Liver, biliary and pancreatic pathology Flashcards
1
Q
Chronic liver disease lasted ___
Must have +
A
> 6 months
stellate activation and cirrhosis
2
Q
4 types of liver cells:
A
hepatocytes
Kupffer cells
endothelial cells of fenustrates
stellate cells
3
Q
hepatic macrophages that breakdown RBCs
A
Kupffer cells
4
Q
function of hepatocytes near artery = \_\_ near central vein = \_\_\_
A
artery = metabolic processes
central vein = toxin clearance
5
Q
normally stellate cells are ___ and function =__
A
quiescent
store fat, vit. A and control sinusoid blood flow
6
Q
Damage to the liver causes loss of ___ on hepatocytes, ___ activate, ___ are lost from epithelial cells and __ cells are activated
A
hepatic microvilli
Kupffer cells
fenustrates
Stellate
7
Q
Liver damage=>
activated stellate cells: proliferate, become more ___, attract ___ and chemotaxis of __ => extracellular matrix degradation and ___ laid down = ___=>
A
contractile
leukocytes
stellate cells
collagen = fibrogenesis=> cirrhosis
8
Q
Liver damage:
Causes stellate apoptosis which => ___
A
TIMP - tissue inhibitor of metalloproteases
resolution
9
Q
What activates Kupffer cells?
A
product of damaged cells
activation factors eg. TGFB1, PDGF …
10
Q
Can diagnose steatosis by
A
US
11
Q
2 hit theory for NASH:
A
1= too many tri.s to store = free FAs 2= ox. stress + lipid peroxidation due to MCD diets/pro-inflam cytokine release = reperfusion injury
12
Q
Autoimmune disease characterised by +AMA antibodies, T cell CD4 mediated against intra-hepatic bile ducts, mostly in women
A
PBC (primary biliary cirrhosis)
13
Q
Autoimmune hepatitis is more common in M/F?
A
females 4:1
14
Q
Histology of autoimmune hepatitis shows:
A
piecemeal necrosis
interface hepatitis
numerous plasma cells
15
Q
Type 2 AI hepatitis is more/less common than type one
Occurs usually in ___
+AI antibodies =
A
more
young adults / children
AMA, LKM-1
16
Q
Type 1 AI hepatitis is associated with which +AI antibodies
A
ANA, ASMA, SLA(marks severity), IgG, AMA, pANCA
17
Q
Diagnosis of AI hepatitis is based on which investigations?
A
increased AST and ALT in LFTs
Increased IgG, AI Igs
liver biopsy
18
Q
treatment of AI hepatitis =
A
corticostreoids - prednisolone (start high dose then lower to maintenance dose)
azathioprine
19
Q
PSC is more common in M/F? \+antibodies? is AI destruction of \_\_\_ image of biliary tree shows \_\_\_ associated with \_\_\_
A
M 4:1 ANCA mainly large and medium intra and extrahepatic bile ducts onion skinning/ beading of biliary tree UC
20
Q
PBC or PSC increases risk of cholangiocarcinoma
If also have UC it increases risk of ___ too
A
PSC
colorectal carcinoma
21
Q
Haemochromatosis=
A
autosomal recessive disease of Fe overload
22
Q
___ mutations in __ gene =>___
In haemochromatosis
A
C282Y/H63D
HFE gene
=> liver doesnt signal enterocyte to stop absorbing Fe
23
Q
bronzed diabetic has…
A
haemochromatosis
24
Q
treatment of haemochromatosis =
A
venesection
25
Wilson's disease =
autosomal recessive condition where loss of function/protein in caeruloplasmin => copper deposits in tissues and basal ganglia
26
Kaiser fleischer rings =
Copper
| Wilson's
27
Wilson's is associated with ____ and ___ problems
liver (cirrhosis, sub-fulminant liver failure)
| neuro (Chorea)
28
If have chronic liver disease and emphysema you have ...
