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Systemic Final > Biliary system and pancreas > Flashcards

Biliary system and pancreas Flashcards

1
Q

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

A

Just do it!

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2
Q

What are components of bile?

A

Bile acids, cholesterol, bilirubin

Phosphatidyl choline, xenobiotics

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3
Q

Purposes of bile?

A

Recycle cellular garbage

Break down and absorb fats and fat soluble vitamins

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4
Q

What’s another name for cholelithiasis?

A

Gall stones

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5
Q

Epidemiology of gall stones?

A

Ladies over 40

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

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6
Q

Symptoms of cholelithiasis?

A

Asymptomatic

Biliary colic

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7
Q

How would you diagnose cholelithiasis?

A

Ultrasound

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8
Q

Would you ever do a gall bladder transplant?

A

Only if you were immunocompromised

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9
Q

When would you do a cholecystectomy

A

If gall stone >2.5cm or you had hemolytic anemia

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10
Q

How would you treat uncomplicated cases of cholelithiasis?

A

Lithotripsy or bile acid tabs

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11
Q

What is choledocholithiasis

A

Gall stone lodged in common bile duct

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12
Q

Symptoms of choledocholithiasis?

A

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

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13
Q

How would you diagnose choledocholithasis?

A

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

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14
Q

How would you treat choledocholithasis?

A

ERCP
Biliary stent
lithotripsy or cholecystectomy

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15
Q

What are complications that can occur with choledocholithiasis?

A

Pancreatitis and acute cholangitis

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16
Q

What happens with acute cholangitis?

A

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

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17
Q

Symptoms of acute cholangitis?

A

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

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18
Q

How would you diagnose acute cholangitis?

A

ERCP and CBC
Blood culture
CT/MRI

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19
Q

How would you treat acute cholangitis?

A

Antibiotics, drain biliary tree, hospitalize and cholecystectomy

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20
Q

What is cholecystitis?

A

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

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21
Q

What happens to the gallbladder with cholecystitis?

A

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

22
Q

Symptoms of cholecystitis?

A

Abdominal dysfunction stuff

Pain, nausea and vomitting, and fever

23
Q

How would you diagnose cholecystitis?

A

Ultrasound or CT

24
Q

How would you treat cholecystitis?

A

Cholecystectomy, pain meds and antibiotics

Fasting to relieve pain

25
Q

What happens with primary sclerosing cholangitis?

A

Chronic cholangitis leading to chronic inflammation and fibrosing of biliary tree

26
Q

What other disease is primary sclerosing cholangitis associated with?

A

IBD, namely ulcerative colitis

27
Q

Symptoms of primary sclerosing cholangitis?

A

Hepatomegaly, splenomegaly, jaundice

can be asymptomatic too

28
Q

Epidemiology of primary sclerosing cholangitis?

A

50yo males

29
Q

How would you diagnose primary sclerosing cholangitis?

A

ERCP
MRC
Percutaneous cholangiogram

30
Q

Prognosis for primary sclerosing cholangitis?

A

Poor prognosis

Sclerosis leads to cirrhosis

31
Q

How do you treat primary sclerosing cholangitis?

A

Temporary balloon stent
IV fluids and antibiotics
Liver transplant if cirrhosis

32
Q

What is the purpose of the pancreas?

A

Exocrine: Digestive enzymes from acinar cells

33
Q

What can cause acute pancreatitis?

A

Alcohol, genetics, obstruction of biliary tree

Vascular injury, infection

34
Q

What is acute pancreatitis?

A

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

35
Q

What’s the pathophysiology of pancreatitis?

A

Obstruction
Acinar cell damage
Acinar transport damage

36
Q

How do you diagnose acute pancreatitis?

A

Ultrasound/CT/MRI

37
Q

Symptoms of acute pancreatitis?

A

Hypoxia, Tachypnea, hypOtension

Abdomen problem stuff: pain, N/V and fever

38
Q

How do you treat acute pancreatitis?

A

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

39
Q

What’s chronic pancreatitis caused by?

A 
Autoimmune, herditary, obstruction of duct
#1 cause is alcohol
Also idiopathic
40
Q

What systems are obstructed with chronic pancreatitis?

A

Endocrine and exocrine systems of pancreas

41
Q

Who typically has chronic pancreatitis?

A

Middle aged males

42
Q

Symptoms of chronic pancreatitis?

A

Abdomen pain

Jaundice and inability to digest complex foods

43
Q

How would you image for chronic pancreatitis?

A

Xray/CT/Endoscopic ultrasound with or without biopsy

44
Q

How would you treat chronic pancreatitis?

A

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

45
Q

Prognosis of chronic pancreatitis?

A

Poor. 50% survive 10 years

46
Q

Who is at risk for pancreatic cancer?

A

Middle aged males

47
Q

What are risk factors for pancreatic cancer?

A

FHx, Chronic pancreatitis or pancreatic cysts

Breast cancer, overweight/DM, smoke

48
Q

Symptoms of pancreatic cancer?

A

Pain, jaundice, weightloss

Diarrhea and vomitting

49
Q

How do you diagnose pancreatic cancer?

A

Histology and imaging

50
Q

How do you treat for pancreatic cancer?

A

Can’t

Can try to resect, but just give palliative care

51
Q

Prognosis for pancreatic?

A

Poor. 25% survive another 5 years

52
Q

True or false: Both acute and chronic pancreatitis are irreversible

A

False. Acute pancreatitis IS reversible whereas chronic is not

Systemic Final (8 decks)

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