UGI and Hepatobiliary

Question 1

Typical bacteria causing ascending cholangitis:

Answer 1

e.coli

Question 2

Reynold’s pentad:

Answer 2

Charcot’s triad + hypotension and confusion

Question 3

Management ascending cholangitis:

Answer 3

• IV antibiotics

- ERCP after 24-48 hours to relieve obstruction

Question 4

4Fs risk factors for biliary colic:

Answer 4

• fat
• female
• fertile
• forty
  (other: diabetes, Crohn’s, rapid weight loss, vibrates, COCP)

Question 5

Features of cholangiocarcinoma:

Answer 5

• persistent biliary colic symptoms
• anorexia, jaundice, weight loss
• palpable mass in RUQ (Courvoisier sign)
• periumbilical lymphadenopathy (Sister Mary Joseph nodes)
• left supraclavicular adenopathy (Virchow node)

Question 6

Main risk factor for cholangiocarcinoma:

Answer 6

primary sclerosing cholangitis

Question 7

Causes of chronic pancreatitis:

Answer 7

• alcohol excess
• genetic: cystic fibrosis, haemachromatosis
• ductal obstruction: tumours, stones, structural abnormalities: pancreas divisor and annular pancreas

Question 8

Investigation chronic pancreatitis:

Answer 8

• xray: pancreatic calcification
• CT more sensitive
• faecal elastase

Question 9

Management chronic pancreatitis:

Answer 9

• pancreatic enzyme supplements
• analgesia
• antioxidants

Question 10

What type of cancer are most gallbladder cancers?

Answer 10

adenocarcinomas

Question 11

What is porcelain gallbladder?

Answer 11

• intramural gallbladder wall calcification

- result of chronic cholecystitis

Question 12

Gallbladder cancer TNM staging:

Answer 12

T1 - invades lamina propria and/or muscular layer
T2 - tumour invades perimuscular connective tissue without involvement of visceral peritoneum or liver
T3 - invades visceral peritoneum and/or liver and/or adjacent organ
T4 - tumour invades vascular structures and/or invades 2 or more adjacent organs

Question 13

When is gallbladder cancer resection contraindicated:

Answer 13

• metastatic disease
• malignant ascites
• vascular invasion

Question 14

What is gastric MALT lymphoma?

Answer 14

• H pylori 95%
• good prognosis
• if low grade 80% respond to H pylori eradication
• paraproteinaemia may be present

Question 15

Complications of laparoscopy:

Answer 15

• vasovagal reaction in response to abdominal distension
• extra peritoneal gas insufflation: surgical emphysema
• injury to gastro intestinal tract
• injury to blood vessels

Question 16

Causes of bilious vomiting in neonates:

Answer 16

• duodenal atresia
• malrotation with volvulus
• jejunal/ileal atresia
• meconium ileus
• necrotising enterocolitis

Question 17

Duodenal atresia:

Answer 17

• few hours after birth

- AXR shows double bubble sign

Question 18

Malrotation with volvulus:

Answer 18

• 3-7 days post birth
• compromised circulation causes peritoneal signs and haemodynamic instability
• UGI contrast study shows DJ flexure more medial
• USS may show abnormal orientation of SMA and SMV

Question 19

Jejunal/ileal atresia:

Answer 19

• within 24 hours of birth

- AXR: air fluid levels

Question 20

Meconium ileus:

Answer 20

• first 24-48 hours
• abdominal distension and bilious vomiting
• air: fluid levels on AXR, sweat test to confirm cystic fibrosis

Question 21

Necrotising enterocolitis:

Answer 21

• usually second week of life

- dilated bowel loops on AXR, pneumatosis and portal venous air