α-1 anti-trypsin deficiency
29
Budd-Chiari syndrome =
thrombosis of the hepatic veins due to congenital webs + Protein C/S deficiency
30
__ used to diagnose Budd-Chiari
| Treat with
US
| recanalisation/TIPSS
31
Drug that causes liver fibrosis =
| Drug is for:
methotrexate
| psoriasis and rheumatoid arthritis
32
Cardiac cirrhosis of the liver is caused by :
increased R heart pressure
33
Cirrhosis =
1) liver ___ due to less ____
2) disruption of ___
3) generation of ____
dysfunction due to less hepatocytes
vasculature
abnormal signalling
34
Portal vein hypertension is defined as > ___mmHg OR a _:_ ratio of more than __
5-8mmHg
| Portal:hepatic vein P >5mmHg leading to an increase in hydrostatic P in portal vein
35
normal portal vein + hepatic vein bp are _+_
| gradient =>
7mmHg portal
4mmHg hepatic
pushes blood through liver
36
4 anastamoses of portal venous to hepatic venous system:
oesophageal+gastric venous plexus
umbilical vein reopens from L portal vein -> epigastric venous system
retroperitoneal collaterals behind the spleen
anal venous plexus
37
caput medusae is engorged ____
umbilical and epigastric veins
38
portal hypertension causes _+_ varices
oesophageal and anorectal
39
Prehepatic causes of portal hypertension are
thrombosis/occlusion of veins before liver
40
Intrahepatic causes of portal hypertension are
pre-sinusoidal: eg. schistosomiasis
post-sinusoidal eg. cirrhosis, alcoholic hepatitis
Budd-Chiari
41
Sinusoidal hypertension causes release of enogenous ___ eg.
| =>
vasodilators eg. NO, CO, CGRP, glucagon
| splanchnic and peripheral vascular resistance drops
42
Ascites occurs due blood pooling and systemic vasodilation =>
activates ___
hypodynamic circulation as decreased effective arterial blood volume
RAAS
43
End stage liver failure is due to ___ hepatocytes
insufficient
44
Signs of compensated liver failure:
```
spider naevi (blanch on pressure)
gynaecomastia
spleno/hepatomegaly
palmar erythema
NONE possibly
```
45
Signs of decompensated liver failure:
ascites
jaundice
encephalopathy
easy bruising
46
Treatment of ascites =
```
no NSAIDs
stop drinking alcohol
low salt
spironolactone and loop
paracentesis
TIPSS
transplant
```
47
Alcoholics get vitamin __ supplements to prevent __
B1 - thiamine
| Wernicke-Korsakoff syndrome
48
In ascites you retain __ and ___
NaCl and H2O
49
treatment of spontaneous bacterial peritonitis due to ascites
antibiotics, terlipressin and maintain renal perfusion
50
encephalopathy occurs in liver disease due to :
NH3 is not removed from gut => brain and is deposited
51
treatment of liver related encephalopathy =
lactulose
| rifaxamin
52
Prophylaxis for varices
variceal ligation
| non-selective β-blockers (propranolol - best / carvidelol - best tolerated)
53
in acute variceal bleed treatment =
terlipressin (vasoconstrict)
sclerotherapy/balloon tamponade (bridge)
ligation
TIPSS
54
If have liver disease put on an ___ as clotting factor balance is off
anti-coagulant
55
UKELD score of >__ is needed to be listed as have a _% 1yr mortality risk
Unless have ___ in which go on list with score
49
9%
HCC/other syndrome
49
56
As the degree of liver dysfunction increases what happens to the markers (ascites, bilirubin, albumin, PT and encephalopathy)
increase: ascites, bilirubin, PT, encephalopathy
decease: albumin
57
3 major factors of portal hypertension: reduced_+_+_
liver blood flow
metabolic function
plasma proteins
58
If oral dose is greater than IV dose this suggests
1st pass metabolism is important factor
59
endothelin and oestrogen levels in liver disease inc/decrease because ___
increase
| not metabolised by liver
60
Activation of RAAS in liver disease => (3) electrolyte and fluid consequences
Na+ and H2O retention
| K+ depleted
61
Hepatorenal syndrome =
is mainly caused by __
___ compensate for ____ vasoconstrition
therefore dont give ___ as make renal problems worse by decreasing ___
renal failure caused by hepatic disease
endothelin
renal prostaglandins compensate for endothelin
NSAIDs are a NO as decrease PGs
62
NSAIDs in liver disease cause
1) less renal PGE synthesis =>worsen renal impairment, Na retention, worsen CHF
2) more cirrhosis peptic ulcers
63
codeine doesnt work in liver disease patients because
it is a pro drug and liver no longer activates it
64
Don't give __/__ in liver disease as worsens encephalopathy
sedatives/opioids
65
Highly reactive intermediate in paracetamol metabolism =
N-acetyl-p-benzoquinamine
66
highly reactive intermediate in paracetamol metabolism is removed by ___
glutathione
67
Running out of ___ in paracetamol overdose causes liver necrosis by ___
glutathione
| N-acetyl-p-benzoquinamine
68
Pain relief in liver disease
give paracetamol 1mg bds - dont exceed 3g per day
codeine 30mg tds - watch for sedation
NO NSAIDs
69
Are thiazide diuretics used in ascites? Why/why not?
