Gastro, Hepatobiliary, Surgery Flashcards
1
Q
What is the epithelium lining for the oesophagus? The stomach?
A
Oesophagus: stratified squamous
Stomach: columnar
2
Q
Symptoms of dyspepsia?
A
Heartburn
Acid regurgitation
Retrosternal pain
Hoarse voice
Bloating
3
Q
Red flag symtoms for GORD?
A
DYSPHAGIA of any kind, any age
Symptoms at >55
Anaemia
Weight loss
Anorexia
Recent onset
Malaena/haematemesis
4
Q
Conservative management for GORD?
A
Conservative:
Avoid alcohol, spicy foods
Weight loss
Stop smoking
Stay upright after eating
Smaller, lighter meals
5
Q
Medical management for GORD?
A
Gaviscon/Rennie to neutralise acid
PPIs
Ranitidine (H2 antagonist) if PPI not tolerated
6
Q
Surgical management of GORD?
A
Laparoscopic fundoplication
7
Q
Tests for H pylori?
A
Urea breath test (drink radiolabelled C13)
Stool antigen test
CLO test (endoscopy and biopsy)
8
Q
1st line treatment for H pylori? Duration?
A
triple therapy: omeprazole, amoxicillin, clarithromycin for 7 days
9
Q
Treatment for H pylori if 1st line is ineffective after 4-8 weeks?
A
Omeprazole, amoxicillin, metronidazole
10
Q
Treatment for H pylori if penicillin allergy?
A
Omeprazole, metronidazole, clarithromycin
11
Q
When is retesting for H pylori done? Which test is used?
A
4-8 weeks after by urea breath test
12
Q
Strongest risk factor for Barretts?
A
GORD
13
Q
Treatment for Barretts?
A
-PPI
-ANY kind of dysplasia is treated endoscopically (mucosal resection/radiofrequency ablation)
14
Q
What is the management of dyspepsia symptoms?
A
One of:
1. Full dose PPI 1 month
- Test for H pylori and treat if positive.
If symptoms persist, do the other option
15
Q
What core symptoms must be present for diagnosis of IBS? For how long?
A
ABC:
Abdominal pain, bloating, change in bowel habit.
For at least 6 months
16
Q
Other symptoms of IBS?
A
- Change in stool passage (straining, urgency, incomplete evacuation)
- Abdo pain relieved by defecation
- Passage of mucus
17
Q
What other tests must be done before diagnosing IBS?
A
- Anti tTG
- Faecal calprotectin
18
Q
Conservative management for IBS?
A
- exercise
- good diet (fluid, small regular meals, reduced processed food, reduce caffeine and alcohol, avoid triggers)
19
Q
Medical management for IBS?
A
-Loperamide for diarrhoea
-Laxatives for constipation (avoid lactulose –> bloating)
-TCA 2nd line
-SSRI 3rd line
20
Q
Peak incidence of ulcerative colitis?
A
15-25 and 55-65
21
Q
Most common site of inflammation in UC?
A
Rectum
22
Q
Symptoms of UC?
A
-Bloody diarrhoea
-Tenesmus
-Abdominal pain in LLQ
-Fever, malaise, weight loss, anorexia
23
Q
Extra-intestinal signs of UC?
A
-Erythema nodosum
-Pyoderma gangrenosum
-Uveitis
-Large joint arthritis/AS
-PRIMARY SCLEROSING CHOLANGITIS
24
Q
What imaging is done for UC? How does this change for those with severe UC?
A
-Colonoscopy and biopsy. If severe, flexible sigmoidoscopy
-Barium enema shows loss of haustration
-AXR shows lead pipe appearance
25
Medication to induce remission in UC? How does induction change in severe UC?
-Topical/oral 5ASA
-Topical/oral steroid
Step up as required, with topical then oral
If severe,
-Admit for IV steroids
-IV ciclosporin if not responding
26
What do you give if there are >2 exacerbations of UC in 1 year?
Oral azathioprine
27
What to give to maintain remission of UC?
topical +-/ oral 5ASA
28
Features of UC (U C CLOSEUP)?
-Continuous inflammation
-Limited to rectum and colon (up to ileocaecal valve)
-Only superficial mucosa affected
-Smoking protective
-Excrete blood + mucus
-Use aminosalicylates
-PSC
29
Symptoms of CD?
