Pancreatic And Hepatic Disorders

Front 1

T or F in asymptomatic gallstones need to be tx with surgery?

Back 1

-false, NO surgery only if the gallstone is greater than 3 cm

Front 2

What are symptoms of gallstone disease?

Back 2

fever, pain, guarding in RUQ, biliary colic, + murphys sign

Front 3

What labs would be abnormal in cholelethiasis?

Back 3

-mild leukocytosis, high bilirubin (2-3mg), alkaline phosphatase and transaminase

Front 4

What is a major complication of cholecystectomy?

Back 4

- injury to the common bile duct resulting in chronic biliary stricture, infection or cirrhos

Front 5

What is the treatment for acute cholecystitis?

Back 5

-start antibiotics for gram negative anaerobes (second gen cephalosporin), blood cultures, IV fluids, NPO
- schedule lap chole in 2-3 days

Front 6

So if you have a pt with symptomatic cholelithiasis, with elevated alkaline phos and increased bili what should you think?

Back 6

-suspect common bile duct obstruction when a pt has jaundice or elevated liver enzymes

Front 7

What is the treatment plan for common bile duct stone?

Back 7

- ERCP followed by lap chole or lap chole with intraoperative cholangiogram

Front 8

What is the management in a pt with symptomatic cholelithiasis and elevated amylase?

Back 8

- if pt does not have symptoms of pancreatitis then it is irrelevant and return to normal. Then the cholecystectomy and operative cholangiography many be performed

Front 9

What test is need in a pt with biliary pancreatitis?

Back 9

- Cholangiogram

Front 10

What are some symptoms ass. with pancreatitis?

Back 10

- high fluid requirement, hypocalcemia, oliguria, hypotension, pulmonary complications and you must delay cholecystectomy

Front 11

How does empyema of the gallbladder present on US?

Back 11

- U/S: distended gb with fluid htat has internal echoes and gallstones, pt will have fever, RUQ pain

Front 12

What is the management of empyema of the gb?

Back 12

IV antibiotics, emergent exploration with cholecystectomy

Front 13

What is your dx with a US that showed dilated common bile duct, and air in the biliary system and removal of the gb?

Back 13

- suppurative cholangitis which results from bacteria in the cbd

Front 14

What is the treatment for suppurative cholangitis?

Back 14

- ERCP with sphincterotomy and decompression of the biliary tree and stone removal

Front 15

T or F
Elderly pt may manifest sepsis with hypothermia and leukopenia?

Back 15

TRUE

Front 16

What is the concern with an "palpable gallbladder" that is inflamed and fever?

Back 16

RUPTURE!
-they need to go to the OR quickly

Front 17

What would dx if a pt is bilirubint 9, fever, RUQ pain and tenderness?

How do you want to work this pt up?

Back 17

acute cholangitis

resuscitation, antibiotics, U/S of biliary tree
- if obstruction is seen the ERCP and bilary decompression is warranted

Front 18

Somthing to Know: flip card

Back 18

A common duct stone occuring within 2 years after cholecystectomy is a retained stone BUT
- after 2 years is termed a primary common bile duct stone

Front 19

What is the tx for biliary strictures?

Back 19

choledochojejunostomy (pg 177)
or endoscopic dilation

Front 20

What is the tx with acute cholangitis

Back 20

RUQ U/S if stones IV antibiotics, ERCP with stone extraction, lap chole

Front 21

What is a HIDA scan and what is it good for?

Back 21

good for detecting biliary leaks and acute cholecystitis

Front 22

What is the ddx in painless Jaundice?

Back 22

CA at head of pancreas
Klatskin tumor
stricture in common bile duct
stone at ampulla

Front 23

What do you think of a pt with intermittent symptoms of abd pain, jaundice, fever, and chills?

Back 23

Common bile duct stone that are at the ampulla

Front 24

What is the next step in a pt with painless jaundice, no gallstones on US or pancreatic masses?

Back 24

CT of the abdomen son

Front 25

What pt are considered inoperable in pancreatic CA?

Back 25

with distant mets
NO mets to liver
confirmed metastases are signs of incurable disease

Front 26

What is one of the first things to do when operating on a pancreatic CA

Back 26

assessing for metastatic disease or invasion of tissue

Front 27

What is the next step in a pt with painless jaundice, US with dilated intrahepatic ducts but not common bile duct?

Back 27

Cholangiocarcinoma: tumor of the biliary tree at the biurcation of the hepatic ducts

Next step: ERCP or percutaneous transhepatic cholangiography with biopsy

if CA order CT if no signs of metz then exploration with resection

Front 28

What is the management of a pt with uncomplicated pancreatitis?

Back 28

NPO, IV hydration, pain control, observation

Front 29

Pt presents wtih abd pain, elevated amylase, hypotension, hypoxemia, multiorgan failure....what is the dx?

Back 29

severe necrotizing pancreatitis + systemic inflammatory response syndrome

tx: major fluid resuscitation