no
| worsens hypokalaemia and hypomagnesaemia
70
Are loop diuretics used in ascites? Why/why not?
no
reduces intra-vascular volume
worsens hypokalaemia and hypomagnesaemia
71
Which diuretic is used for ascites? Why?
Spironolactone in big doses+ fluid restriction
72
How much water loss do you aim for per day when using diuretics for ascites?
1kg/day
73
Forms of sedation used in liver disease
Phase II metabolised benzodiazepines in low doses
| eg. lorazepam, oxazepam, lormetazepam
74
Are antibiotics safe to give in liver disease?
Yes, mostly.
Aminoglycosides = nephrotoxic
quinolones = epileptogenic
metronidazole = reduced metabolism by liver disease
75
To measure drug levels in liver disease must measure
free drug level
| not just plasma levels as lots are unbound
76
In liver disease use drugs with ___ excretion
avoid __-drugs
Drugs to be wary of:
renal
pro-drugs
CNS drugs, sedatives, anticoagulants, NSAIDs, theophyllines, aminoglycosides
77
Acute liver disease defintion
rapid development of liver dysfunction wo prior liver disease
less than 6 months in duration
78
LFTs that is raised shows liver damage
ALT and AST
79
LFT that is more specific for liver damage
ALT>AST
80
LFT found in liver bile duct and bone
ALP
81
Cholestatic LFTs =
GGT and ALP
82
LFT that monitors cirrhosis due to alcohol =
GGT
83
GGT is made in cells __+__
hepatocytes around intrahepatic bile ducts
| bile duct cells extrahepatically
84
bilirubin is raised in __/__/__
bile obstruction
liver damage
increased RBC breakdown
85
albumin is decreased in (5)
```
liver disease
Fe deficiency
infection
poor diet
diarrhoea
```
86
PT increases in __+__
| Is the best test to monitor for
vitamin K deficiency
liver disease
monitor liver function - do every 6 hrs
87
causes of acute liver disease =
```
Hepatitis viruses
CMV
EBV
toxoplasmosis
drugs
shock
cholangitis
alcohol
cancer
Budd-Chiari
Pregnancy
```
88
Investigations for acute liver disease =
LFTs, PT, Hx (itch, jaundice, exposure)
examine
US
Virology
89
For itch in liver disease give (3)
Na bicarbonate bath, cholestyramine or ursodeoxycholic acid
90
_/_/_ (electrolytes) are usually low in liver disease so monitor and maybe supplement
Mg
| K PO4
91
Drugs that cause acute liver disease =
```
paracetamol
co-amoxiclav
flucloxacillin
NSAIDs
"protein powder"
```
92
Fulminant hepatic failure = __+__ in previously normal liver
jaundice and encephalopathy
93
Causes of fulminant hepatic failure = (7)
```
paracetamol + other drugs
Hep A+B
Budd Chiari
Pregnancy
Cancer
Wilson's
mushrooms
```
94
treatment of fulminant hepatic failure =
supportive
inotropes and fluids
manage increased intracranial P
may need transplant
95
Hep A is spread by ___
causes acute/chronic hepatitis
vaccine?