-Diarrhoea most common +/- blood
-Abdo pain
-Perianal disease
-Systemic unwellness
-Cobblestone appearance of gut
30
Extra-intestinal symptoms of CD?
-Erythema nodosum
-Pyoderma gangrenosum
-Apthous ulcers
-Episcleritis
-Large joint arthritis
31
What is seen on biopsy in UC vs CD?
UC: inflammation up to submucosa, crypt abscess
CD: transmural inflammation, goblet cells, granulomas
32
What is seen on enema of CD?
-Kantor string sign - strictures in terminal ileum
-Proximal bowel dilation
-Rose thorn ulcer (contrast highlights ulcers that poke deep into bowel wall like a rose thorn)
33
Important lifestyle change for CD?
Stop smoking
34
What is used to induce remission in CD?
Glucocorticoids
35
What is used to maintain remission in CD?
Azathioprine
Methotrexate 2nd line
36
Features of CD? (NESTS)
No blood mucus
Entire GI tract
Skip lesions on endoscopy
Terminal ileum most affected/transmural inflammation
Smoking risk factor
37
2 most common causes of peptic ulcers?
H pylori
NSAIDs/steroids
38
Treatment for confirmed peptic ulcer?
Full dose PPI for 4-8 weeks
H pylori eradication if positive
39
Follow up after treatment gastric ulcers? Duodenal ulcers?
Gastric: endoscopy 6-8 weeks after PPI to check healing and malignancy
Duodenal: no endoscopy needed
40
Presentation of upper GI bleed?
Haematemesis
Melaena
Signs of hypovolaemic shock
41
What is seen on blood test in upper GI bleed?
Raised urea
42
Scoring systems used to assess risk of upper GI bleed?
Glasgow Blatchford before endoscopy
Rockall score after endoscopy for rebleeding
43
Management of upper GI bleed? (ABATED)
ABCDE
Bloods
Access (2 large bore)
Transfuse (FFP/platelets/prothrombin)
Endoscopy (OGD)
Drugs (stop anticoagulants/NSAIDs)
44
Recommended alcohol intake per week?
14 units weekly men and women
45
Signs of liver disease?
-Jaundice
-Ascites
-Varices (oesophageal, rectal)
-Caput medusae
-Spider naevi
-Encephalopathy
-Palmar erythema
-Asterixis
-Bruising
-Gynaecomastia
46
Pattern of LFTs in alcoholic liver disease?
AST and ALT raised (AST:ALT >3)
-GGT raised
-Low albumin
-Raised PT
47
Imaging done in alcoholic liver disease?
US - increased echogenicity, cirrhotic changes, Fibroscan
Endoscopy - assess and treat oesophageal varices
CT/MRI - fatty infiltration, HCC, organomegaly, ascites
Liver biopsy - can confirm diagnosis
48
Management of alcoholic liver disease?
-Stop drinking
-Detox regime + thiamine
-High protein, low salt diet
-Steroids improve short term outcomes
-Treat complications of cirrhosis
49
Incidence of Coeliac?
1%
50
Which antibodies are associated with Coeliacs?
anti TTG
anti EMA
51
Which part of the bowel is most affected by Coeliacs?
Jejunum
52
Which HLA types are most associated with Coeliacs?
HLADR2 and HLADR8
53
Presentation of Coeliacs?
-Failure to thrive
-Abdominal pain
-Foul smelling diarrhoea difficult to flush
-Weight loss
-Fatigue
-Iron deficient anaemia
54
Complications that can occur from Coeliacs?
-Anaemia
-Osteoporosis
-Hyposplenism
-Lactose intolerance
-T cell lymphoma of small intestine if continuing to eat gluten
-GI malignancy
55
What tests for Coeliac? What must the patient do prior to testing?
Patient must be eating gluten for at least 6 week to prove presence of inflammation
-Total IgA levels
-Specific coeliac antibodies (anti TTG, anti EMA)
-Endoscopy with intestinal biopsy is gold standard (crypt hyperplasia, villous atrophy, intraepithelial lymphocytosis)
56
Management of Coeliac?
Gluten free diet
Offer pneumococcal vaccine if hyposplenism
57
Causes of liver cirrhosis?
NAFLD
Alcoholic liver disease
Hepatitis B and C
58
Blood results in someone with liver cirrhosis?
-LFTs all deranged
-Low albumin and prolonged PT
-Hyponatraemia in fluid retention (Ascites)
-Urea and creatinine raised in hepatorenal syndrome
-AFP used to screen for HCC
-ELF test in NAFLD
59
What might US show in liver cirrhosis?
