Biliary Tract + Pancreatic Disease

Question 1

Are gallstones more common in men or women and are they symptomatic?

Answer 1

Women

Yes - symptomatic

Question 2

How do gallstones + pigmented gallstones form?

Answer 2

Imbalance of too much cholesterol compared to and bile

Excess bilirubin joins to surface of micelle

Question 3

5 F’s of a patient at risk of gallstones?

Answer 3

Female
Forty
Fat
Fertile
Fair

Question 4

What is acute cholecystitis + key sign?

Answer 4

Obstruction of cystic duct by stone causing inflammation of the gall bladder
Murphy’s sign

Question 5

Main tests for diagnosing cholecystitis?

Answer 5

Ultrasound

MRCP/ERCP

Question 6

Immediate treatment for cholecystitis?

Answer 6

IV antibiotics + fluids

Urgent cholecystectomy

Question 7

Difference between appearance of acute and chronic cholecystitis?

Answer 7

Acute = filled with pus
Chronic = thick wall

Question 8

What is biliary colic, how does it classically present and treatment?

Answer 8

Stone stuck in cystic duct
Pain/nausea for 2-6 hrs radiating to back
IV fluids

Question 9

3 symptoms, 2 signs and key raised blood for acute pancreatitis?

Answer 9

Epigastric pain, nausea and vomiting

Cullen’s and Grey Turner’s

Question 10

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

Answer 10

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

Question 11

1st line imaging for acute pancreatitis?

Answer 11

US

Question 12

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

Answer 12

Sentinel loop

Question 13

Glasgow Prognostic Score of more than … means sever pancreatitis?

Answer 13

3

Question 14

2 complications of acute pancreatitis?

Answer 14

Hyperglycaemia

Pseudocysts

Question 15

What is a pseudocyst?

Answer 15

Pocket of fluid

Question 16

How is a pseudocyst be treated?

Answer 16

Endoscopic or surgical drainage

Question 17

Management of acute pancreatitis?

Answer 17

IV fluids

Short-term antibiotics

Question 18

What is the commonest cause of chronic pancreatitis and what is the main AXR finding?

Answer 18

Alcohol

Calcification and dilation of ducts

Question 19

Chronic pancreatitis causes loss of exocrine and endocrine ducts. True or false?

Answer 19

True

Question 20

Treatment for chronic pancreatitis?

Answer 20

Surgery - Pustow, Frey or Beger proceure

Question 21

Pancreas type of cancer, associated with what 2 things and treatment?

Answer 21

Adenocarcinoma
Smoking and pancreatitis
Surgery - Whipple’s

Question 22

4 signs of appendicitis?

Answer 22

Nausea
Fever
Leukocytosis
RIF pain

Question 23

What does gastrinoma cause?

Answer 23

Acid hypersecretion (increased gastrin release)

Question 24

Inflammation of the appendix must involve?

Answer 24

The muscle coat

Question 25

Positive psoas test and McBurnery’s point?

Answer 25

Appendicitis

Question 26

Test and treatment for appendicitis?

Answer 26

US

Laparascopic appendicectomy

Question 27

What is gallstone ileus and how is it treated?

Answer 27

Gallstone obstructing ileum

Laparotomy

Question 28

What is gallstone ileus and how is it treated?

Answer 28

Gallstone obstructing ileum

Laparotomy

Question 29

Common sign of jaundice?

Answer 29

Yellow skin/eyes

Question 30

Bilirubin is normally conjugated in the liver with what molecule?

Answer 30

UDP-glucuronosyl trasnferase

Question 31

What is Gilbert’s syndrome?

Answer 31

Lack of UPD-glucuronosyl transferase

Question 32

2 causes of pre-hepatic jaundice?

Answer 32

Haemolysis

Gilbert’s

Question 33

Hepatic jaundice cause?

Answer 33

Liver cells are diseased

Question 34

Post-hepatic jaundice cause?

Answer 34

Obstruction to the bile duct

Question 35

Stools only turn pale for which type of jaundice?

Answer 35

Post-hepatic

Question 36

2 tests and treatment for jaundice?

Answer 36

US and ERCP/MRCP

Stent or remove blockage