Biliary Tract + Pancreatic Disease Flashcards
Women get gallstones more commonly than men. True/False?
True
Most people with gallstones are asymptomatic. True/False?
True
How do gallstones form?
Abnormal bile composition (usually due to excess cholesterol) causes hardening of bile
List some risk factors for developing gallstones (think of the 5 F’s)
Female
Forty
Fat
Foetus
Fair (i.e. white skin)
There once was a fat forty-year-old fair female with a foetus.
What is acute cholecystitis?
Obstruction of cystic duct by stone causing inflammation of the gall bladder
List some investigations for diagnosing gallstones
Ultrasound
CT scan
MRCP/ERCP
Outline treatment for acute cholecystitis
IV antibiotics + fluids
Urgent cholecystectomy
What is the 2nd most common hepatobiliary cancer?
Cholangiocarcinoma
What is the only chance of cure of cholangiocarcinoma?
Surgical resection
What is the most common toxin that causes acute pancreatitis?
Alcohol
GET SMASHED is a mnemonic for causes of pancreatitis. What does it stand for?
Big 3= drugs, alcohol, gallstones
Gallstones
Ethanol (alcohol)
Trauma
Steroids
Mumps, malignancy
Autoimmunity
Scorpion stings
Hyperlipidaemia, hypercalcaemia
ERCP
Drugs
List imaging that would be done for acute pancreatitis
AXR
Ultrasound
CT scan, MRI
MRCP/ERCP
What may be seen on CXR for acute pancreatitis (common exam buzzword)?
Sentinel loop
Also pleural effusion in later stages
List typical symptoms of acute pancreatitis
Epigastric pain radiating to the back
Nausea, vomiting
Tenderness
Loss of appetite
Jaundice
Hypoglycaemia and hypocalcaemia can complicate acute pancreatitis. True/False?
False
Hyperglycaemia, not hypo, and hypocalcaemia
What is a pseudocyst?
Walled-off fluid collection
How might a pseudocyst be treated?
Endoscopic or surgical drainage
What is involved in a cystgastrostomy?
Create a fistula between the pseudocyst and stomach, so that its contents drain into the stomach
What are the 3 major consequences of chronic pancreatitis?
Pain
Endocrine insufficiency
Exocrine insufficiency
What is the commonest cause of chronic pancreatitis?
Alcohol abuse
What diseases is hereditary chronic pancreatitis associated with?
Cystic fibrosis
a1-antitrypsin deficiency
Hyperparathyroidism
Outline essential treatment for chronic pancreatitis
Endocrine function - address diabetes
Exocrine function - enzyme supplements (CREON)
Pain - opioids, paracetamol, NSAIDs
There are number of specific surgical procedures for chronic pancreatitis - what is the general procedure that is done?
Duodenum/jejunum joined to pancreas to enable pancreatic juice to drain
What is the most common cancer of the exocrine pancreas?
Adenocarcinoma
List common cancers of the endocrine pancreas
Gastrinoma
Insulinoma
Glucagonoma
What does insulinoma cause?
Hypoglycaema (increased insulin causes more glucose storage)
What does glucagonoma cause?
Hyperglycaemia (increased glucagon causes more glycogen breakdown)
What does gastrinoma cause?
Acid hypersecretion (increased gastrin release)
Prognosis of pancreatic cancer is very poor. True/False?
True