Investigations?
faeco-oral
acute - CANNOT cause chronic
vaccine given to travellers
serology and Hep A IgM
96
Hep E is spread by ___
vaccine?
acute/chronic
faeco-oral/zoonosis - british pigs/abroad in tropics
no vaccine
acute unless IC
97
Hep D is ony found with ___
| = _/_ infection
Hep B
| co/superinfection
98
Hep B is spread by _/_/_
acute/chronic
vaccine?
sex, blood, mother to child
chronic usually
yes vaccine
99
```
HBsAg =
HBeAg =
HB DNA =
HB IgM =
HB IgG =
```
HBsAg = current infection - present in all infected
HBeAg = present in highly infectious
HB DNA = increased level =increased infectivity and worse prognosis - monitors therapy
HB IgM = recently infected
HB IgG = immunity
100
Hep C is spread by _/_/_
acute/chronic?
vaccine?
investigation
sex (less effectively than B), blood, mother and child
chronic in 75%
no vaccine
+ve antibody alwats present
PCR for RNA +ve = active, -ve = previous infection
101
Treatment of acute viral hepatitis
monitor
notify public health
immunise contacts
102
chronic viral hepatitis treatment =
antivirals (8 for HCV - if RNA +ve and genotype known, 6 for HBV - if HBsAg and DNA +ve)
vaccinate for other HVs, pneumococcal and influenza
less alcohol
screeen for HCC - serum AFP and US
103
Interferon α =
human protein that's part of immune response to viral infection
Injected as PEG-interferon α = antiviral
104
Sustained virological response (SVR) after Hep C therapy is declared when _
no HCV RNA after 6 moths of stopping therapy
105
Chronic HCV patients (even if cured) get __ screening every ___
HCC - US
| 6 months
106
3 zones from portal triad >> central vein =
| ___ most susceptible to injury as receives least O2
periportal>mid-acinar>pericentral
| pericentral
107
Cirrhosis induced by alcohol is ___nodular
micronodular
108
```
Intense drinking of alcohol
2-3days =
4-6wks =
months-yrs =
yrs =
```
fatty liver
hepatitis
fibrosis - irreversible
cirrhosis
109
characteristics of alcoholic hepatitis:
hepatocyte necrosis, neutrophils, mallory bodies, pericellular fibrosis
110
Mason's triad seen in cirrhosis =
blue collagen, white fat, red hepatocytes
111
Viral hepatitis causes =
```
Hep ABCDE viruses
δ agent
EBV
yellow fever
HSV
CMV
```
112
Hepatitis A is directly/indirectly cytopathic
directly
113
Chronic viral hepatitis on histology =
interface hepatitis
piecemeal necrosis
councilman bodies - lobular inflam
114
Chronic hepatitis causes =
Hep B and C
PBC
PSC
AI or drug induced hepatitis
115
PBC main autoantibodies =
AMA
116
PBC/PSC is predominant in females
```
PBC = 90% females
PSC = 70% males
```
117
AI hepatitis is more common in M/F
| characteristic findings =
```
Females
usually triggered
ass with other AIs
SM/nuclear/LKM autoantibodies
Increased IgG
numerous plasma cells
```
118
PSC/PBC is associated with onion skinning of bile ducts
PSC
119
PSC/PBC is associated with granuloma wreaths around bile ducts
PBC
120
Autosomal recessive cause of iron overload
worse in M/F?
