Billiary & Pancreatic Disease

Question 1

Why do we get gallstones?

Answer 1

Abnormal bile composition 
Bile stasis 
Infection 
Excess cholesterol 
Excess bilirubin

Question 2

What are the categories of gallstones?

Answer 2

Mixed
Cholesterol
Pigment
Primary bile duct stones

Question 3

Risk factors for gallstones

Answer 3

Age > 40 
Female 
High fat diet 
Obesity 
Pregnancy 
Hyperlipidaemia 
Bile salt loss (Crohn's) 
Diabetes
Dysmotility of GB
Prolonged fasting 
TPN

Question 4

What are the 5 F’s of gallstone risk factors?

Answer 4

Fair 
Fat 
Female
Fertile
Forty

Question 5

Symptoms of gallstones

Answer 5

Biliary colic 
Pain after eating fatty meal 
Pain increases on inspiration 
Jaundice & itching 
Tachycardia

Question 6

What is biliary colic?

Answer 6

Pain as gallstone impacts on cystic duct
Radiates to back/shoulder
Especially after fatty meal

Question 7

Causes of severe acute abdominal pain

Answer 7

Biliary colic 
Peptic ulcer
Oesophageal spasm 
MI
Acute pancreatitis

Question 8

What is acute cholecystitis?

Answer 8

Inflammation of gallbladder causing obstruction of cystic duct
Becomes infected

Question 9

Investigations for gallstones

Answer 9

Ultrasound
Ct scan
MRCP/ERCP

Question 10

Treatment of gallstones

Answer 10

Depends on affect they are having on patients life
Keyhole surgery

Usodeoxycholic acid

Question 11

Complications of gallstones

Answer 11

Jaundice 
Cholangitis 
Acute pancreatitis 
Gallstone ileus 
Carcinoma

Question 12

What is the best investigation for CBD pathology?

Answer 12

MRCP

Question 13

What procedure is used to remove gallstones?

Answer 13

ERCP

Question 14

Causes of pancreatitis

Answer 14

G - gallstones
E - ethanol
T - trauma

S - steroids 
M - mumps 
A - autoimmune 
S - scorpion/spider bites 
H - hyperlipidaemia/hypercalcaemia 
E - ERCP
D - drugs

Question 15

What is a gallstone ileus?

Answer 15

Small bowel obstruction as gallstone impacted in distal ileum
Passes through fistula between gallbladder and duodenum

Question 16

Treatment of gallstone ileus?

Answer 16

Urgent laparotomy

Interval cholecystectomy in 3 months

Question 17

Clinical presentation of cholangiocarcinoma

Answer 17

Jaundice 
Weight loss
Anorexia 
Lethargy 
(50% have lymph node metastasis at diagnosis)

Question 18

Investigations for cholangiocarcinoma

Answer 18

Duplex ultrasound
Spiral CT/ ERCP/ PTC
MRI/MRCP

Question 19

Treatment of cholangiocarcinoma

Answer 19

Surgical resection 
Biliary stent (palliation)

Question 20

3 diseases of the pancreas

Answer 20

Acute pancreatitis
Chronic pancreatitis
Pancreatic tumours

Question 21

Imaging for pancreatitis

Answer 21

CXR/AXR
Ultrasound 
Ct scan 
MRI 
ERCP (not diagnostic)

Question 22

Complications of pancreatitis

Answer 22

Fluid collections 
Necrosis 
Ascites
Bleeding 
Abscess 
Sepsis 
Pleural effusion 
Renal failure

Question 23

Symptoms of acute pancreatitis

Answer 23

Diffuse abdominal pain (radiate to back) 
Nausea & vomiting 
Indigestion 
Abdominal tenderness 
Loss of appetite +/- weight loss 
Temperature 
Jaundice

Question 24

Treatment of acute pancreatitis

Answer 24

Treat underlying cause of necessary

Nutritional support

Question 25

What is chronic pancreatitis?

Answer 25

Progressive and irreversible da,age of pancreatic tissue | Results in permanent loss of endocrine/exocrine function

Question 26

Causes of chronic pancreatitis

Answer 26

GET SMASHED

Question 27

Imaging for chronic pancreatitis

Answer 27

CXR/AXR Ultrasound CT scan MRI

Question 28

Treatment of pancreatitis

Answer 28

Dependent on the cause

Question 29

Treatment of pancreatitis caused by cysts or pseudocysts

Answer 29

Endoscopic drainage

Question 30

Treatment of autoimmune pancreatitis

Answer 30

Steroids

Question 31

Pancreatitis caused by cancer

Answer 31

Pancreatectomy

Question 32

Complications of chronic pancreatitis

Answer 32

``` Splenic vein thrombosis Pseudoaneurysms Pancreatic cancer Pseudocysts Bile duct or duodenal obstruction Pancreatic ascites Pleural effusion ```

Question 33

Management of biliary/duodenal obstruction caused by pancreatitis

Answer 33

Stent Bypass Resection

Question 34

What is the main type of exocrine pancreatic carcinoma?

Answer 34

Adenocarcinoma

Question 35

Where are adenocarcinomas of the pancreas located?

Answer 35

Pancreatic head, body or tail

Question 36

What are the types of endocrine pancreatic cancer?

Answer 36

Gastrinoma Insulinoma Glucagonoma

Question 37

What is the effect of gastrinoma?

Answer 37

Produces gastrin causing increased stomach acid causing gastric/duodenal ulcers

Question 38

What is the effect of an insulinoma?

Answer 38

Produces insulin causing body to store sugar rather than burn it Hypoglycaemia

Question 39

What is the effect of glucagonoma?

Answer 39

Produces glucagon, increases blood sugar levels, hyperglycaemia

Question 40

Symptoms of pancreatic cancer

Answer 40

``` Jaundice Back pain Abdo pain Weight loss Nausea Vomiting ```

Question 41

Risk factors for pancreatic cancer

Answer 41

Smoking Charred meat Obesity Diabetes

Question 42

Investigations for pancreatic cancer

Answer 42

Ultrasound CT scan MRI/MRCP

Question 43

Treatment of inoperable pancreatic cancer

Answer 43

Stent or bypass (palliation)

Question 44

Treatment of operable pancreatic cancer

Answer 44

Whipple resection (tumour on head) Total pancreatectomy Distal pancreatectomy Mid segment pancreatectomy

Question 45

What system is used to stage pancreatic cancer?

Answer 45

TNM classification

Question 46

What is the most common pathology of the biliary tract?

Answer 46

Gallstones