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GIHEP > 11. Gallstones and Pancreatitis > Flashcards

11. Gallstones and Pancreatitis Flashcards

1
Q

What are gallstones made from?

A

Bile and sometimes calcium

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2
Q

What imaging is used to see gallstones?

A

Ultrasound

Calcified can be seen on x ray

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3
Q

What is cholelithiasis?

A

Stones in the gallbladder

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4
Q

What is choledocholithiasis?

A

Stones in the common bile duct

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5
Q

What are the predisposing factors to gallstones?

A

Older, female
Obesity, diabetes, high fat diet
High oestrogen
Gall bladder hypomobility

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6
Q

What are the causes of gall bladder hypomobility?

A

Low CCK due to rapid weight loss, bariatric surgery

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7
Q

What conditions cause gallstones to be predominantly bilirubin/pigment stones?

A

Crohn’s disease (both bilirubin and cholesterol stones)
Cirrhosis
Haemolysis
Parasites

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8
Q

What are the symptoms of gallstones?

A

Biliary colic
RUQ or epigastric pain lasting 30 mins to 4 hours
Radiating to back and right shoulder

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9
Q

What is the differential for gallstones?

A 
Dyspepsia
Peptic ulcer disease
Acute pancreatitis
Oesophageal pain
MI
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10
Q

What are the complications associated with gallstones?

A

Acute cholecystitis
CBD obstruction
Mirizzi syndrome
Gall bladder adenocarcinoma

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11
Q

What are the consequences of CBD obstruction?

A

Obstructive jaundice
Ascending cholangitis
Acute pancreatitis

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12
Q

What is Mirizzi Syndrome?

A

Obstruction to CBD by external compression from impacted gallstones

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13
Q

What is acute cholecystitis?

A

Cystic duct obstruction causes stasis in the gall bladder and secondary infection

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14
Q

What are the signs and symptoms of acute cholecystitis?

A

Fever, high WCC
Nausea, vomiting and RUQ pain for days
Positive Murphy’s sign
No jaundice

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15
Q

What is the treatment for acute cholecystitis?

A

Fluid, analgesia, antibiotics

Cholecystectomy

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16
Q

What complications are associated with acute cholecystitis?

A

Empyema, mucocoele
Risk perforation and peritonitis
Fistula with duodenum

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17
Q

What is chronic cholecystitis?

A

At autopsy gallbladder is chronically inflammed
Shrunken with thick muscle
Never symptomatic

18
Q

What is the treatment for gallstones?

A

If symptomatic remove laproscopically

19
Q

What are the causes of extrahepatic bile duct obstruction?

A

Gall stones in CBD
Tumour
Benign strictures (PSC)
Mirizzi syndrome

20
Q

Which tumours can obstruct bile ducts?

A

Pancreatic adenocarcinoma
Extra-hepatic bile duct adenocarcinoma
Lymph node mets

21
Q

How is extrahepatic bile duct obstruction investigated?

A

Dilated ducts can be seen above obstruction on ultrasound

MRCP (MRI for hepatic system)

22
Q

What is the treatment for extrahepatic bile duct obstruction?

A

Remove stones or put in stent

23
Q

What is ascending cholangitis?

A

Infection of static bile

24
Q

What is Charcot’s triad of ascending cholangitis?

A

Fever
Pain
Jaundice

25
Q

What is Reynold’s pentad of ascending cholangitis?

A

Charcot’s triad
Hypotension
Altered mental state

26
Q

What are the causes of hepatic abscesses?

A

Biliary tract disease with ascending infection

Septic emboli

27
Q

What are the effects of acute pancreatitis?

A

SIRS
Hypocalcaemia, hyperglycaemia
Ileus
Extensive necrosis, pseudocysts, fistula

28
Q

What are the causes of acute pancreatitis?

A 
Gall stones
Alcohol
Post ERCP
Trauma, ischaemia, major surgery
Drugs, viral
Hyper calcium or lipids
29
Q

What pain is associated with acute pancreatitis?

A

Epigastric pain radiating to back

30
Q

What is the differential for acute pancreatitis?

A

MI
Ruptured AAA
Ischaemic organs

31
Q

What blood test shows acute pancreatitis?

A

Amylase 3x higher than normal

32
Q

What is the treatment for acute pancreatitis?

A

Resuscitate
Analgesia, fluids
nil PO
Treat complications, antibiotics, debridement

33
Q

What is chronic pancreatitis?

A

Fibrosis and inflammation of pancreas

Function impaired and ducts distorted

34
Q

What are the causes of chronic pancreatitis?

A

Alcohol

CF

35
Q

What are the symptoms of chronic pancreatitis?

A

Dull epigastric pain radiating to back
Weight loss, steatorrhoea
Secondary DM

36
Q

What is the treatment of chronic pancreatitis?

A

Analgesia

Enzyme supplements

37
Q

Why is a pancreatic pseudocyst not a true cyst?

A

Not lined by epithelium

38
Q

What are the causes of pancreatic pseudocyst?

A

Pancreatitis
Pancreatic surgery
Trauma

39
Q

What complications are associated with pancreatic pseudocyst?

A

Pain/pressure
Infection
Erosion: blood vessel damage, fistula

40
Q

What can be seen on histology in chronic pancreatitis?

A

Fibrosis
Cysts
Loss of functional acini

GIHEP (30 decks)

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