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HPB SURGERY - Coggle Diagram
HPB SURGERY
Gallstones
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Biliary colic
Colicky abdo pain in RUQ, may radiate to tip of scapula + N&V
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Cholecystitis
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Severe RUQ pain, with N&V, pyrexia, positive Murphy's sign
Grade 2 - elevated WBC, palpable RUQ mass, Sx >72hrs, marked local inflammation
Grade 3 - CVS, renal, hepatic, haematological or neuro dysfunction
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Gallstones made up of cholesterol, bilirubin & calcium salts. 75% cholesterol, black gallstones = bilirubin + mucin glycoproteins, brown = calcium & occur in bile duct normally with infection
Choledocholithiasis
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Vague epigastric pain, jaundice (scratch marks), sometimes fever &/or rigors
Courvoisier's law - jaundice in a patient with a painless palpable enlarged gallbladder is unlikely to be gallstones
Mirizzi syndrome - common hepatic duct obstructed by extrinsic compression from impacted stone in cystic duct or gallbladder infundibulum
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Cholangitis
Charcot's triad - RUQ pain, jaundice & fever
Severe acute cholangitis = Reynold's pentad - RUQ pain, jaundice, fever, hypotension, altered metnal status
Treatment = IV antibiotics & removal of stones via ERCP once resolved. Urgent drainage can be done by ERCP or PTC (percutaneous transhepatic cholangiography)
Gallstone pancreatitis
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Obstruction = local inflammation & bile reflux into pancreatic duct = activates normally non-activated pancreatic juice causing autodigestion
Investigations
Imaging
Abdo U/S, MRI has high sensitivity, ERCP (seldom used only for diagnosis)
Bloods
WCC, CRP, serum bilirubin, ALP & GGT, ALT & AST
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