Dr.mohammed August 28, 2016
1
DDX of jundice +fever+ abd. Pain
1-stone in CBD
2-acute cholecystitis
3-CA oh head of pancreas
4-acute hepatitis
The patient with jaundice here
the first investigation to be done is liver
function test because he is from Hx carry
high suspicion of Acute hepatitis
Second investigation is U/S
-
Third investigation is MRI and MRCP
.
patient with perforated D.U
-
First investigation is plain X-ray
Second one is U/S
* complication of ERCP
1- acute pancreatitis
2 _ bleeding
3 _ perforation
m acute abdomen refers to a
The ter
-
sudden, severe abdominal pain of unclear
etiology that is less than 24 hours in
duration. It is in many cases a medical
emergency, requiring urgent and specific
diagnosis. Several causes need surgical
treatment.
Mx of pt with stone in CBD ?
1-removal of stone by ERCP
Pareparation of pt with obstructive jaundice for surgery(including ERCP)
1-rehydration of pt to avoid RF
2-AB
3-Vit.K
Then we will do cholecystectomy
Mx of pt with jaundice d/t Ca of head of pancreas?
Tests to asses liver functions:
S. Bilirubin (0.3 – 1mg %)
Amino transferase enzymes:
o Alanine amino transferase (ALT)
o Aspartate amino transferase (AST)
Alkaline phosphatase (3-13 KA %)
raised in pt. with cholestetic jaundice as they are present in
the membrane of cells and in the canaculi.
to differentiate bt. the hepatic and extra hepatic ALP we do
1- ALP isoenzymes test
2- y-Glutamyl transferase
3- 5-nucleotidase
Plasma protein:
o Albumin
o Globulin
Immunoglobulins:
o IgG
o IgM
o IgA
Coagulation factors
Prothrombin time
o Prolonged prothrombin time – acute liver disease
1 2 5 7 10
o Prolonged prothrombin time – Cholestatic jaundice
2 7 9 10
Serological tests: for hepatitis A, B and C and other viruses
Auto antibodies
α feto protein
α1 anti trypsin α 1 globulin
Caeruloplasmin α 2 globulin
S. Copper
S. Ferritin, S. iron S.iron binding capacity
(BSP) Bromsulphthalein test-for Dubin-Jonhnson's
syndrome
Dr.mohammed August 28, 2016
2
T-tube(in remix p27)
Medical causes of abdominal pain ?
1-Ischaemic Heart Disease
2-Pleural Inflammation
3-DKA
4-Sickle Cell Disease
5-Henoch–Schönlein Purpura
porphyrja
-
7
Malaria
-
6
Sudden abdominal pain (epigastric) DDX ???
1-PDU
2-acute cholecystitis
DDx of air under diaphragm ??
1-perforated PU
2-perforated other than pu(other organ)
3-previous laparotomy
4-pneumonitis colitis
5-reptured H.cyst
Rx of PU is by closure of perforation by suturing