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

Severe acute pancreatitis is associated with multi-organ failure and complications. True/False?

Answer 10

True

Question 11

List some obstructive causes of acute pancreatitis

Answer 11

Biliary disease
Pancreatic duct stricture
Tumours of ampulla or pancreas

Question 12

What is the most common toxin that causes acute pancreatitis?

Answer 12

Alcohol

Question 13

List some viral causes of acute pancreatitis

Answer 13

Coxsackie B
Hepatitis
Mumps

Question 14

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

Answer 14

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

Question 15

List blood tests that would be done for acute pancreatitis

Answer 15

FBC, U&Es
LFTs
Clotting, CRP
Amylase, glucose, Ca, lipase

Question 16

List imaging that would be done for acute pancreatitis

Answer 16

AXR
Ultrasound
CT scan, MRI
MRCP/ERCP

Question 17

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

Answer 17

Sentinel loop

Also pleural effusion in later stages

Question 18

Glasgow Prognostic Score involves using the mnemonic PANCREAS to assess severity of pancreatitis. How many factors on this score indicate severe pancreatitis?

Answer 18

3 or more factors

Question 19

List typical symptoms of acute pancreatitis

Answer 19

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

Question 20

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

Answer 20

False

Hyperglycaemia, not hypo, and hypocalcaemia

Question 21

What is a pseudocyst?

Answer 21

Walled-off fluid collection

Question 22

How might a pseudocyst be treated?

Answer 22

Endoscopic or surgical drainage

Question 23

What is involved in a cystgastrostomy?

Answer 23

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

Question 24

Prophylactic antibiotics play a key role in the treatment of acute pancreatitis. True/False?

Answer 24

False

Where used should be short-term defined period

Question 25

What are the 3 major consequences of chronic pancreatitis?

Answer 25

Pain Endocrine insufficiency Exocrine insufficiency

Question 26

What is the commonest cause of chronic pancreatitis?

Answer 26

Alcohol abuse

Question 27

What diseases is hereditary chronic pancreatitis associated with?

Answer 27

Cystic fibrosis a1-antitrypsin deficiency Hyperparathyroidism

Question 28

What would a CT scan of chronic pancreatitis likely show?

Answer 28

Calcification of pancreas Dilated pancreatic duct Fluid collection

Question 29

Outline essential treatment for chronic pancreatitis

Answer 29

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

Question 30

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

Answer 30

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

Question 31

What is the most common cancer of the exocrine pancreas?

Answer 31

Adenocarcinoma

Question 32

List common cancers of the endocrine pancreas

Answer 32

Gastrinoma Insulinoma Glucagonoma

Question 33

What does insulinoma cause?

Answer 33

Hypoglycaema (increased insulin causes more glucose storage)

Question 34

What does glucagonoma cause?

Answer 34

Hyperglycaemia (increased glucagon causes more glycogen breakdown)

Question 35

What does gastrinoma cause?

Answer 35

Acid hypersecretion (increased gastrin release)

Question 36

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

Answer 36

True