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biliary and pancreatic Flashcards

1
Q

whta is cholecystitis

A

inflam of gallbladder commonlu secondary to gall stones

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2
Q

symptoms of acute cholecystitis

A

fever, RUQ pain, N+V

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3
Q

what sign is illicted in acute cholecystitis

A

Murphys sign

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4
Q

dx of acute cholecystsitis and what would be seen what investigations can be used secondary

A

USS >4cm thickening = DISTENSION
HIDA or MRCP

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5
Q

what is seen in chronic cholecystsits vs acute

what pathology is seen in gallbladder in chronic and not acute

A

chronic is thickened but not distended and
rokitansky aschkoff sinuses- kinda like diverticula

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6
Q

management of acute cholecystitis - acute and surgical

A

conservative - nil by mouth
iv lfuids
iv abx
NG if vom

ERCP or LAP CHOLE

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7
Q

common ascending cholangitis organisms

A
  1. e.coli
  2. klebsiella
  3. enterococcus
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8
Q

casues of ascending cholangitis

A

gallstone obstructing bile flow
ERCP related infection

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9
Q

what is ascending cholangitis

A

infection and inflam of the bile ducts

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10
Q

mangement of Ascending cholangitis

A

ERCP

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11
Q

what is reynolds pentad

A

fever, pain , jaundice, confusion(hepatic encephalopathy) and hypotension

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12
Q

what is courvoisiers law

A

painless palpable gallbladder and jaundice is probable pancreatic cancer

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13
Q

complications of acute chilecystitis

A

mucocele
empyema
fistula
perforation
mirittzi syndrome - external compression of heaptic duct

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14
Q

what conditions are assoc with cholangiocarcinoma

A

PSC, UC

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15
Q

what is klatskin tumour

A

cholangiocarcinoma at the join of hepatic ducts

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16
Q

what tumour marker is used for cholangiocarcinoma

A

CA 19-9

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17
Q

pathophysiology of pancreatitis

A

autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis

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18
Q

what are cullen and grey -turners sign

A

seen in pancreatitis
cullen - peri umbilical bruising
grey-tuenre- flank bruising

19
Q

investigations for pancretitis

A

amylase/lipase

USS - however can be diagnosed clinically

20
Q

which is more sensitive in pancreatitis amylase or lipase

A

lipase

21
Q

how raised is amylase in pancreatitis

A

3x upper limit

22
Q

what is better in delayed presentations of pancreatitis amylase or lipase and why

A

lipase - longer half lfe

23
Q

what scoring system is used to assess severity of pancreatitis

A

GLASGOW

24
Q

what is an indicator of severity in pancreatitis

A

age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

25
Q

what is involved in the glasgow scoring system

A

P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)

26
Q

what drugs casue pancreatitis

A

azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate, sitagliptin

27
Q

main treatment of pancreatitis

A

fluid resus

28
Q

complications of pancreatitis

A

pseudocysts
Peripancreatic fluid collections
necorsis
abscess
aemorrhage

29
Q

what is a systemi ccomplication of pacnreatitis

A

ARDS

30
Q

most common casue of chronic pancreatitis

A

alcohol

31
Q

features/symps of chronic pancreatitis

A

pain worse following meal
steatorrhoea
DM

32
Q

what is seen on the pancreas in chronic pancreatitis

A

calcification

33
Q

investigations for chronic pancreatitis

A

XRAY
CT

34
Q

what test can be used to assess exocrine function of pancreas

A

faecal elastase

35
Q

management of chronic pancreatitis

A

creon - enzyme supplemet

36
Q

most common type of pancreatic tumour

A

adenocarcioma

37
Q

features of pancreatic cancer

A

weightloss, painless jaundice, steatorrhoea, jaundice, diabetes secondary to loss of endorine function

38
Q

investigation of choice for pancreatic cancer

A

CT

39
Q

what sign is seen on CT in pancreatic cancer

A

doubel duct

40
Q

treatment of pacreatic cancer

A

whipple

41
Q

complication of whipple

A

dumping syndrome and peptic ulcer

42
Q

what can be done in pancreatic cancer if surgery not suitable

A

ERCP for stent

43
Q

pancreatic cancer assoc with what conditions

A

smoking, DM, chronic pancreatitis, HNPCC, MEN , BRCA 2, KRAS gene

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