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43 Cards in this Set
- Front
- Back
what organ gives deep epigastric pain radiating to the back
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pancreas:
- tumour - inflam |
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what's the prognosis for pancreatic cancer
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<3% 5yr
worst ca survivial rate lymph node involvement = worse prognosis |
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through what immediate duct does bile enter the duodenum at the major duodenal papillae
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ampulla of vater
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risk factors for gallstones (5F's)
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Female, Fat, Fourty, Fair, FH
DM genetic high cholesterol |
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what 4 components is bile made of
when does gallstones form |
BR, cholesterol, phospholipids & bile salts
when imbalance in ratio of cholesterol: BR: salts |
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3 types of gallstones & cause for each
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PIGMENT: excess BR (haemolysis)
CHOLESTEROL: 5F's MIXED |
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gallstones can cause what 4+ syndromes/ diseases
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cholecystitis (acute/ chronic)
biliary colic pancreatitis (acute/ chronic) post-hepatic/ obstructive jaundice (ascending cholangitis, gallstone ileus) |
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how do gallstones normally present
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90% asymptomatic
others: - biliary colic - cholecystitis - pancreatitis - obstructive jaundice - gallstone ileus - ascending cholangitis |
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what's cholecystitis
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inflammation of the GALLBLADDER, GS in cystic duct---> obstruction of bile outflow
commonly assoc with gallstones --> infection can cause: empyema, rupture, peritonitis, intesne adhesions 2-3days |
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S&Ss acute cholecystitis
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continuous EPIGASTRIC/ RUQ pain
vomiting fever local peritonitis GB mass MURPHY's sign (pain inspiration when palpating) |
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differentiate biliary colic from cholecystitis
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cholecystITIS= inflammatory component;
- fever - ↑WCC - local peritonism BILIARY COLIC: PAIN RUQ, radiates to back +/- jaundice |
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Ix's & treatment for acute cholecystitis
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WCC, USS (thickened GB wall & stones)
NBM, analgesics, IVI, abx's ? cholecystectomy - perforation |
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what is chronic cholecysitis
S&Ss (how different from acute cholecystitis) |
GS in cystic duct--> chronic inflammation of GB +/- colic
vague abdo discomfort distention nausea flactulance intolerance of fats |
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Ix findings (USS) and treatment for chronic cholecystitis
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USS- gallstones, dilated bile ducts, thickened GB wall (not distended!)
ERCP+sphinctometry CHOLECYSTECTOMY |
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if s gallstone is impacted in the amuplla of vater, what does that cause
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pancreatitis
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gallstone impaction in the CBD causes post-hepatic obstruction. If these ducts are infected what disease ensues.
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ascending cholangitis
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how does the pain from biliary colic to acute cholecystitis change
does pain radite |
intermittent (stone in GB and obstructing ducts on contraction only) to constant (impacted in cystic duct)
if inflammation irritates inferior surface diaphragm, pain can radiate to R.shoulder tip. |
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what's are the classic Ix's for gallstone related diseases
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BR, ALP, aminotransferase levels
USS ?MRCP ERCP- interventional! |
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what type of cancer is associates with the GB
- what is it associated with - local invasion of where - prognosis (good/bad) |
rare- ADENOCARCINOMA
associated with gallstones (end stage chronic cholecystitis) invasion of LIVER POOR prognosis |
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what's cancer of the bile ducts called & type
associated with what 2 other diseases presentation |
CHOLANGIOCARCINOMA- adenocarcinoma (rare)
assoc with PSC, UC OBSTRUCTIVE jaundice |
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presentation of acute pancreatitis:
- adults/ children? - S&Ss? |
adults
gradual or sudden SEVERE EPIGASTRIC/ central pain (general or localised) RADIATES to BACK nausea & VOMITING relieved by SITTING forwards/ heat periumbilical DISCOLOURATION ↑HR, hypotension, fever, jaundice, shock reduced/ no BS |
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causes of pancreatitis
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"I GET SMASHED" + shock
Infection Gallstones Ethanol Trauma Steroids Mumups Auto-immune Scorpion vemon Hyperlipidaemia ERCP (iatrogenic) & Emboli Drugs |
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key findings in tests / Ix's for ACUTE pancreatitis
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serum ↑AMYLASE (acutely only)
urinary ↑amylase serum ↑LIPASE ↑CRP ↑glucose ↑ca |
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pathogenesis of pancreatitis
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no outflow- AUTODIGESTION of pancreatic acini (eg lipase, amylase, proteases...)
