Biliary/Pancreatic Conditions

Question 1

What are the 5Fs for risk factors of gallstones?

Answer 1

Female - Fat - Fertile (pregnancy) - Fair - Forty

Question 2

What are the 3 categories of gallstones and which is the most common?

Answer 2

Mixed (most common), cholesterol and pigment

Question 3

Where can biliary colic radiate to?

Answer 3

Upper abdomen, back and shoulder

Question 4

What is the management of biliary colic?

Answer 4

• Pain killers
• Low fat diet/lose weight if obese
• Observe 3-6 months
• Recurrent episodies of pain/colic: cholecystectomy (lap or open)
• if unfit: ursodeoxycholic acid 10mg/kg/day

Question 5

Cholethiasis

Answer 5

Gall stones present

Question 6

Cholestasis

Answer 6

Bile can’t flow from liver to duodenum, often due to gallstone

Question 7

Cholecystitis

Answer 7

Inflammation of the gallbladder (with or without stones). Initially sterile in the gallbladder, but becomes infected.

Question 8

Cholangitis

Answer 8

Infection of the bile duct (if ascending - goes from CBD up to liver)

Question 9

What is the treatment for acute cholecystitis?

Answer 9

• IV antibiotics and IV fluids
• Nil by mouth
• US to confirm diagnosis
• Urgent cholecystectomy (asap)

Question 10

What are some of the complications of gallstones?

Answer 10

Jaundice, cholangitis, acute pancreatitis and gallstone ileus

Question 11

What are the causes of pancreatitis?

Answer 11

Gallstones
Ethanol
Trauma

Steroids 
Mumps
Autoimmune
Scorpions
Hyperlipidaemia/Hyperthermia/Hypercalcaemia
ERCP
Drugs

Question 12

What is the pathophysiology of acute pancreatitis?

Answer 12

Autodigestion of peri-pancreatic tissues by activated enzymes due to bile reflux

Question 13

What is the management for cholangiocarcinoma?

Answer 13

Curative: Biliary and liver resection
Palliative: biliary stent

Question 14

What is the pathophysiology of gallstones?

Answer 14

Disruption of the balance of the cholesterol and bile salts in the bile (e.g. cholesterol stones result from too much cholesterol, and pigment stones from too much bilirubin from excess haemolysis etc)

Question 15

Cholangiocarcinoma

Answer 15

Carcinoma of the bile ducts

Question 16

What is the definitive test for pancreatitis?

Answer 16

Amylase

Question 17

What is the management of pancreatitis?

Answer 17

Supportive mostly

Surgical: puestow procedure (anastomose pancreatic duct and jejunum) or frey procedure (cored out diseased portions)

Question 18

What is the most common cancer of the exocrine pancreas?

Answer 18

Adenocarcinoma

Question 19

Wha is the difference between mild and severe acute pancreatitis?

Answer 19

Mild is associated with minimal organ dysfunction, while severe involves complete organ failure, with possible local complications

Question 20

What are the symptoms of pancreatitis?

Answer 20

• Epigastric/diffuse abdominal pain +/- radiation to the back
• Nausea and vomiting
• Indigestion
• Abdominal tenderness
• Loss of appetite +/- weight loss
• Temperature
• Jaundice (pain

Question 21

What score can be used to rate the severity of pancreas?

Answer 21

- Glasgow Prognostic Score:
• PaO2  55 years 
• Neutrophils: (WBC >15 x109/l 
• Calcium  16mmol/l)
• Enzymes: (AST/ALT > 200 iu/L or LDH > 600 iu/L)
• Albumin 10mmol/L) 

Any 3 factors means acute severe pancreatitis

Question 22

What are some of the main complications of acute pancreatitis?

Answer 22

Pseudocyts, abscesses, nectrosis, ascites, splenic artery aneurysm and pleural effusion