ABC of Liver, Pancreas and Gall Bladder (ABC Series) by Beckingham

By Beckingham

A evaluate of scientific and surgical difficulties affecting the liver, pancreas and biliary approach. This publication offers the fundamental details for clinical and nursing scholars, GPs and junior health center medical professionals regularly scientific and surgical education. It offers algorhithms for diagnosing and treating universal ailments (e.g. gallstones, hepatitis) in addition to info for referring, and permitting knowledgeable dialogue with sufferers concerning remedy and diagnosis of rarer stipulations akin to malignancies and transplantation.

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Computed tomography is useful to identify other intra-abdominal abscesses. Endoscopic retrograde cholangiopancreatography is used to define the site and cause of biliary obstruction and to allow biliary stenting and drainage. Treatment Empirical broad spectrum parenteral antibiotic treatment should be started as soon as an abscess is diagnosed. Antibiotics should include penicillin, an aminoglycoside, and metronidazole, which are effective against E coli, K pneumoniae, bacteroides, enterococcus, and anaerobic streptococci.

True polycystic liver disease is seen as part of adult polycystic kidney disease, an uncommon autosomal dominant disease that progresses to renal failure. Patients nearly always have multiple renal cysts, which usually precede development of liver cysts. Liver function is normal, and most patients have no symptoms. Occasionally the cysts cause pain because of distension of the liver capsule, and such patients may require cyst fenestration or partial liver resection. Thick walled cysts and those containing septa, nodules, or echogenic fluid may be cystic tumours (cystadenoma, cystadenocarcinoma) or infective cysts (hydatid cysts and abscesses; see later article in this series), and patients should be referred for specialist surgical opinion.

Abdominal ultrasonography is indicated at an early stage to identify gall stones and exclude biliary dilatation. The pancreas is visible in only 30-50% of patients because of the presence of bowel gas and obesity. When visible it appears oedematous and may be associated with fluid collections. Small gall stones may be missed during an acute episode, and if no cause is found patients should have repeat ultrasonography six to eight weeks after the attack. In patients in whom a diagnosis of pancreatitis is uncertain, early computed tomography is useful to look for pancreatic and peripancreatic oedema and fluid collections.

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