- fat necrosis - tissue destruction & haemorrhage |
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complications of ACUTE pancreatitis (6)
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infection of nectrotic pancreas---> sepsis---> SHOCK ---> DEATH
PSEUDOCYSTS (peripancreatic fluid collections surrounded by granulation tissue) ABSCESS HYPOCALCAEMIA HYPERGLYCAEMIA (no insulin released to store glucose) |
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causes of CHRONIC pancreatitis
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ALCOHOL
genetic (autosomal dom)= increase ca risk autoimmune CF duct obstruction |
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clinical features S&Ss of CHRONIC pancreatitis
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epigastric pain --> back (severe episodic/ chronic)
wt loss (anorexia/ low lipase) fatigue/ DM (low insulin & glucagon) malabsorption (low enzymes) steatorrhoea (low lipase) jaundice in obstruction |
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pancreatic ca:
- type tumour - associated risk factors - presentation age & sex |
ADENOCARCINOMA- ductal origin (rarely- carcinoid)
smoking, alcohol, DM 1+2, obesity M>60yrs |
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S&Ss pancreatic ca
- characteristic features |
ANOREXIA, WT LOSS, DM, ACUTE PANCREATITIS
head: PAINLESS obstructive JAUNDICE, palpable GB body/tail:dull EPIGASTRIC pain---> BACK relieved by sitting FORWARD |
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Ix's in pancreatic ca
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LFTs- cholestatic jaundice, FBC- anaemic
USS ★CT★ ERCP MRI biopsy? |
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prognosis of acute pancreatitis is directly related to what
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SYSTEMIC inflammatory response--> multiple organ failre
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what surgery is performed for pancreatic ca
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WHIPPLE's op
(pancreatectomy: total, distal, midsegment) (bypass) |
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which hormone stimualtes pancreas to release proteases and collipase
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CCK from I cells of duodenum & pranceras
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secretin:
-released from which cells, where - direct effect on pancreas? - effect of pancreas secretion in response? |
S cells in duodenum secrete SECRETIN-->
pancreatic HCO3 release ---> reduced gastric emptying & secretions, ↑bile secretion |
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which hormone secreted from which cells INHIBIT pancreatic acinar cells
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SOMATOSTATIN released from islets and D cells of pyloric gland area.
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what dig enzymes does the exocrine pancreas (acinar & ductal cells) secrete
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amylase, lipase, colipase, phospholipase,
proteases: -trypsinogen -chymotrypsinogen - procarboxypeptidase |
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GLASGOW prognostic score fro acute pancreatitis 3+= acute severe
what 8 critera are scored ("PANCREAS"0 |
PaO2
Age >55 Neutrophils Ca Renal function (urea high) Enzymes: AST/ALT high Sugar glucose high |
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treatment for acute pancreatitis complicated by pseudocyst or abscess (2)
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majority spontaneously resolve
- large ones >6wks --> USS-guided ENDOSCOPIC DRAINage - SURGICAL DRAINage (when cyst anatomy complicated) CONTROL sepsis |
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treatment of pancreatitis complicated by INFECTED necrosis (2)
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drainage or
necrosectomy & lavage setrile necrosis: conservative mangement |
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Ix findings in chronic pancreatitis (CT/ USS) -(3)
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DILATED pancreatic duct
CALCIFICATION intrapancreatic FLUID collection |
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treatment of CHRONIC pancreatitis
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ALCOHOL & smoking abstinence
pain control STENTING bypass/ resection- PUESTOW procedure DRAINAGE (of pseudocysts, fluid) |
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what's Zollinger-Ellison syndrome
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gastrinoma (endocrine tumour of the pancreas)
↑gastrin = ↑stomach acid = peptic ulceration |
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what is the TNM staging of a tumour
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T= size
1- mucosa 2- submucosa 3- muscle 4- adventitia / peritoneum |