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
Severe acute pancreatitis is associated with multi-organ failure and complications. True/False?
True
List some obstructive causes of acute pancreatitis
Biliary disease
Pancreatic duct stricture
Tumours of ampulla or pancreas
What is the most common toxin that causes acute pancreatitis?
Alcohol
List some viral causes of acute pancreatitis
Coxsackie B
Hepatitis
Mumps
GET SMASHED is a mnemonic for causes of pancreatitis. What does it stand for?
Gallstones Ethanol (alcohol) Trauma Steroids Mumps, malignancy Autoimmunity Scorpion stings Hyperlipidaemia, hypercalcaemia ERCP Drugs
List blood tests that would be done for acute pancreatitis
FBC, U&Es
LFTs
Clotting, CRP
Amylase, glucose, Ca, lipase
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
Glasgow Prognostic Score involves using the mnemonic PANCREAS to assess severity of pancreatitis. How many factors on this score indicate severe pancreatitis?
3 or more factors
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
Prophylactic antibiotics play a key role in the treatment of acute pancreatitis. True/False?
False
Where used should be short-term defined period
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
What would a CT scan of chronic pancreatitis likely show?
Calcification of pancreas
Dilated pancreatic duct
Fluid collection
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