Fe confirmed in liver by ___
Primary Haemochromatosis
Males (and females post-menopause)
Perls stain
121
Risk factors for gallstones
```
Fat, fair, female, Forty, fertile (5Fs)
diabetic
Crohn's (bile salt loss)
dysmotility of GB
prolonged fasting
TPN
```
122
Pigment gallstones =
excess bilirubin due to haemolysis = black stones
123
soft white gallstones are caused by too much
cholesterol
124
Mucocoele =
gallbladder gets blocked eg. by gallstone = fills with mucus
125
inflammation of the gallbladder =
cholecystitis
126
Acute cholecytitis is indicated by presence of ___ causes intense __ in 2-3 days
neutrophils (pus)
| adhesions
127
Chronic cholecystitis causes wall to be __ but not ___
| have ___ sinuses
thickened but not distended
| Rokitansky-Aschoff sinuses
128
carcinomas of the gallbladder =
adenocarcinomas - poor prognosis
129
adenocarcinoma of the bile ducts =
| present with __
cholangiocarcinoma
| obstructive jaundice - poor prognosis - rarely resectable
130
tumour at confluence of R and L hepatic ducts =
klatskin tumour
131
Increased serum __ indicates pancreatitis
AMYLASE
132
Causes of acute pancreatitis =
(GET SMASHED)
| alcohol and cholelithiasis (mainly), shock, mumps, hyperparathyroidism, hypothermia, trauma, iatrogenic
133
In pancreatitis pancreas releases __+__ consequences =
proteases - tissue destruction and haemorrhage
| lipases - intra+peripancreatic fat necrosis - may bind Ca2+
134
Acute pancreatitis complications include hypo___ and hyper ___
hypocalcaemia
| hyperglycaemia
135
Treatment of acute pancreatitis
monitor and modify cause to prevent recurrence
136
Causes of chronic pancreatitis
```
GET SMASHED
alcohol
gallstones
CCF
familial, hyperparathyroidism
```
137
Autodigestion of pancreatic acinar cells occurs in __
pancreatitis
138
Carcinoma of the pancreas =
| histologically looks like :
adenocarcinoma
| irregular abortive glands in a dense stroma
139
RBCs lifespan =
100-120 days
140
In small intestine bacteria convert colourless __/___ to brown stercobilirubin
stercobilinogen/urobilinogen
141
Yellow colour in urine =
urobilin
142
Limiting factor in bilirubin conjugation that results in pre-hepatic jaundice due to unconjugated bilirubin
glucaronyl transferase
143
There is no increase in ___ bilirubin in pre-hepatic jaundice
urinary
144
In pre-hepatic jaundice LFTs are __
normal
145
Jaundice is less marked in which cause of jaundice out of the 3?
Pre-hepatic
146
In pre-hepatic jaundice urine and faeces are
normal colour
147
In hepatic jaundice ___ hyperbilirubinaemia predominates
| associated symptoms = stools are ___ ; + ___
conjugated
stools normal but may be pale if excretion is significantly impaired
tender hepatomegaly
148
___ jaundice causes pale stools and dark orange urine
post-hepatic - conjugated bilirubin
149
In abscence of liver disease ____ liver cancer is more common
metastatic
150
Commonest liver tumour =
| affects females or males more
haemangioma
| females
151
Appearance of liver haemangioma
symptoms
Diagnosis investigations
Treatment
single small wall demarcated capsule that is surrounded by hypervascularisation
asymptomatic
US - CT - MRI - no need for FNA
NO need for treatment
152
Focal Nodular Hyperplasia (FNH) classic appearance
central scar with a large artery with branches radiating to the peripheries = hub+spokes
153
FNH is due to a congenital ___ abnormality
associated with __+__
it is a ___ response to abnormal ____ flow
vascular
Osler-Weber-Rendu and liver haemangioma
hyperplastic response
arterial flow
154
Benign liver lesion that is isointense on sulfur colloid scan and has sinusoids, bile ductules and Kupffer cells present on histology
FNH - focal nodular hyperplasia
155
FNH is more common in ___ (demographic)
young and middle aged women
156
FNH symptoms
malignancy risk?
Diagnosis investigations
treatment
asymptomatic - min. pain and bleeding risk
no malignancy risk
US - CT - MRI - may need FNA (normal hep.s and Kuppfer w. central core)
no treatment
157
Appearance of hepatic adenoma
normal hepatocytes with no portal tract, central veins of bile ducts.
Usually are solitary fat containing lesions
158
Benign liver lesion that is associated with contraceptive hormones and is more common in females
liver adenoma
159
Hepatic adenoma is usually found in the __ lobe
symptoms =
malignancy risk?
