Bile Duct

Question 1

What is primary biliary cirrhosis/cholangitis?

Answer 1

Rare autoimmune disease (mainly females) - granulomas + bile duct loss

Question 2

How does primary biliary cirrhosis (PBC) affect the liver?

Answer 2

Turns it green - due to trapped bile

Question 3

What autoimmune condition affects males more than females?

Answer 3

Primary Sclerosing cholangitis (fibrosis of the bile ducts leading to increased risk of malignancy)

Question 4

How is primary biliary cirrhosis/cholangitis treated?

Answer 4

Urseo deoxycholic acid

Question 5

How is primary biliary cirrhosis/cholangitis diagnosed?

Answer 5

Cholestatic LFTs (ALP + GGT) 
\+ liver biopsy (to confirm)

Question 6

What are the symptoms of gall stones in the majority of patients?

Answer 6

None - asymptomatic

Question 7

What are pigment stones (gall stones)?

Answer 7

Black gall stones - produced from bilirubin

Question 8

What is ascending cholangitis?

Answer 8

A blockage of the bile duct with a galls stone that causes bacteria to accumulate above it and infection to occur which tracks backwards towards the liver

Question 9

What is cholecystitis?

Answer 9

Inflammation of the gall bladder associated with gall stones - can be acute or chronic

Question 10

What is the major complication of acute cholecystitis?

Answer 10

Empyema which can rupture and cause peritonitis

Question 11

What changes occur in chronic cholecystitis?

Answer 11

thickening and fibrosis of the gall bladder wall causing it to become non-functional

Question 12

What is the anatomical complication of surgery of the pancreas?

Answer 12

The head is attached firmly to the duodenum meaning it can’t be resected without the duodenum

Question 13

Which 2 functions can pancreatic disease affect?

Answer 13

Exocrine (malnutrition) + endocrine (diabetic) functions

Question 14

What sign int he blood is indicative of pancreatitis?

Answer 14

Serum amylase - amylase not usually present in the bloodstream

Question 15

What is the prognosis for pancreatic cancer?

Answer 15

Very poor - usually asymptomatic until too late to treat
Affects a lot of surrounding structures if metastatic (direct spread, spread through SMV bloodstream to liver, spread to lymph nodes)

Question 16

What are the reasons for gall stone formation?

Answer 16

Abnormal bile composition,
Stasis of bile,
Infection,
Excess bilirubin, 
Excess cholesterol

Question 17

What happens in acute cholecystitis?

Answer 17

Inflammation in gall bladder due to obstruction of the cystic duct, starts off sterile however becomes infected

Question 18

What is the gold standard for gall stone diagnosis?

Answer 18

Abdominal ultrasound (can also be seen on CT)

Question 19

How is cholecystitis treated?

Answer 19

Nil by mouth

IV fluids + antibiotics

Question 20

If a gall stone enters the common bile duct what are the risks?

Answer 20

Acute pancreatitis,
Jaundice,
Cholangitis

Question 21

How can gall stones be removed?

Answer 21

ERCP (can also do diagnosis) or surgery

Question 22

What causes acute pancreatitis?

Answer 22

Alcohol + gallstones

Question 23

What is cancer of the bile duct called?

Answer 23

Cholangiocarcinoma

Question 24

How is cancer in the bile duct treated?

Answer 24

Surgery - bile duct + liver resection

Question 25

How is colangiocarcinoma diagnosed?

Answer 25

ERCP
Spiral CT
Ultrasound

Question 26

Which LFTs, when abnormal , indicate duct duct damage?

Answer 26

ALP + GGT