Hepatobiliary Crash Course

Question 1

Most common anatomical location of pancreatic adenocarcinoma

Answer 1

Pancreatic head!

Often asymptomatic in early disease and therefore diagnosed late

Question 2

Pancreatic adenocarcinoma anatomical location

Answer 2

Question 3

Answer 3

Ca 19-9

Question 4

Answer 4

E

Question 5

Approx …% of pancreatic adenocarcinoma cases are respectable at diagnosis

Answer 5

Question 6

What does he have?

Answer 6

Acute pancreatitis
Acute abdomen
Uncontrolled release of pancreatic enzymes
Can be mild to severe to life-threatening

Question 7

Answer 7

Gallstones then alcohol

Question 8

I GET SMASHED

Answer 8

Question 9

Answer 9

A

Question 10

Glasgow score - pancreatitis severity

Answer 10

Question 11

Acute pancreatitis management

Answer 11

Supportive care with fluids and analgesia - catheter and fluid balance imp
Amylase test
Nutrition - enteral feeding preferred, NG/NJ if oral isnt tolerated
TPN if enteral route not tolerated
Further measures - cholecystectomy if gallstones are the cause
Antibiotics if infected necrosis or other source
Identify and manage complications

Question 12

Appendicitis?
Cholangitis?
Biliary colic?
Gastroenteritis?
Acute cholecystitis?

Answer 12

Biliary colic

Question 13

Biliary colic

Answer 13

Question 14

Investigations in biliary colic

Answer 14

USS + LFTs

Question 15

Most appropriate management option

Answer 15

Elective laparoscopic cholecystectomy

Question 16

Murphy’s sign - what is it?

Answer 16

Palpate RUQ, elicits pain on inspiration

Question 17

Acute cholecystitis

Answer 17

Gallstone may become impacted within the cystic duct

Impaired drainage leads to stasis and bacterial growth

Question 18

Complications of acute cholecystitis

Answer 18

Perforation and empyema - but is uncommon

Question 19

Overview of gallstone related pathology

Answer 19

Question 20

What is best for CBD stone recognition?

Answer 20

MRCP

Question 21

Hepatocellular cancer screening in cirrhosis patients?

Answer 21

6 monthly USS +/- AFP

Question 22

Hepatocellular carcinoma

Answer 22

Primary liver cancer occurring predominantly in patients with cirrhosis
One of the major complications of cirrhosis and chronic hep B
Patients may be asymptomatic, picked up on screening
Others present with weight loss, sweats, mass, pain and jaundice

Question 23

Hepatocellular carcinoma - management

Answer 23