upper GI HPB

Question 1

PSC risk factor for

Answer 1

cholangiocarcinoma

Question 2

gall bladder can lead to referred pain in

Answer 2

interscapular region due to diaphragmatic irritation

Question 3

The most common organism causing cholangitis is

Answer 3

E. coli, followed by Klebsiella. Streptococcus and Pseudomonas are known causes of cholangitis but are less common

Question 4

Charcot’s triad

Answer 4

fever is the most common feature, seen in 90% of patients
RUQ pain 70%
jaundice 60%
hypotension and confusion are also common (the additional 2 factors in addition to the 3 above make Reynolds’ pentad)

Question 5

Pseudocysts

Answer 5

in acute pancreatitis result from organisation of peripancreatic fluid collection. They may or may not communicate with the ductal system.
The collection is walled by fibrous or granulation tissue and typically occurs 4 weeks or more after an attack of acute pancreatitis
Most are retrogastric
75% are associated with persistent mild elevation of amylase
Investigation is with CT, ERCP and MRI or endoscopic USS
Symptomatic cases may be observed for 12 weeks as up to 50% resolve
Treatment is either with endoscopic or surgical cystogastrostomy or aspiration

Question 6

preferred diagnostic test for chronic pancreatitis

Answer 6

CT pancreas with contrast

Question 7

test for acute pancreatitis

Answer 7

serum lipase (more sensitive than amylase)

Question 8

complications of acute pancreatitis

Answer 8

ARDS
peripancreatic fluid collections
pseudocysts
pancreatic necrosis
pancreatic abscess
haemorrhage

Question 9

at cholecystectomy 15% have

Answer 9

gallstones in CBD

Question 10

gastrectomy neuro complication

Answer 10

b!2 deficiency- subacute combined degeneration of cord

Question 11

ascending cholangitis not responding to abx (sensitive and drug levels are adequate)

Answer 11

empyema

Question 12

surgical emphysema sign on CXR

Answer 12

If the anterior chest wall is affected air can outline the pectoralis major muscle, giving rise to the ‘ginkgo leaf’ sign.

Question 13

Modified-Glasgow Score

Answer 13

used to stratify patients by risk of severe pancreatitis. A score of ≥3 suggests a significant increase in likelihood of severe pancreatitis. These patients may benefit from intensive care.
P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

Question 14

AFP raised in

Answer 14

hepatocellular carcinoma

Question 15

bile salts absorbed in

Answer 15

terminal ileum