Pancreas and biliary pathology Flashcards
What are the classical symptoms of gallstones?
- Right upper quadrant pain that may radiate to the shoulder or the back (between the shoulder blades)
- Crampy pain, attacks increasing in frequency
- Nausea/vomiting
What are the options for treatment of gallstones?
- Conservative: painkillers, avoiding fatty foods
* Operative: removal of the gallbladder and cystic duct
What are gallstones?
•Can be pure or mixed cholesterol and bile pigment
What keeps cholesterol in solution in the bile?
Micelles that contain bile acids and phospholipids
What causes the colour of the bile?
Bilirubin (a breakdown product of haemoglobin)
When does bile become lithogenic (stone forming)
Lithogenic for cholesterol if there is an excessive secretion of cholesterol or decreased secretion of bile salts
What is the treatment of gallstones that have traveled down into the common bile duct?
- ERCP
* Lap chole and bile duct
What investigations should be carried out for suspected bile duct gallstones?
- MRCP
- Endoscopic ultrasound
- Operative cholangiogram
What are the symptoms of acute pancreatitis?
- Severe upper abdominal pain
- Fever
- Leucocytosis
- Raised serum amylase
How can gallstones cause a pancreatitis?
Gallstone at the ampulla causes bile reflux up into the pancreatic duct causing a pressure build up and damage to the cells
What are the complications of acute pancreatitis?
- Fat necrosis
- Acute haemorrhagic pancreatitis
- Pancreatic abscess
- infected pancreatic necrosis
What is the treatment of a pancreatic abscess?
- Drainage
* necrosectomy and antibiotics
What are the differentials for a pancreatic cyst?
- Intraductal papillary mucinous neoplasm
- Mucinous cystic neoplasm
- Serous cystadenoma
What are the risk factors of pancreatic cancer?
- Germline mutations
* Smoking
What are the signs and symptoms of pancreatic cancer?
- Painless obstructive jaundice
- New onset diabetes
- Abdominal pain due to pancreatic insufficiency or nerve invasion
- Tumours in head may obstruct the pancreatic duct and bile duct (double duct sign on radiology)
What is Whipple’s resection?
- Removal of the head of pancreas, first part of the duodenum, the gallbladder and the bile duct
- Only for tumours of the head of the pancreas
What is the neoadjuvant therapy for pancreatic cancer?
- Folfirinox chemotherapy
* Associated with limited improvement in metastatic disease
Give an example of a pancreatic neuroendocrine tumour
Insulinoma (90% are benign, presents with hypoglycaemia)
What are the classification fo cholangiocarcinoma?
Intrahepatic/extrahepatic depending on the origin
What does intrahepatic cholangiocarcinoma need to be distinguished from?
Metastatic adenocarcinoma and hepatocellular carcinoma
What is the cholangiocarcinoma treated by?
Whipple’s resection