R
usually asymptomatic - maybe haemorrhage/RUQ pain
malignancy development risk
160
Multiple hepatic adenomas =
| rare condition associated with ___
adenomatosis
| Glycogen storage disease
161
Investigations for hepatic adenoma
| treatment
US (filling defect)
CT (diffuse arterial enhancement)
MRI - may need FNA
stop hormones - observe every 6mnths - if no regression then excise
162
Benign liver lesions =
Cystic lesions
Hepatic adenoma
haemangioma
FNH - focal nodular hyperplasia
163
4 cystic liver lesions =
simple
hydatid
polycystic liver disease
liver abscess
164
Characteristics of simple cystic liver lesion =
liquid collection lined by an epithelium, no biliary tree communication, solitary and unloculated
165
Symptoms of simple cystic liver lesion
| treatment
asympt - but sympt.s if haemorrhages, ruptures, infection, compresses
none - if symptomatic then open drainage
166
Hydatid cysts in the liver are caused by ___ from ___(geog)
Echinococcus granulosus
| E. Europe, America and Africa
167
Treatments for hydatid cysts in liver =
```
conservative = open cystectomy
radical = lobectomy/pericystectomy
medical = albendazole
percutaneous drainage
PAIR
```
168
Polycystic liver disease is due to __
embryonic ductal plate malformation of intrahepatic biliary tree
169
3 types of polycystic liver disease
Von Meyenburg Complexes (microhamartomas)
Polycystic liver disease
ADPKD - auto dom polycystic kidney disease
170
In Von Meyenburg Complexes are due to remnants of ___ causing small cysts
symptoms =
not ___ genetically linked
cystic bile duct malformations
asymptomatic
germline
171
In Polycystic liver disease liver and renal function is ___
| ___+__ genes related
preserved
PRKC5H
SEC63
172
In ADPKD ____+___ symptoms are common
potential ___
genes=
renal failure and extra-hepatic symptoms
massive hepatic enlargement
PKD1+2
173
Presentation of polycystic liver diseases
abdominal pain and distension
compression symptoms
failure of affected organ
174
treatment of polycystic liver diseases
conservative = somatostatin analogues - sympt relief and decrease liver volume
in advanced = aspiration/transplant
175
Liver abscesses present with
| Hx may include:
high fever, leukocytosis, abdominal pain, complex lesion
| Hx = dental procedure, abdo/biliary infection
176
Treatment of liver abscess =
broad sprectrum antibiotics 4wks with repeat imaging
aspiration
echocardiogram (check for endocarditis
no regression = open drainage
177
Malignant primary liver lesions =
HCC - hepatocellular cancer
fibro-lamellar carcinoma
hepatoblastoma
intrahepatic cholangiocarcinoma
178
Most common malignant primary liver cancer =
| most common in M/F
HCC - hepatocellular caracinoma
| Males
179
Biggest risk factor for HCC and what causes it
cirrhosis
| eg. NASH, alcohol, HBV, HCV, aflatoxin
180
Marker for HCC
| may not be raised in___
AFP - alphafetoprotein
| small HCC
181
Investigations to diagnose HCC
```
blood = LFT, clotting tests, AFP
US
triphasic CT (v. early arterial perfusion)
MRI
Biopsy
```
182
Treatment of HCC
small, single and preserved liver function = curabel resection
3 or fewer nodes/less than 5cm = transplant
worse = chemo + palliative
local ablation - temporary measure
TACE
Sorafenib
183
Fibro-lamellar carcinoma is commonest in which age range?
