open, minimally invasive/endoscopic necrosectomy
Pancreatic abscess
- Ope/percutaneous drainage
Pancreatic pseudocyst
- Usually resolves if 6 cm or less
- Otherwise, surgical drainage into stomach/small intestine/endoscopic drainage into stomach
Haemorrhage
- Embolisation
24
Q

What is Charcot’s triad?

A

Pain
Fever
Obstructive jaundice

25
Q

What do dark urine and pale stools mean?

A

Obstructive jaundice

26
Q

What is Charcot’s triad a clinical presentation of?

A

Acute cholangitis

27
Q

What is the management for cholangitis?

A

Life-threatening!
Resuscitation
Broad spectrum Abx
- Ampicillin + gentamicin +/- metronidazole/tazobactam + pipericillin
Early (within 24 hours) ERCP/endoscopic sphincterotomy/extraction of stone
Laporoscopic cholecystectomy (within 3 weeks)

28
Q

How can cholangitis cause septicaemia?

A

Bile usually has low-grade bacteria > obstruction > stasis > bacteria multiply > high back pressure pushes bacteria to liver > enter blood stream > septicaemia

29
Q

Of what is painless jaundice a hallmark?

A

Carcinoma of head of pancreas

30
Q

What is Courvoisier’s sign?

A

Non-tender, palpable gallbladder under right costal margin

31
Q

What is CA19.9 a tumour marker for?

A

Pancreatic
Gallbladder
Common bile duct

32
Q

Why can you get coagulopathy if you have jaundice?

A

Bile not flowing > fat-soluble vitamins not being absorbed, including vitamin K

33
Q

Which cancer survivals are measured in two years, not five?

A

Pancreatic cancer

Oesophageal

34
Q

How is suitability for resection in pancreatic cancer assessed?

A

Actively look for reasons not to resect = metastases
Exclude advanced local disease
- Superior mesenteric artery encacement
- Coeliac/para-aortic lymphadenopathy

35
Q

How is pancreatic cancer confirmed if resection is not possible?

A

Endoscopic US-guided fine needle aspiration

36
Q

What does palliation for pancreatic cancer involve?

A

Relieve billiary obstruction, usually with ERCP
- Metal stent if reasonable expectation of survival
- Plastic stent if limited survival
+/- palliative chemotherapy
Supportive care

MD2 Surgery and Anaesthesia (31 decks)

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