-Nodular liver surface
-Corkscrew appearance of arteries that have increased flow
-Enlarged portal vein with reduced flow
-Ascites
-Organomegaly
60
What scoring system is used to assess severity and prognosis of liver cirrhosis?
Child-Pugh score
61
What scoring system is used to assess for mortality in those with compensated cirrhosis?
MELD score
62
Management of liver cirrhosis?
-US and AFP every 6 months for HCC
-Endoscopy if varices
-High protein, low sodium diet
-MELD score 6 monthly
63
Complications of liver cirrhosis?
-Malnutrition
-Ascites
-Varices
-Hepatic encephalopathy
-Spontaneous bacterial peritonitis
-Hepatorenal syndrome
64
What is SAAG and how is it calculated
Serum Ascites Albumin Gradient helps to clarify the cause of ascites.
serum albumin conc - ascites albumin conc
High SAAG (raised portal pressure)
Low SAAG (cancer, infection)
65
What criteria diagnoses SBP?
Neutrophils in ascitic fluid >250cells/microlitre
66
Most common cause of SBP? Treatment?
E.coli
Cefotaxime
67
What is seen on bloods in hepatorenal syndrome?
Raised urea and creatinine
68
What is given to treat hepatic encephalopathy?
Lactulose to remove ammonia
Rifaximin to kill bacteria that creates ammonia
69
How does hepatorenal syndrome occur?
Dilation of portal vessels reduces blood flow to other areas. In kidneys, reduction of blood flow causes RAAS. There is vasoconstriction leading to further reduction in blood flow to kidneys, resulting in rapid deterioration in kidney function
70
Risk factors for NAFLD?
NAFLD is part of the metabolic syndrome, so risk factors:
-OBESITY
-Hyperlipidaemia
-T2DM
-Smoking
-Hypertension
71
What is shown on US of NAFLD?
-Hepatomegaly
-Increased echogenicity
72
Pattern of LFTs in NAFLD?
ALT > AST (opposite of alcoholic liver disease)
73
Management of NAFLD?
Lifestyle changes and monitoring
-Stop smoking
-Exercise/weight loss
-Control diabetes, BP, cholesterol
-Avoid alcohol
74
Causes of hepatitis?
-Alcoholic hepatitis
-NAFLD
-Viral hepatitis
-Autoimmune hepatitis
-Drug induced hepatitis
75
Symptoms of hepatitis?
-Abdo pain
-Fatigue
-Pruritus
-Muscle and joint pain
-N&V
-Jaundice
-Fever
76
Pattern of LFTs seen in hepatitis?
-Deranged, raised AST and ALT, smaller increase in ALP
-Increase in bilirubin
77
Transmission of HepA?
Typical history?
-Faecal-oral route (contaminated water/food)
-Typically recent travel, eating potentially dirty foods and presenting a few weeks later with hepatitis symptoms
78
Transmission of HepB?
Contact with blood/bodily fluids
79
Presence of HBsAg means?
Active infection
80
Presence of HBeAg means?
Viral replication, high infectivity
81
Presence of HBcAb IgM means?
Recent/acute infection <6 months ago
82
Presence of HBcAb IgG means?
Past infection >6 months ago
83
Presence of HBsAb means?
Past/current infection with antibodies or vaccinated
84
What HepB serology would you see in those immunised?
HBsAb, all others negative
85
What HepB serology would you see in someone who has had previous infection but not a carrier?
HBcAb +ive
HBsAg -ive
86
What HepB serology would you see in someone who has had previous infection and is a carrier?
HBcAb +ive
HbsAg +ive
87
Early symptoms of haemochromatosis?
Fatigue
Erectile dysfunction
Arthralgia
88
Other symptoms of haemochromatosis?
Bronze skin
T1DM
symptoms of liver disease
Hypothyroidism
Cardiac deposits
89
Investigations for haemochromatosis?
-Transferrin saturation (>55% men, >50% women)
-Serum ferritin and iron raised
-Genetic testing
-Liver biopsy with Perl's stain
-Joint Xray shows chondrocalcinosis
90
Management of haemochromatosis?
-Venesection
Desferrioxamine 2nd line
-Avoid alcohol
91
Usual onset of Wilson's disease?
10-25 years
92
Symptoms of Wilsons?
