Pancreatic-Biliary Disease Flashcards
How do gallstones present?
Increasing frequency of attacks of right upper quadrant pain which is crmpay in nature and usually occurs after meals
No jaundice or fever, unless stones are stuck in the bile duct
What type of gallstones are most common?
Mixed stones
Most gallstones can be seen on x-ray. T/F?
False - only 10% of stones have sufficient calcium to be seen on x-ray
What imaging modality is used to look for gallstones?
Ultrasound
What is the presentation of gallstones in the bile duct?
Acute and severe RUQ pain and obstructive jaundice
What are the expected LFT results for obstructive jaundice as seen in gallstones in the bile duct?
Raised ALP and bilirubin
How can gallstones in the bile duct be investigated?
MRCP
Endoscopic ultrasound
Operative cholangiogram
How are gallstones in the bile duct treated?
ERCP, laparoscopic cholestectomy and bile duct clearance
What is the presentation of acute pancreatitis?
Severe acute upper abdominal pain with fever, light-headedness and vomiting
What features will be seen on blood results in acute pancreatitis?
Leucocytosis
Raised serum amylase
What are the most common causes of acute pancreatitis?
Alcohol
Gallstones
Other than alcohol excess and gallstones, what are the possible causes of acute pancreatitis?
ERCP
hypercalcaemia
Drugs (e.g. azathioprine)
Mumps
What are the potential complications of acute pancreatitis?
Pancreatic abscesses
Infective pancreatic necrosis
Avascular haemorrhage pancreatitis
How are pancreatic abscesses treated?
Drainage or necrosectomy plus antibiotics
What is an intraductal mutinous neoplasm of the pancreas?
A desuplatic, papillary lining secreting mucin which is in continuity with the main pancreatic duct or a side duct
What are the features of a mutinous cystic neoplasm of the pancreas?
Mutinous lining
Ovarian type stroma
A serous cyst adenoma of the pancreas is always malignant. T/F?
False - it is almost always benign
What are the signs and symptoms of pancreatic cancer?
Painless obstructive jaundice New onset diabetes Weight loss Hepatomegaly Fatigue/lethargy Abdo pain due to pancreatic insufficiency or nerve invasion
How is pancreatic cancer usually diagnosed?
CT
Pancreatic cancer has a poor prognosis. T/F?
True
What is involved in supportive care for pancreatic cancer?
Insertion of a stent via ERCP to manage jaundice
What test is required if chemotherapy is being considered for the treatment of pancreatic cancer?
Brushings to pathologically confirm cancer
What surgical procedure can be used to treat tumours of the head of the pancreas?
Whipple’s resection
Most patients with pancreatic cancer are suitable candidates for surgery with Whipple’s. resection. T/F?
False
What neoadjuvant therapy to surgery can be used in the treatment of pancreatic cancer?
Folfrinox chemotherapy
What is the most common cancer type of the pancreas?
Pancreatic carcinoma
Where in the pancreas are most carcinomas?
The head of the pancreas
What is the most common subtype of pancreatic carcinoma?
Ductal adenocarcinoma
Perineurial invasion is common in pancreatic carcinoma. t/f?
tRUE
What is the biggest risk factor for pancreatic carcinoma?
Smoking
What is the most common type of functional neuroendocrine pancreatic tumour?
Insulinoma
Insulinomas are usually benign. T/F?
True
How do insulinomas present?
Hypoglycaemia
Malignant endocrine tumours of the pancreas have a better prognosis than pancreatic carcinoma. T/F?
True
Why does carcinoma of the ampulla of Vater have a better prognosis than pancreatic carcinoma?
Because of its location, it presents at an earlier stage
What subtype of cholangiocarcinoma has a similar morphology and prognosis to pancreatic carcinoma?
Extrahepatic cholangiocarcinoma
How is extra hepatic cholangiocarcinoma treated?
Whipple’s operation to remove common bile duct and involved pancreas/duodenum
Gallstones are present in most cases of gallbladder carcinoma. T/F?
True
There is a poor prognosis for gallbladder carcinoma unless…?
It is found incidentally in a gallbladder removed due to chronic cholecystitis
