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13. GI and Liver > Pancreatic/Biliary Disease > Flashcards

Pancreatic/Biliary Disease Flashcards

1
Q

What are the ?? main types of pancreatic/biliary disease?

A

Gallstones

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2
Q

What are the risk factors for developing gallstones? (4)

A

4 Fs:

Female
Fat
Forty (years old)
Fair

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3
Q

What is the main symptom of gallstones?

Describe it. (5)

A

Biliary colic:

  • Acute onset
  • Severe
  • Location: RUQ/epigastrium
  • Steady character
  • Duration: 4-6 hours
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4
Q

How are gallstones diagnosed?

Describe the features of gallstones on this particular procedure.

A

Ultrasound

Features:

  • Mobile
  • Echogenic
  • Shadowing
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5
Q

List 4 indications for a cholecystectomy for gallstones.

A

Recurrent biliary colic
Cholecystitis
Pancreatitis
Cholangitis

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6
Q

List 4 complications of gallstones.

A

Acute cholecystitis
Chronic cholecystitis
Acute pancreatitis
Ascending cholangitis/biliary sepsis

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7
Q

List 4 risk factors for acute cholecystitis.

A

4Fs
Rapid weight loss
Pregnancy
Hormonal drugs

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8
Q

Describe the clinical features of acute cholecystitis.

What are the symptoms? (5)

What are the signs? (2)

A 
SYMPTOMS:
Pain in RUQ/epigastrium
Radiation to right shoulder
Fever
Nausea
Jaundice

SIGNS:
Positive Murphy’s sign
Deranged LFTs

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9
Q

What is Murphy’s sign, and how is it elicited?

What does it indicate?

A

Examiner’s fingers pressed on the gallbladder. Patient asked to breathe in

Positive: pain
Negative: no pain

Positive result indicates cholecystitis

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10
Q

What changes in LFTs might be caused by acute cholecystitis? (4)

A

Elevated ALP/AST
Elevated ASP
Mild hyperbilirubinaemia
Mild hyperamylasaemia

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11
Q

Describe the features seen on ultrasound in acute cholecystitis. (4)

A

Gallbladder wall thickening (3+mm)
Gallstones
Gallbladder enlargement
Positive sonographic Murphy’s sign

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12
Q

List 4 complications of acute cholecystitis.

A

Gallbladder empyema
Perforation
Gangrene
Gallstone ileus

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13
Q

How would you treat acute cholecystitis? (2)

A

Resolves within 4 days

Antibiotics
Analgesia

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14
Q

List 3 causes of cholangitis/biliary sepsis.

A

Gallstones
Biliary manipulation
Hepatobiliary malignancy

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15
Q

Describe the symptoms of cholangitis/biliary sepsis. (8)

HINT: there are 1 groups of symptoms.

A

Charcot’s triad:

  • Fever
  • Jaundice
  • RUQ pain

Reynold’s pentad:

  • Fever
  • Jaundice
  • RUQ pain
  • Mental confusion
  • Septic shock
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16
Q

Describe the signs on investigation found in cholangitis/biliary sepsis. (2)

A

Obstructive LFTs (raised ALP, bilirubin)

Positive blood cultures, especially:

  • Klebsiella
  • E. coli
  • Enterococcus
17
Q

How would you treat cholangitis/biliary sepsis? (3)

A

Broad spectrum antibiotics

ERCP (endoscopic retrograde cholangio-pancreatography)

PTC (percutaneous transhepatic cholangiography)

18
Q

List 11 causes of acute pancreatitis.

HINT: acronym: “I GET SMASHED”

A

Idiopathic
Gallstones
Ethanol
Trauma

Steroids
Mumps/malignancy
Autoimmune
Scorpion sting
Hypercalcaemia/lipidaemia
ERCP/EUS
Drugs (esp. azathioprine)
19
Q

What are the 2 types of acute pancreatitis?

