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Y1 GASTROENTEROLOGY > Biliary Tract and Pancreatic Disease > Flashcards

Biliary Tract and Pancreatic Disease Flashcards

1
Q

Women get gallstones more commonly than men. True/False?

A

True

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2
Q

Most people with gallstones are asymptomatic. True/False?

A

True

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3
Q

How do gallstones form?

A

Abnormal bile composition (usually due to excess cholesterol) causes hardening of bile

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4
Q

List some risk factors for developing gallstones (think of the 5 F’s)

A 
Female
Forty
Fat
Foetus
Fair (i.e. white skin)
There once was a fat forty-year-old fair female with a foetus.
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5
Q

What is acute cholecystitis? What symptom can this result in?

A

Obstruction of cystic duct by stone causing inflammation of the gall bladder
Biliary colic

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6
Q

List some investigations for diagnosing gallstones

A

Ultrasound
CT scan
MRCP/ERCP

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7
Q

Outline treatment for acute cholecystitis

A

IV antibiotics + fluids

Urgent cholecystectomy

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8
Q

What is the 2nd most common hepatobiliary cancer?

A

Cholangiocarcinoma

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9
Q

What is the only chance of cure of cholangiocarcinoma? What is an alternative?

A

Surgical resection

Palliation - Biliary stent

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10
Q

Severe acute pancreatitis is associated with multi-organ failure and complications. True/False?

A

True

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11
Q

List some obstructive causes of acute pancreatitis

A

Biliary disease
Pancreatic duct stricture
Tumours of ampulla or pancreas

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12
Q

What is the most common toxin that causes acute pancreatitis?

A

Alcohol

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13
Q

List some viral causes of acute pancreatitis

A

Coxsackie B
Hepatitis
Mumps

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14
Q

GET SMASHED is a mnemonic for causes of pancreatitis. What does it stand for?

A 
Gallstones
Ethanol (alcohol)
Trauma
Steroids
Mumps, malignancy
Autoimmunity
Scorpion stings
Hyperlipidaemia, hypercalcaemia
ERCP
Drugs
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15
Q

List blood tests that would be done for acute pancreatitis

A 
FBC, 
U&Es
LFTs
Clotting, CRP
Amylase, glucose, Ca, lipase
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16
Q

List imaging that would be done for acute pancreatitis

A 
AXR
Ultrasound
CT scan, 
MRI
MRCP/ERCP
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17
Q

What may be seen on CXR for acute pancreatitis (common exam buzzword)?

A

Sentinel loop

Also pleural effusion in later stages

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18
Q

Glasgow Prognostic Score involves using the mnemonic PANCREAS to assess severity of pancreatitis. How many factors on this score indicate severe pancreatitis?

A

3 or more factors

19
Q

List typical symptoms of acute pancreatitis

A 
Epigastric pain radiating to the back
Nausea, vomiting
Tenderness
Loss of appetite
Jaundice
20
Q

Hypoglycaemia and hypocalcaemia can complicate acute pancreatitis. True/False?

A

False

Hyperglycaemia, not hypo, and hypocalcaemia

21
Q

What is a pseudocyst? What are some other complications of acute pancreatitis?

A 
Walled-off fluid collection
Abscess
Ascites
Pleural effusiob
Necrosis/infection
22
Q

How might a pseudocyst be treated?

A

Endoscopic or surgical drainage

23
Q

What is involved in a cystgastrostomy?

A

Create a fistula between the pseudocyst and stomach, so that its contents drain into the stomach

24
Q

Prophylactic antibiotics play a key role in the treatment of acute pancreatitis. True/False?

A

False

Where used should be short-term defined period

25
Q

What are the 3 major consequences of chronic pancreatitis?

A

Pain
Endocrine insufficiency (DM)
Exocrine insufficiency

26
Q

What is the commonest cause of chronic pancreatitis?

A

Alcohol abuse

27
Q

What diseases is hereditary chronic pancreatitis associated with?

A

Cystic fibrosis
a1-antitrypsin deficiency
Hyperparathyroidism

28
Q

What would a CT scan of chronic pancreatitis likely show?

A

Calcification of pancreas
Dilated pancreatic duct
Fluid collection

29
Q

Outline essential treatment for chronic pancreatitis

A

Endocrine function - address diabetes
Exocrine function - enzyme supplements (CREON)
Pain - opioids, paracetamol, NSAIDs

30
Q

There are number of specific surgical procedures for chronic pancreatitis - what is the general procedure that is done?

A

Duodenum/jejunum joined to pancreas to enable pancreatic juice to drain

31
Q

What is the most common cancer of the exocrine pancreas?

A

Adenocarcinoma

32
Q

List common cancers of the endocrine pancreas

A

Gastrinoma
Insulinoma
Glucagonoma

33
Q

What does insulinoma cause?

A

Hypoglycaema (increased insulin causes more glucose storage)

34
Q

What does glucagonoma cause?

A

Hyperglycaemia (increased glucagon causes more glycogen breakdown)

35
Q

What does gastrinoma cause?

A

Acid hypersecretion (increased gastrin release)

36
Q

Prognosis of pancreatic cancer is very poor. True/False?

A

True

37
Q

What investigations are done if pancreatic cancer is suspected?

A

US
Triple phase CT
MRI+MRCP

38
Q

What are the management options for inoperable compared to operable tumours?

A

ERCP or PTC + stent

Laparoscopy + TNM staging or resection + palliative bypass

39
Q

How do gallstones cause jaundice?

A

Get stuck in the bile duct

40
Q

How do gallstones cause pancreatitis?

A

Get stuck in the pancreatic duct

41
Q

What is acute pancreatitis?

A

Autodigestion of the pancreas by activated enzymes

42
Q

What is gallstone ileus? How is it managed?

A

Small bowel obstruction usually in the distal ileum, causing intermittent colic
Urgent laparotomy to remove stone

43
Q

What might be raised in FBC for pancreatitis?

A

Increased serum amylase

Y1 GASTROENTEROLOGY (24 decks)

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