Brain: dysarthria, dementia, parkinsonism, depression, psychosis, chorea
Liver: hepatitis, cirrhosis
Cornea: Kayser-Fleischer rings
Renal tubular acidosis
Haemolysis
Blue nails
93
Investigations for Wilson's disease?
-Serum caeruloplasmin is low, serum free copper is high
-Slit lamp
-Genetic testing
-Liver biopsy is gold standard, looking for copper content
94
Management for Wilsons?
Penicillamine to chelate copper
Trientine if penicillamine not tolerated
95
Ratio of M:F for primary biliary cholangitis?
1:9
96
What is PBC?
Intrahepatic inflammation of small bile ducts in liver
97
Which condition is most associated with PBC?
Sjogren's (80%)
RA
98
Features of PBC?
-Middle aged woman with itching
-Fatigue
-Cholestatic jaundice, pale stool, steatorrhoea
-RUQ pain
-Xanthelasma, xanthomata
99
What immunology is seen in PBC?
-serum IgM raised
-anti-mitochondrial M2 in 98%
-smooth muscle antibodies
100
Pattern of LFTs in PBC?
ALP raised as obstructive pathology
101
What complications of PBC?
RISK OF HCC x20
Cirrhosis
102
Management of PBC?
1st line is ursodeoxycholic acid that slows disease progression and improves symptoms
Cholestyramine helps hyperbilirubinaemia and pruritus
Fat soluble vitamin supplementation
103
What is primary sclerosing cholangitis?
Intra/extra hepatic ducts become sclerosed and fibrotic, causing obstruction to bile flow out of the liver
104
What condition is associated with PSC?
UC
105
Typical PSC patient?
Male, Aged 30-40 with UC and family history
106
Symptoms of PSC?
Cholestasis (jaundice, pruritis, raised bilirubin and ALP)
RUQ pain
Fatigue
Hepatomegaly
107
What is seen on LFTs in PSC?
-Deranged LFTs with ALP most raised
-Raised bilirubin
108
What imaging is used to diagnose PSC and what feature is seen?
MRCP gold standard, can also do ERCP. Shows beads on a string appearance
109
Immunology in PSC?
p-ANCA
anti smooth muscle
ANA
110
Complications of PSC?
-Acute bacterial cholangitis
-Cholangiocarcinoma
-Increased risk of colorectoal cancer
-Cirrhosis and liver failure
-Fat soluble vitamin deficiency
111
Management of PSC?
No definitive treatment
ERCP to stent strictures
Cholestyramine
112
What types of liver cancer are there?
HCC (80%)
Cholangiocarcinoma (20%)
113
Risk factors for liver cancer?
-Cirrhosis
-PSC
-PBC (20x)
114
Painless jaundice associated with which cancer?
Pancreatic cancer
Cholangiocarcinoma
115
Investigations for liver cancer
-AFP marker for HCC
-Ca19-9 marker for cholangiocarcinoma
-Liver US
-CT/MRI for diagnosis an dstaging
-ERCP for biopsies in cholangiocarcinoma
116
Treatment for HCC and cholangiocarinoma?
-Poor prognosis
-Chemo/radio not effective
-Resection possible but needs to be early
-ERCP to relieve any obstructive symptoms in cholangiocarcinoma
117
What can cause Budd Chiari syndrome?
-Polycythaemia rubra vera
-Thrombophilias
-Pregnancy
-COCP
118
What triad of symptoms presents in Budd Chiari?
-Sudden onset, severe abdominal pain
-Ascites
-Tender hepatomegaly
119
What is the first line investigation in Budd Chiari?
Doppler flow US
120
What age range does acute appendicitis affect the most?
10-20
121
Symptoms of acute appendicitis?
-Central abdominal pain radiating to RIF
-May have vomiting
-Mild pyrexia
-Anorexia
122
Which signs can be elicited on examination of acute appendicitis?
Rovsing sign - palpation in LIF causes RIF pain
Psoas sign - pain on hip extension
McBurneys point is tender - 1/3 distance from ASIS to umbilicus
123
What other conditions need to be excluded before diagnosing acute appendicitis?
Pregnancy, renal colic, UTI
124
What does urinalysis show in acute appendicitis?
Leucocytes but no nitrites
125
Management of acute appendicitis?
Laparoscopic appendicectomy with prophylactic IV antibiotics
126
Complications of hernia?
