CORE SURG > hepatobiliary surgery > Flashcards

hepatobiliary surgery Flashcards

(41 cards)

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1
Q

at what level of bilirubin is jaundice usually seen?

A

> 35 mmol/L

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2
Q

normal serum bilirubin?

A

3-17 mmol/L

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3
Q

causes of prehepatic jaundice?

A
  • autoimmune hemolytic anemia
  • drug toxicity
  • transfusion reaction
  • congenital - hereditary spherocytosis, sickle cell
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4
Q

causes of hepatic jaundice?

A
  • gilberts (unconj)
  • crigler-najjar (unconj)
  • viral hepatitis
  • alcoholic liver disease
  • toxic drug jaundice
  • metastatic disease
  • dubin johnsin
  • rotor
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5
Q

causes of post hepatic jaundice - intraluminal causes ?

A

choledocholithiasis

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6
Q

causes of post hepatic jaundice - mural causes ?

A
  • primary sclerosing cholangitis

- biliary stricture

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7
Q

causes of post hepatic jaundice - extrinsic causes ?

A
  • carcinoma of head of pancreas, ampulla of vater or bile duct
  • chronic pancreatitis
  • enlarged lymph nodes in porta hepatis
  • mirizzi syndrome
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8
Q

what is mirizzi syndrome?

A

-external biliary compression from a stone impacting the neck of the gallbladder

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9
Q

what is charcots triad?

A

Triad seen in ascending cholangitis?

  • RUQ pain
  • fever and rigors
  • jaundice
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10
Q

murphys sign suggests…

A

gallbladder inflammation

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11
Q

Courviousiers law

A

A painless, palpable gallbladder in a patient with jaundice is unlikely due to gallstone disease and may suggest malignant obstruction

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12
Q

what are the three components of bile?

A
  • cholesterol
  • bile salts
  • phospholipids
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13
Q

complications of acute cholecystitis?

A
  • empyema or abscess of gallbladder
  • perforation with peritinitis
  • gallstone ileus
  • jaundice due to compression of adjacent bile duct (Mirizzi)
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14
Q

what is chronic cholecystitis?

A

-attacks of RUQ and tenderness

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15
Q

management of chronic cholecystitis?

A

-analgesia and routine cholecystectomy

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16
Q

patho of a mucocele?

A

-when stones block the neck of the gallbladder and bile is reabsorbed but mucous is continued to be secrete leading to a large tense globular mass in the RUQ

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17
Q

treatment of ascending cholangitis?

Study These Flashcards
A

-IV fluids, antibiotics and relieving the obstruction

18
Q

next ix after ultrasound for ascending cholangitis?

19
Q

next investigation after ERCP for ascending cholangitis?

Study These Flashcards
A

if stone is identified on ERCP -> MRCP or percutaneous cholangiography

20
Q

SEPSIS 6

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A

TAKE 3:

  • lactate
  • blood cultures
  • urine output

GIVE 3:

  • oxygen
  • fluids
  • antibiotics
21
Q

Management of ascending cholangitis:

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A
  • analgesia
  • IV fluids
  • antibiotics
  • oral intake restricted
  • THEN plan for either elective cholecystectomy, or perform during admission
22
Q

I GET SMASHED - aetiologies for pancreatitis?

Study These Flashcards
A 
I-idiopathic
G-gallstones
E-ethanol/alcohol
T-trauma
S-steroids
M-mumps & other infections
A-autoimmune
S-spider/scorpion
H-hypertriglyceridemia
E-ERCP
Drugs and toxins
23
Q

severe pancreatitis can result in…

24
Q

left flank bruising in pancreatitis =

Study These Flashcards
A

grey-turners sign

25
periumbilical bruising in pancreatitis =
cullens sign
26
what is the name of the scale that determines MORTALITy of pancreatitis
ransons
27
what is the name of the scale that determines the SEVERITY of pancreatitis
glasgow
28
BEDSIDE investigations for pancreaittis
-ECG, urine dipstick
29
Blood tests for someone with pancreatitis
-FBC, LFTS, ALK phos, coag, cross match, ca, blood glucose, amylase, electrolytes,CRP ABGs
30
why are lipase and urinary amylase sometimes useful for diagnosisng pancreatitis?
they remain elevated longer than serum amylase
31
Imaging for suspected pancreatitis
``` CXRAY - rule out free air under diagphram Ultrasound for gallstones Abdominal XRAY - CT Endoscopic ultrasound MRCP ```
32
Local complications of pancreatitis
- abscess - pseudocyst - necrosis/gangrene - splenic vein thrombosis/hemorhage - peripancreatic fluid collection
33
what is a pseudocyst?
collection of fluid that does not have epithelial lining
34
Systemic complications of pancreatitis
- sepsis - arythmia - hypovolemia - renal failure - ARDS, pleural effusions, pneumonia - DIC - hyperglycemia - hypocalcemia - death - intestinal hemorhage/ileus
35
Ix for CHRONIC pancreatitis
- abdominal xray - abdominal ultrasound - pancreatic duct dilation - CT - MRCP - ERCP - endoscopic ultrasound combined with aspiration cytology/biopsies - fecal elastase to check endocrine function
36
non-surgical management of chronic pancreatitis
- stop offending agents (alcohol) - decrease fat in diet - creon - insulin (if necessary) - pain control
37
surgical options for chronic pancreatitis (if medical therapy fails)?
- pancreatoduodenectomy (whipples procedure) - partial or distal pancreatectomy - pancreaticojejunostomy
38
most common type of pancreatic cancer
ductal adenocarcinoma
39
tumour marker for pancreatic cancer?
CA-19-9
40
most common endocrine tumour of the pancreas?
insulinoma
41
90% of insulinomas are (benign/malignant)
benign
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