Biliary Tract Disease

Question 1

What two substances, in excess, can cause gallstones?

Answer 1

Bilirubin and cholesterol

Question 2

What are the four types of gallstones, most common first?

Answer 2

Mixed
Cholesterol
Pigment
Primary Bile Duct Stones

Question 3

What IBD can cause bile salt loss leading to gallstones?

Answer 3

Crohns

Question 4

What are the five Fs for gallstone risk factors?

Answer 4

Forty, female, fatty diet, fat, foetus

Question 5

What does a gallstone impacting in a cystic duct lead to?

Answer 5

Biliary colic

Question 6

What biliary colic, where does the pain ratiate to?

Answer 6

Back/shoulder

Question 7

What is acute cholescystitis?

Answer 7

Inflammation in GB, obstruction of cystic duct

Question 8

What three ways can diagnose gallstones?

Answer 8

1. US
2. CT
3. MRCP

Question 9

What are the 4 steps for treating acute cholecystitis?

Answer 9

1. IV antibiotics and IV fluids
2. Nil by Mouth
3. US to confirm
4. Urgent cholecystectomy

Question 10

What are three complications of gallstones, if they migrate into CBD?

Answer 10

1. Jaundice
2. Cholangitis
3. Acute pancreatitis

Question 11

What investigation is used for diagnosing CBD pathology?

Answer 11

MRCP

Question 12

What technique is used to remove stones?

Answer 12

ERCP

Question 13

What part of the biliary tree is affect if there is itch, nausea, anorexia, jaundice and abnormal LFTs?

Answer 13

CBD

Question 14

What is gallstone ileus?

Answer 14

Gallstone impacted in distal ileum

Question 15

How does gallstone ileus arrive?

Answer 15

Fistula between gallbladder and duodenum

Question 16

What are the two treatments for gallstone ileus?

Answer 16

Urgent laparotomy

Interval cholecystectomy

Question 17

What is the second most common hepatobiliary cancer?

Answer 17

Cholangiocarcinoma

Question 18

What three investigations are done to stage/assess cholangiocarcinoma?

Answer 18

Duplex US
Spiral CT/ERCP/PTC
MRI/MRCP/MRA

Question 19

What treatment is the only chance for cure with cholangiocarcinoma?

Answer 19

Surgical resection of bile duct and liver

Question 20

What is palliation treatment for cholangiocarcinoma?

Answer 20

Biliary stent - ERC/PTC

Question 21

What is the name of the complete resection surgery in cholagniocarcinoma?

Answer 21

Whipples

Question 22

obstructive jaundice, raised CA-9-19 and CEA?

Answer 22

Cholangiocarcinoma