Incarceration
Strangulation
Obstruction
127
What are the main treatment options for hernia?
Conservative management if no symptoms and not suitable for surgery
Tension free repair preferred if surgical
128
How to differentiate between direct and indirect inguinal hernia?
Reduce hernia, apply pressure to deep inguinal ring. Remains reduced if indirect hernia
129
Risk factors for diverticulosis?
Age
Low fibre diet
Obesity
NSAIDs
130
Presentation of acute diverticulosis?
LIF pain
Anorexia
N&V
Diarrhoea
Infection symptoms
131
Management of chronic diverticulosis?
High fibre diet
Bulk forming laxatives (avoid stimulant)
132
Management of acute diverticulosis?
NBM
IV fluids
IV antibiotics
Analgesia
133
How much water is needed per day for maintenance fluids?
25-30ml/kg/day
134
How much sodium, potassium and chloride is needed for maintenance per day?
1mmol/kg/day
135
How much glucose is needed for maintenance per day?
50-100g/day
136
What is the resuscitation fluid protocol?
-500ml bolus stat and reassess
-Repeat with boluses of 250-500ml and reassess
-Escalate if not responding after 2L
137
Which medications need to be stopped/changed prior to surgery?
-Stop warfarin/DOACs
-Stop oestrogen medications 4 weeks prior
-Increase steroids
-Stop sulfonylureas, be careful with other diabetic drugs
138
Explain 3rd spacing fluid loss
Obstruction in the bowel means that the fluid that usually gets secreted in the lumen cannot get by. It doesnt get reabsorbed in the colon so remains in the gut
139
Causes of small and large bowel obstruction?
Adhesion (small)
Hernia (small)
Malignancy (large)
140
Presentation of bowel obstruction?
-Bilious vomiting
-Abdominal distension and pain
-Absolute constipation
-Tinkling bowel sounds
141
What investigations to be done when there is bowel obstruction?
AXR 1st line - distended loops of bowel
CXR - pneumoperitoneum
Contrast CT - gold standard
142
Management of bowel obstruction
-A-E
-Bloods (electrolyte imbalance, metabolic alkalosis)
-Drip and suck (IV fluids, NG tube with drainage)
-Surgery
143
Which 2 inherited conditions are the strongest risk factors for bowel cancer?
1. Hereditary nonpolyposis colorectal cancer (Lynch syndrome)
2. Familial adenomatous polyposis (FAP)
144
What are the red flags that should make you consider bowel cancer?
-Change in bowel habit
-Unexplained weight loss
-Rectal bleeding
-Unexplained abdominal pain
-Iron deficiency anaemia
-Abdominal/rectal mass
145
What tumour markers are used for cancers: colorectal, pancreatic, HCC, cholangiocarcinoma, ovarian, breast, prostate?
Colorectal - CEA
Pancreatic - Ca19-9
HCC - AFP
Cholangiocarcinoma - Ca19-9
Ovarian - Ca125
Breast - Ca15-3
Prostate - PSA
146
What type of cancers are cholangiocarcinoma?
Cancer of the bile ducts - usually adenocarcinoma
147
Risk factors for cholangiocarcinoma?
Primary sclerosing cholangitis
148
Presentation of cholangiocarcinoma?
-PAINLESS, OBSTRUCTIVE JAUNDICE
-Unexplained weight loss
-Palpable gallbladder
-Hepatomegaly
149
What investigations for cholangiocarcinoma?
-CT/MRI and biopsy for diagnosis
-CTTAP for mets
-CA19-9 tumour marker
-MRCP/ERCP to insert stent and biopsy
150
Where does pancreatic cancer usually affect? What type of cancer
Usually adenocarcinomas of head of pancreas
151
Symptoms of pancreatic cancer?
-PAINLESS, OBSTRUCTIVE JAUNDICE
-Unintentional weight loss
-Palpable mass in epigastric region
-Change in bowel habit
-N&V
-New or worsening of diabetes
152
What investigations for pancreatic cancer?
-US has high sensitivity
-CTTAP for mets
-Ca19-9 marker
MRCP/ERCP for stent and biopsy
153
What sign may be seen on imaging of pancreatic cancer?
Double duct sign - simultaneously dilation of common bile duct and pancreatic duct
154
What management for pancreatic cancer?
Surgery:
-Total pancreatectomy, distal pancreatectomy
-Whipple procedure (Radical pancreaticoduodenectomy)/modified Whipple procedure (preserves pylorus)
Palliative care
155
Most common cause of acute cholecystitis?
