Biliary conditions

Question 1

What are gallstones?

Answer 1

small stones, usually comprised of cholesterol that are formed within the gallbladder

Question 2

Why can gallstones result in pancreatitis?

Answer 2

They can block the drainage of the pancreatic duct

Question 3

What is the ampulla of vater?

Answer 3

The union of pancreatic duct and the common hepatic duct

Question 4

what is the layer of muscle that surrounds the ampulla of vater?

Answer 4

the sphincter of oddi

Question 5

Cholestasis

Answer 5

the blockage of flow of bile “stasis”

Question 6

Cholethiasis

Answer 6

presence of gallstones

Question 7

Choledocholithiasis

Answer 7

gallstones in the bile duct

Question 8

Biliary colic

Answer 8

intermittent right upper quadrant pain caused by gallstones irritating the bile ducts

Question 9

Cholangitis

Answer 9

inflammation of the bile ducts

Question 10

Gallbladder empyema

Answer 10

pus in the gallbladder

Question 11

What are the 4 risk factors of gallstones?

Answer 11

fair, forty, fat, female

Question 12

What are the symptoms of gallstones?

Answer 12

biliary colic
triggered pain (pain after eating fatty meals)
nausea and vomiting
pain can last from 30 minutes up to 8 hours

Question 13

What could it imply if bilirubin is raised?

Answer 13

gallstone or cholagiocarcinoma

Question 14

what could it indicate if ALP is raised?

Answer 14

biliary obstruction AND liver/bone malignancy/cirrhosis/paget’s disease

Question 15

If either/or ALT and AST are raised, what does this indicate?

Answer 15

hepatocellular injury

Question 16

if ALT and AST are both raised as well as ALP

Answer 16

SUSPECT Cholestasis

Question 17

If ALT and AST are higher than ALP

Answer 17

indicative of more hepatocellular injury than an obstructive picture

Question 18

In what order does the imaging of gallbladder take place

Answer 18

1. ultrasound
2. MRCP
3. ERCP - to remove stones
4. CT scan to rule out cholangiocarcinoma

Question 19

What is the name of surgical removal of the gallbladder?

Answer 19

cholecystectomy

Question 20

What is acute cholecystitis?

Answer 20

inflammation of the gallbladder caused by blockage to the cystic duct

Question 21

What are the symptoms of acute cholecystitis?

Answer 21

fever, jaundice and right upper quadrant pain, vomiting, tachycardia,

Question 22

imaging of cholecystitis

Answer 22

abdominal USS and MRCP to visualise the biliary tree

Question 23

management of cholecystitis

Answer 23

IV fluids for hydration, antibiotics and NG tube if the patient is vomiting

Question 24

what is acute cholangitis

Answer 24

infection and inflammation of bile ducts

Question 25

name 3 species that can cause cholangitis

Answer 25

e. coli
klebsiella species
enterococcus species

Question 26

what is charcot’s triad?

Answer 26

fever
jaundice
right upper quadrant pain

Question 27

how is cholangitis managed?

Answer 27

pt is nil by mouth, IV fluids, blood cultures, IV antibiotics, using ERCP for stone removal, dilation for strictures and to take any biopsies if needed

Question 28

what is offered to patients when ERCP is not suitable?

Answer 28

percutaneous transhepatic cholangiogram, whereby drain is inserted through the skin and liver

Question 29

What is cholangiocarcinoma

Answer 29

cancer of the bile ducts

Question 30

What are the risk factors for cholangiocarcinoma?

Answer 30

primary sclerosing cholangitis and liver flukes parasite

Question 31

what are the signs and symptoms of cholangiocarcinoma?

Answer 31

obstructive jaundice, pale stools, dark urine, pruritis, RUQ pain, palpable gallbladder

Question 32

Courvoisier’s law

Answer 32

painless jaundice + palpable gallbladder upon examination = cholangiocarcinoma

Question 33

Why is a CTAP performed in looking for cholangiocarcinoma

Answer 33

to see if there are any metastasis

Question 34

what is CA 19-19?

Answer 34

a tumour marker that indicates pancreatic cancer/cholangiocarcinoma

Question 35

how can ERCP be used to relieve obstruction in cholangiocarcinoma?

Answer 35

put a stent in to open up the bile ducts

Question 36

What is the location of most pancreatic cancers?

Answer 36

the head of the pancreas

Question 37

why can pancreatic cancer cause obstructive jaundice?

Answer 37

if the tumour grows large enough, it can compress the bile ducts

Question 38

Why does pancreatic cancer have such a poor prognosis?

Answer 38

1. it can metastasise early

2. it doesn’t present with symptoms until advanced

Question 39

What are the signs and symptoms of pancreatic cancer?

Answer 39

yellow skin and sclera of eyes
pruritus
new onset of type 2 diabetes
change in bowel habit

Question 40

NICE guidelines for referrals:

a) over 40 with
b) over 60 with

Answer 40

a) jaundice = 2 week wait

b) wt loss and any other associated symptoms = direct access CT abdomen

Question 41

What is trousseau’s sign of malignancy?

Answer 41

migratory thrombophlebitis - the formation of a thrombus that moves from its site and the area becomes inflamed

Question 42

name the 5 investigations carried out in order for diagnosis of pancreatic cancer

Answer 42

1. CT tap
2. CA 19-19 tumour marker
3. MRCP
4. ERCP
   Biopsy

Question 43

What surgical procedure takes place to treat pancreatic cancer?

Answer 43

whipple procedure - the head of the pancreas is removed along with pylorus of stomach, gallbladder, bile duct and duodenum