A

Interstitial oedematous acute pancreatitis

Necrotising acute pancreatitis

20
Q

How do you classify the severity of acute pancreatitis? (3)

A

Mild:

  • No organ failure
  • No complications

Moderate:

  • Organ failure lasting <48 hours
  • Local complications

Severe:
-Persistent organ failure

21
Q

Describe the symptoms of acute pancreatitis. (4)

What are the symptoms of severe pancreatitis? (3)

A 
SYMPTOMS:
Acute, severe upper abdo pain
Radiation to back
Partially relieved by sitting/bending forwards
Jaundice

SEVERE PANCREATITIS:
Multi-organ failure
Pleural effusion
Ascites

22
Q

Describe the signs found on examination of acute pancreatitis. (2)

A

Cullen’s sign - bruising around umbilicus

Grey Turner sign - bruising on the flanks

23
Q

How would you diagnose acute pancreatitis? (3)

A

Elevated serum amylase
Elevated serum lipase
CT scan

24
Q

How would you manage acute pancreatitis? (3)

A

Supportive treatment
Treat underlying cause
Drainage of persistent fluid collections

25
Q

List 6 causes of chronic pancreatitis.

HINT: remember: “TIGARO”

A 
Toxic/metabolic (esp. alcohol)
Idiopathic
Genetic
Autoimmune
RAP/SAP associated (post-necrotic, vascular or post-irradiation)
Obstruction
26
Q

List 3 types of mutation which can cause chronic pancreatitis.

Which other condition is associated with one of these?

A

PRSS1
CFTR (cystic fibrosis)
SPINK1

27
Q

Describe the symptoms of chronic pancreatitis. (6)

Which sign might you see? What causes it?

A 
Pain (radiates to back; relieved sitting forwards/with hot water bottle)
Malnutrition
Bloating
Steatorrhoea
Weight loss
Brittle diabetes

Erythema ab igne - mottled grey skin lesions caused by constant use of hot water bottles

28
Q

Which 5 imaging methods would you use to diagnose chronic pancreatitis?

Which feature is seen on all of them?

Give 2 further investigations.

A

IMAGING:
Ultrasound
CT scan
MRCP (magnetic resonance cholangiopancreatography)
ERCP (endoscopic retrograde cholangiopancreatography)
Abdominal x-ray (AXR)

Feature: pancreatic calcification

FURTHER TESTS:
Labelled carbon breath test
Wedge biopsy

29
Q

Which criteria are used to measure severity of chronic pancreatitis?

A

Rosemont criteria

30
Q

How would you treat chronic pancreatitis? (6)

A
  1. Potent analgesia
  2. Duct drainage
  3. Fix exocrine/endocrine needs
  4. Smoking cessation
  5. Alcohol cessation
  6. Surgery
31
Q

List 2 complications of chronic pancreatitis.

A

Diabetes

Pancreatic cancer

32
Q

List 10 causes of pancreatic exocrine insufficiency.

HINT: there are 2 main categories of causes.

A 
PANCREATIC DISEASE:
Acute pancreatitis
Diabetes mellitus
Pancreatectomy
Duct obstruction, e.g.
-Cystic fibrosis
-Chronic pancreatitis
-Pancreatic cancer
DUODENAL DISEASE:
Gastrectomy
Coeliac disease
IBD
Zollinger-Ellison syndrome
33
Q

How do you diagnose pancreatic exocrine insufficiency? (2)

A

Faecal elastase

Response to PERT

34
Q

How do you treat pancreatic exocrine insufficiency? (3)

A

Creon

If ineffective:

  • Add PPI
  • Increase enzyme dose
35
Q

List 4 complications of acute pancreatitis.

A

Fat necrosis
Acute haemorrhagic pancreatitis
Pancreatitic abscess
Pancreatic pseudocyst

36
Q

List the 4 types of cancer affecting the pancreas and biliary tree.

A

Pancreatic carcinoma
Pancreatic endocrine tumour
Cholangiocarcinoma
Carcinoma of gallbladder

37
Q

What are the 2 types of cholangiocarcinoma?

A

Intrahepatic

Extrahepatic

38
Q

Which 3 locations are the commonest sites for gallstones to get stuck?

A

Gallbladder fundus
Sphincter of Oddi
Pancreatic duct

13. GI and Liver (9 decks)

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