Gallstones
156
Symptoms of acute cholecystitis?
-RUQ pain (may radiate to right shoulder)
-Fever
-N&V
-Tachycardia, tachypnoea
-Murphy's sign
-Raised inflammatory markers and WBC
157
Investigations for acute cholecystitis?
-Abdo US 1st line (thickened gallbladder wall, stones, fluid around gallbladder)
-MRCP can show biliary tree if stone not seen on US but suspected
158
Management for acute cholecystitis?
-Conservative (NBM, IV fluids, Abx, NG tube)
- ERCP to remove stones in CBD
-Cholecystectomy
159
What is acute cholangitis?
Infection and infection of bile ducts. High mortality due to sepsis
160
Causes of acute cholangitis?
-Bile duct obstruction
-Infection from ERCP
161
Most common organisms to cause acute cholangitis?
-E.coli
-Klebsiella
-Enterococcus
162
Presentation of acute cholangitis?
Charcot's triad
-RUQ pain
-Fever
-Jaundice
163
Management of acute cholangitis?
-Emergency admission for sepsis and investigations
-NMB, IV fluids, blood culture, IV abx, HDU/ICU
164
Risk factors for gallstones?
4F's:
-Fat
-Fair
-Female
-Forty
165
Symptoms of gallstones
Can be asymptomatic
-Biliary colic in RUQ
-Pain triggered by meals (especially high fat)
-N&V
166
Complications of gallstones?
-Acute cholecystitis
-Acute cholangitis
-Obstructive jaundice
-Pancreatitis
167
Imaging for gallstones?
-US 1st line
-MRCP
-ERCP can be done to stent
168
Management of gallstones?
Only if asymptomatic
-Cholecystectomy
169
Triad of symptoms in chronic mesenteric ischaemia?
-Central colicky abdo pain after eating
-Weight loss (food avoidance)
-Abdominal bruit
170
Diagnosis and imaging for mesenteric ischaemia?
CT angiography
171
Management for chronic mesenteric ischaemia?
-Treat modifiable risk factors
-Clopidogrel and statins
-Revascularisation to improve blood flow to intestines by endovascular procedures such as mesenteric artery stenting
172
Presentation of acute mesenteric ischaemia?
-Acute abdo pain
-Shock, peritonitis, sepsis
-Necrosis and perforation if untreated
173
Diagnosis and imaging for acute mesenteric ischaemia?
-Contrast CT
-Bloods (METABOLIC ACIDOSIS AND RAISED LACTATE are highly suggestive)
174
Management for acute mesenteric ischaemia?
Surgery to remove necrotic bowel or remove/bypass thrombus
175
Causes of pancreatitis?
I GET SMASHED:
-Idiopathic
-Gallstones
-Ethanol
-Trauma
-Steroids
-Mumps
-Autoimmune
-Scorpion sting
-Hyperlipidaemia, hypercalcaemia
-ERCP
-Drugs (furosemide, thiazide diuretics, azathioprine, mesalazine)
176
Presentation of acute pancreatitis?
-Severe epigastric pain radiating to back
-Associated vomiting
-Abdominal tenderness
-Systemically unwell
177
Which blood markers are indicative of acute pancreatitis?
-Amylase raised 3x normal in acute pancreatitis
-Lipase more sensitive
-CRP
178
Imaging for acute pancreatitis?
-US for gallstones
-CT abdomen assesses for complications (necrosis, abscess, fluid collection
179
Management for acute pancreatitis?
-A-E
-IV FLUIDS
-NMB
-Analgesia
-Monitoring
-ERCP/cholecystectomy to treat gallstones
-Abx if infection
180
Complications of acute pancreatitis?
-Necrosis of pancreas which can become infected
-Abscess formation
-Peripancreatic fluid collection
-Chronic pancreatitis
181
Most common cause of chronic pancreatitis?
Alcohol
182
Monitoring of chronic pancreatitis disease progression?
-Exocrine function as measured by faecal elastase
-Endocrine function as measured by diabetes
183
Complications of chronic pancreatitis?
-Diabetes
-Obstruction of pancreatic juice
-Formation of pseudocysts and abscesses
184
Management of chronic pancreatitis?
-Stop smoking
-Stop drinking
-Analgesia
-CREON
-Insulin
-ERCP to treat strictures/obstruction
