Liver, Biliary Tract, Pancreas

GMS/Surgery Ang Li

This is going to be a long lecture. Try to stay awake Ben....

Gall bladder

Gall stones BIG TOPIC need to know this well. Gall bladder cancers - need to know the differences in presenting symptoms.

Gallstones

Mixed, Cholesterol (yellow) and Pigment (green-black) stone types. Imbalances in bile composition lead to their formation:

Abnormal anatomy Haemolytic infection/disease DM, Pregnancy, Diet affect cholesterol composition. Crohns

Clinical Features

Biliary colic severe, colicky, RUQ pain

Pancreas
- An organ with exocrine AND endocrine functions. Will only deal with exocrine in this lecture. - Acute Pancreatitis - Chronic Pancreatitis - Pancreatic Cancer

Acute Pancreatitis

Pancreatic inflammation, with auto-digestion from released pancreatic enzymes. Patient can present with:

Mild to Severe epigastric pain, radiating to the back. Usually sudden onset. Signs of hypovolaemic shock Vomiting/Nausea More academic signs include (Grey-Turner, Cullen's sign) Mild jaundice

Mild pancreatitis will show with epigastric pain, nausea and vomiting and possibly jaundice. Severe pancreatitis will show with extreme epigastric pain, hypovolaemic shock, absent bowel sounds, resp. + renal problems.

Causes of acute pancreatitis

I GET SMASHED GET are the three most important to remember. Idiopathic, Gallstones, EtOH, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hyperlipidaemia, ERCP, Drugs (furosemide)

Investigations

Serum Amylase >1000 IU/L is diagnostic. (range 21-101 IU/L)

Management

Resuscitate For patients with mild disease : Fluids, Analgesia, monitor pulse, BP and temp. for deterioration. In sever disease get ICU involved. Close invasive monitoring required.

Chronic Pancreatitis

Liver