Biliary system and pancreas

Question 1

Draw out the biliary tree and label the bits as you go

Answer 1

Just do it!

Question 2

What are components of bile?

Answer 2

Bile acids, cholesterol, bilirubin

Phosphatidyl choline, xenobiotics

Question 3

Purposes of bile?

Answer 3

Recycle cellular garbage

Break down and absorb fats and fat soluble vitamins

Question 4

What’s another name for cholelithiasis?

Answer 4

Gall stones

Question 5

Epidemiology of gall stones?

Answer 5

Ladies over 40

Especially if pregnant, overweight, DMI, sickle cell, cirrhosis

Question 6

Symptoms of cholelithiasis?

Answer 6

Asymptomatic

Biliary colic

Question 7

How would you diagnose cholelithiasis?

Answer 7

Ultrasound

Question 8

Would you ever do a gall bladder transplant?

Answer 8

Only if you were immunocompromised

Question 9

When would you do a cholecystectomy

Answer 9

If gall stone >2.5cm or you had hemolytic anemia

Question 10

How would you treat uncomplicated cases of cholelithiasis?

Answer 10

Lithotripsy or bile acid tabs

Question 11

What is choledocholithiasis

Answer 11

Gall stone lodged in common bile duct

Question 12

Symptoms of choledocholithiasis?

Answer 12

Symptoms of cholelithiasis + jaundice, high bp and increased heart rate

Question 13

How would you diagnose choledocholithasis?

Answer 13

ERCP (can cause pancreatitis)
MRCP
Ultrasound or CT
Endoscopic Ultrasound

Question 14

How would you treat choledocholithasis?

Answer 14

ERCP
Biliary stent
lithotripsy or cholecystectomy

Question 15

What are complications that can occur with choledocholithiasis?

Answer 15

Pancreatitis and acute cholangitis

Question 16

What happens with acute cholangitis?

Answer 16

Obstruction of biliary tree causes backflow. High pressure and infected bile results

Question 17

Symptoms of acute cholangitis?

Answer 17

Charcot triad: Jaundice, pain, fever/chills
Reynold’s traid: Charcot’s + change in mentation and hypOtension
Biliary colic

Question 18

How would you diagnose acute cholangitis?

Answer 18

ERCP and CBC
Blood culture
CT/MRI

Question 19

How would you treat acute cholangitis?

Answer 19

Antibiotics, drain biliary tree, hospitalize and cholecystectomy

Question 20

What is cholecystitis?

Answer 20

Inflam of gall bladder usually caused by gallstone. Can also be tumor or other diseases

Question 21

What happens to the gallbladder with cholecystitis?

Answer 21

Loses elasticity, doesn’t release juices as well, can rupture

Question 22

Symptoms of cholecystitis?

Answer 22

Abdominal dysfunction stuff

Pain, nausea and vomitting, and fever

Question 23

How would you diagnose cholecystitis?

Answer 23

Ultrasound or CT

Question 24

How would you treat cholecystitis?

Answer 24

Cholecystectomy, pain meds and antibiotics

Fasting to relieve pain

Question 25

What happens with primary sclerosing cholangitis?

Answer 25

Chronic cholangitis leading to chronic inflammation and fibrosing of biliary tree

Question 26

What other disease is primary sclerosing cholangitis associated with?

Answer 26

IBD, namely ulcerative colitis

Question 27

Symptoms of primary sclerosing cholangitis?

Answer 27

Hepatomegaly, splenomegaly, jaundice | can be asymptomatic too

Question 28

Epidemiology of primary sclerosing cholangitis?

Answer 28

50yo males

Question 29

How would you diagnose primary sclerosing cholangitis?

Answer 29

ERCP MRC Percutaneous cholangiogram

Question 30

Prognosis for primary sclerosing cholangitis?

Answer 30

Poor prognosis | Sclerosis leads to cirrhosis

Question 31

How do you treat primary sclerosing cholangitis?

Answer 31

Temporary balloon stent IV fluids and antibiotics Liver transplant if cirrhosis

Question 32

What is the purpose of the pancreas?

Answer 32

Exocrine: Digestive enzymes from acinar cells

Question 33

What can cause acute pancreatitis?

Answer 33

Alcohol, genetics, obstruction of biliary tree | Vascular injury, infection

Question 34

What is acute pancreatitis?

Answer 34

Injury leading to inflam of pancreas. Enzymes inappropriate released and causes more damage

Question 35

What's the pathophysiology of pancreatitis?

Answer 35

Obstruction Acinar cell damage Acinar transport damage

Question 36

How do you diagnose acute pancreatitis?

Answer 36

Ultrasound/CT/MRI

Question 37

Symptoms of acute pancreatitis?

Answer 37

Hypoxia, Tachypnea, hypOtension | Abdomen problem stuff: pain, N/V and fever

Question 38

How do you treat acute pancreatitis?

Answer 38

Most are mild and require no treatment Pain medications, IV fluids Debride of pancreatic necrosis

Question 39

What's chronic pancreatitis caused by?

Answer 39

``` Autoimmune, herditary, obstruction of duct #1 cause is alcohol Also idiopathic ```

Question 40

What systems are obstructed with chronic pancreatitis?

Answer 40

Endocrine and exocrine systems of pancreas

Question 41

Who typically has chronic pancreatitis?

Answer 41

Middle aged males

Question 42

Symptoms of chronic pancreatitis?

Answer 42

Abdomen pain | Jaundice and inability to digest complex foods

Question 43

How would you image for chronic pancreatitis?

Answer 43

Xray/CT/Endoscopic ultrasound with or without biopsy

Question 44

How would you treat chronic pancreatitis?

Answer 44

Treat complications and pain Treat pain and give IV fluids Small low fat meals Stop tobacco and alcohol

Question 45

Prognosis of chronic pancreatitis?

Answer 45

Poor. 50% survive 10 years

Question 46

Who is at risk for pancreatic cancer?

Answer 46

Middle aged males

Question 47

What are risk factors for pancreatic cancer?

Answer 47

FHx, Chronic pancreatitis or pancreatic cysts | Breast cancer, overweight/DM, smoke

Question 48

Symptoms of pancreatic cancer?

Answer 48

Pain, jaundice, weightloss | Diarrhea and vomitting

Question 49

How do you diagnose pancreatic cancer?

Answer 49

Histology and imaging

Question 50

How do you treat for pancreatic cancer?

Answer 50

Can't | Can try to resect, but just give palliative care

Question 51

Prognosis for pancreatic?

Answer 51

Poor. 25% survive another 5 years

Question 52

True or false: Both acute and chronic pancreatitis are irreversible

Answer 52

False. Acute pancreatitis IS reversible whereas chronic is not