HPB Conditions

Question 1

Suggest a reason why a patient might experience RUQ pain with liver metastases.

Answer 1

Growing tumour in liver causes the liver capsule to stretch and therefore stimulates the somatic pain fibres.

Question 2

What scoring system is commonly used to assess the severity of acute pancreatitis? Suggest THREE of the features it includes.

Answer 2

Glasgow score, spells PANCREAS:

PaO2 < 8kPa
Age over 55
Neutrophils over 15
Calcium under 12
Renal function (urea over 16)
Enzymes (AST over 200, LDH over 600)
Albumin under 32
Sugar (glucose over 10)

Score over 2 suggests high likelihood of severe pancreatitis in alcoholic/gallstone pancreatitis.

Question 3

Specifically which analgesic is indicated in pancreatitis/

Answer 3

Pethidine as:

• NSAIDs can worsen liver or renal function
• Morphine can lead to spinchter spasm

Question 4

Suggest THREE causes of chronic pancreatitis.

Answer 4

• Alcohol (70% of cases)
• Genetic:
  + CF
  + HH
• Immune (raised IgG4 in a weird condition)
• High triacylgylcerides (TAGs)