Jaundice (Gallstones and Pancreatitis)

Flashcards about Jaundice, Gallstones, and Pancreatitis, based on lecture notes.

What are the causes of pre-hepatic jaundice?

Sickle cell, Malaria, G6PD deficiency

What are the causes of hepatic jaundice?

Gilbert's syndrome, Crigler-Najjar syndrome, Hepatitis, Cirrhosis, Hepatocellular carcinoma, Alcoholic liver disease, Primary biliary cirrhosis, Primary sclerosing cholangitis

What are the causes of post-hepatic jaundice?

Obstruction of bile ducts: Pancreatitis, Gallstones, Cholangiocarcinoma, Cholangitis, Pancreatic malignancy, Lymphoma

In pre-hepatic jaundice, is bilirubin conjugated or unconjugated?

Unconjugated

In post-hepatic jaundice, is bilirubin conjugated or unconjugated?

Conjugated

What are gallstones?

Small, hard deposits formed abnormally in the gallbladder or biliary tree from bile pigments, cholesterol or calcium

What are the types of gallstones?

Pure cholesterol (10%), Pure pigment (10%), Mixed (80%)

What are the risk factors for gallstones?

Age and female sex, Family History, Pregnancy, Diet and lifestyle, Obesity, Rapid weight loss, Medical conditions, Diabetes Mellitus, Dyslipidaemia

What is biliary colic?

Intermittent epigastric pain caused by a stone impacted in Hartmann's pouch/cystic duct, resulting from gallbladder contraction.

What is acute cholecystitis?

Inflammation of the gallbladder due to chemical/bacterial irritation at the site of an impacted stone.

What is Murphy's sign?

Place your hand on patient's RUQ, ask them to take a deep breath. If their breath catches due to pain on inspiration – this is a + sign

What is ascending cholangitis?

A stone that obstructs the common bile duct, causing an infection to develop behind the stone

What is Charcot's Triad?

RUQ pain + jaundice + fever (seen in ascending cholangitis)

What is Reynold's Pentad?

Charcot's Triad + confusion + hypotension (seen in ascending cholangitis)

What are the benefits of ERCP?

It is both a diagnostic and therapeutic intervention as allows direct visualisation of the biliary system. It is also possible to remove gallstones/sludge or perform sphincterotomy using ERCP.

What are the risks of ERCP?

Bleeding, infection, perforation, pancreatitis (5- 10%), cholangitis

What are the causes of acute pancreatitis (I GET SMASHED)?

Idiopathic, Gallstones, Ethanol (alcohol), Trauma, Steroids, Mumps and other infections, Autoimmune (IgG4), Hypertriglyceridaemia, hypercalcaemia, ERCP, Drugs

What is the first line investigation for suspected pancreatitis?

Serum amylase – 3 times the upper limits

What are the Atlanta Guidelines for acute pancreatitis diagnosis

2/3 of the following criteria: Abdominal pain consistent with the disease, Serum amylase +/- lipase x3 upper limit of normal, Characteristic findings on abdominal imaging

How is the severity of acute pancreatitis assessed?

Ranson score, Glasgow-Imrie scale, CT severity index

How is mild pancreatitis managed?

Fluids, Analgesia +/- anti-emetics, Abdominal US (<24 hrs of admission), Oral diet

How is moderate to severe pancreatitis managed?

Aggressive fluids resus, Nutrition: NPO, NJ tube, IV analgesia, Strict fluid ins and outs monitoring, Antibiotics may be used

What are the complications of pancreatitis?

Pseudocyst formation, Necrotising pancreatitis, ARDS, Pleural effusions, Acute kidney injury, Disseminated intravascular coagulation