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MBChB Finals > RUQ pain > Flashcards

RUQ pain Flashcards

1
Q

Distinguish biliary colic, acute cholecystitis and ascending cholangitis in terms of pain, fever and jaundice?

A

Colic: Intermittent pain
Cholecystitis: Persistent pain + fever
Ascending cholangitis: Persistent pain + fever + jaundice

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2
Q

How can acute cholangitis and ascending cholangitis be distinguished from Primary sclerosing cholangitis and primary biliary cirrhosis?

A

ACs: Fever
PC: Itching

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3
Q

Who is likely to get biliary colic?

A

Fat, females, forties and fertile

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4
Q

Inspiratory arrest on RUQ pain indicates what?

A

Acute cholecystitis

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5
Q

RUQ pain, fever and jaundice associated with hypotension and confusion indicates what?

A

Ascending cholangitis

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6
Q

What is the investigation and management of biliary colic?

A

Ix: US shows acoustic shadowing
Rx: Elective cholecystectomy

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7
Q

What is the investigation and management of acute cholecystitis?

A

Ix: US, HIDA if unsure
Rx: IV antibiotics + cholecystectomy within a week

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8
Q

What is the investigation and management of ascending cholangitis?

A

Ix: Ultrasound
Rx: IV antibiotics + ERCP 24-48 hours later

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9
Q

What is the cause of ascending cholangitis?

A

Infection (E. Coli) due to stagnant bile collecting

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10
Q

What cause of RUQ pain is highly associated with UC?

A

Primary sclerosing cholangitis

due to p-ANCA

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11
Q

Raised AMA-M2 and igM indicates which cause of RUQ pain?

A

Primary biliary cirrhosis

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12
Q

Which RUQ pain cause shows a ‘beaded appearance on ERCP?

A

PSC

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13
Q

What is the first line investigation for primary biliary cirrhosis

A

US to exclude obstruction

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14
Q

How do you treat PSC and PBC?

A 
Both: Cholestyramine for itch
PSC: Liver transplant
PBC
1st: urso
GS: transplant
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15
Q

What RUQ pain cause is associated with skin and joint changes?

A

Primary biliary cirrhosis

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16
Q

Jaundice with RUQ pain and mass raises suspicion of what cause?

A

Cholangiocarcinoma

17
Q

What nodes can you examine for if cholangiocarcinoma is suspected?

A

Periumbilical

Left supraclavicular

18
Q

What clinical features help distinguish pancreatic cancer from cholangiocarcinoma

A

Pancreatic cancer is painless or epigastric

Greasy stool and diabetic symptoms may occur

19
Q

What are the first line and gold standard investigations for cholangiocarcinoma and pancreatic cancer?

A

Both: US first line
Cholangio: MRCP/ERCP then CT
Pancreatic: High resolution CT

20
Q

what is the tumour marker pancreatic cancer?

A

CA 19-9

21
Q

What surgical options are there for bile gallbladder and pancreatic cancer?

A

GC: Cholecystectomy
PC: Whipple’s

MBChB Finals (31 decks)

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