NMS. Casos Clínicos

7 Chapter Pancreatic and Hepatic Disorders Bruce E. Jarrell • Eric D. Strauch

Cutting to the Chase Common Pancreaticobiliary Disorders 1. The natural history of asymptomatic gallstones is benign, and cholecystectomy is not recommended. 2. In most cases, acute cholecystitis should be treated with antibiotics followed by cholecystectomy within several days. 3. Painful jaundice is typically secondary to biliary obstruction due to common bile duct (CBD) stones. 4. Painless jaundice is associated with distal biliary obstruction from tumors. 5. Biliary obstruction due to stones should be treated with removal of the stones by endoscopic retrograde cholangiopancreatography (ERCP), in most cases followed by cholecystectomy or operative common duct exploration at the time of cholecystectomy. 6. Gallstone pancreatitis usually resolves with hydration and observation. Treatment includes evaluating the CBD for the presence of stones, often without the need for ERCP, and removing the gallbladder after the pancreatitis improves to prevent recurrence. 7. Acute cholangitis is suggested by right upper quadrant (RUQ) pain, fever, and jaundice. The patient should receive antibiotics and fluid resuscitation, followed by ERCP and relief of the obstruction. Cholecystectomy is performed after recovery from the sepsis and acute illness. 8. Resected ampullary cancer has the best long-term survival of the pancreatobiliary cancers obstructing the distal CBD. 9. Most pancreatic pseudocysts resolve spontaneously. Common Hepatic Disorders 10. Cystic liver lesions are usually simple cysts, are not usually symptomatic, and do not require surgery. In the presence of fever, sepsis, and internal echoes in the cyst on ultrasound, it may represent an abscess, which is usually drained percutaneously. SAMPLE

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