| It is not ___ related and __ is normal
5-35yos
not cirrhosis related
AFP normal
184
CT for fibro-lamellar carcinoma shows
stellate scar with radial septa
185
Treatment for fibro-lamellar carcinoma=
resection/transplant
| otherwise TACE
186
TACE stands for
Indication =
Procedure =
Trans-arterial chemoembolism
for early cirrhosis
inject chemo and then embolic agent into hepatic artery
187
Gold standard test for diagnosis of gallstones =
US
188
Treatment for biliary colic =
analgesics and low fat diet/lose wt if obese for 3-6months
| if recurrent = ursodeoxycholic acid (for 2yrs)/cholecystectomy
189
Treatment of cholecystitis
IV antibiotics and fluids
nil by mouth
US to confirm diagnosis and if need be cholecystectomy
190
Treatment of gallstones causing acute pancreatitis
cholecystectomy within 2wks if fit
| if frail = ERCP sphincterotomy
191
Gallstone ileus occurs when
GB is inflamed>sticks to duodenum>erodes = fistula>large gallstone through and obstructs small intestine
192
Treatment of gallstone ileus =
urgent laparotomy to remove stone
| cholecystecctomy in 3 months time
193
Treatment for cholangiocarcinoma
resection is only cure
| palliative = biliary stent = survive 1-6months
194
1st line to assess cholangiocarcinoma =
duplex US
195
Endocrine cells of the pancreas and their secreetions
α=glucagon
β = insulin
δ = somatostatin
PP = pancreatic polypeptide
196
Function of pancreatic polypeptide
self-regulates pancreatic secretion+activities+hepatic glycogen levels
197
Predominant feature in mild acute pancreatitis=
interstitial oedema
| minimal organ dysfunction
198
In sever acute pancreatitis its ass. with ___
| ___ may be present
organ failure+/local complication
| pancreatic necrosis
199
3 most common causes of acute pancreatitis
biliary disease
alcohol
post ERCP
200
Painless jaundice =
pancreatic cancer
201
Bloods for acute pancreatitis
AMYLASE
glucose
Ca2+
CRP - U+Es - clotting - FBC - LFTs
202
acute pancreatitis signs on AXR =
sentinel loop / pleural effusion
203
Imaging for acute pancreatitis
A/CXR
US - check for biliary cause)
CT - assess severity and can see complications
204
Only use ERCP to treat acute pancreatitis due to obstruction if ___
patient is jaundiced
205
If have necrosis associated with acute pancreatitis :
Do a ___ to culture
only operate if necrosis is ___
FNA
| infective
206
Chronic pancreatitis definition =
progressive and irreversible destruction of pancreatic tissue leading to permanent loss of exo+endocrine function
207
Hereditory exocrine pancreatic insufficiency makes you 53x more likely to get a ___
pancreatic ductal adenocarcinoma
208
hyper___ in hyperparathyroidism/renal failure can cause chronic pancreatitis
hypercalcaemia
209
Imaging for chronic pancreatitis
C/AXR (pancreatic calcification and duct dilatation)
AUS
CT (dilated ducct, calcification, intrapanc fluid collection)
M/ERCP
MRI
210
Most effective treatment for chronic pancreatitis
Analgesics
| Pustow / Frey / Beger procedures - drain it into duodenum
211
95% of pancreatic cancers are ___
exocrine - adenocarcinomas - occur anywhere in pancreas
212
___crine tumours of the pancreas are more likely to be treatable
endocrine
213
types of endocrine cancers of the pancreas
gastrinoma (=> ^HCl = ulcers)
insulinoma (=> store glucose = hypoglycaemia)
glucagonoma (hyperglycaemia)
somatosatinoma (diabetic steatorrhea)
vipoma (severe diarrhoea, hypoK+, achlorydria)
214
Risk factors for pancreatic cancer=
```
SMOKING
TI+IID
inactivity
obesity
charred meat
```
215
Investigations for pancreatic cancer
Bloods > US > CT (goldstandard can deduce if operable)
| > ERCP and stent
216
cut off stage for surgery of pancreatic cancer
roughly T3 = more than 2cm and invaded surrounding tissue but not organs/vessels
217
Treatment of pancreatic cancer =
surgery (20-30%) whipple resection/pancreatectomy - curative
| palliative = surgery - biliary/gastric/double bypass OR chemo+/ radio
218
Cullen's sign =
| indicates
periumbilical bruising
| pancreatitis
219
Grey Turner's sign =
| indicates
flank bruising
| pancreatitis
220
tenderness on percussion =
peritonism
221
Clinical signs differences between biliary colic and cholecystitis
```
colic = -ve Murphy's
cholycystitis = +ve Murphy's, leukocytosis, may have RUQ peritonitis
```
