Biliary Tract + Pancreatic Disease

Question 1

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

Answer 1

True

Question 2

Most people with gallstones are asymptomatic. True/False?

Answer 2

True

Question 3

How do gallstones form?

Answer 3

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

Question 4

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

Answer 4

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

Question 5

What is acute cholecystitis?

Answer 5

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

Question 6

List some investigations for diagnosing gallstones

Answer 6

Ultrasound
CT scan
MRCP/ERCP

Question 7

Outline treatment for acute cholecystitis

Answer 7

IV antibiotics + fluids
Urgent cholecystectomy

Question 8

What is the 2nd most common hepatobiliary cancer?

Answer 8

Cholangiocarcinoma

Question 9

What is the only chance of cure of cholangiocarcinoma?

Answer 9

Surgical resection

Question 10

What is the most common toxin that causes acute pancreatitis?

Answer 10

Alcohol

Question 11

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

Answer 11

Big 3= drugs, alcohol, gallstones
Gallstones
Ethanol (alcohol)
Trauma
Steroids
Mumps, malignancy
Autoimmunity
Scorpion stings
Hyperlipidaemia, hypercalcaemia
ERCP
Drugs

Question 12

List imaging that would be done for acute pancreatitis

Answer 12

AXR
Ultrasound
CT scan, MRI
MRCP/ERCP

Question 13

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

Answer 13

Sentinel loop
Also pleural effusion in later stages

Question 14

List typical symptoms of acute pancreatitis

Answer 14

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

Question 15

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

Answer 15

False
Hyperglycaemia, not hypo, and hypocalcaemia

Question 16

What is a pseudocyst?

Answer 16

Walled-off fluid collection

Question 17

How might a pseudocyst be treated?

Answer 17

Endoscopic or surgical drainage

Question 18

What is involved in a cystgastrostomy?

Answer 18

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

Question 19

What are the 3 major consequences of chronic pancreatitis?

Answer 19

Pain
Endocrine insufficiency
Exocrine insufficiency

Question 20

What is the commonest cause of chronic pancreatitis?

Answer 20

Alcohol abuse

Question 21

What diseases is hereditary chronic pancreatitis associated with?

Answer 21

Cystic fibrosis
a1-antitrypsin deficiency
Hyperparathyroidism

Question 22

Outline essential treatment for chronic pancreatitis

Answer 22

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

Question 23

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

Answer 23

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

Question 24

What is the most common cancer of the exocrine pancreas?

Answer 24

Adenocarcinoma

Question 25

List common cancers of the endocrine pancreas

Answer 25

Gastrinoma Insulinoma Glucagonoma

Question 26

What does insulinoma cause?

Answer 26

Hypoglycaema (increased insulin causes more glucose storage)

Question 27

What does glucagonoma cause?

Answer 27

Hyperglycaemia (increased glucagon causes more glycogen breakdown)

Question 28

What does gastrinoma cause?

Answer 28

Acid hypersecretion (increased gastrin release)

Question 29

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

Answer 29

True