11. Gallstones and Pancreatitis

Question 1

What are gallstones made from?

Answer 1

Bile and sometimes calcium

Question 2

What imaging is used to see gallstones?

Answer 2

Ultrasound

Calcified can be seen on x ray

Question 3

What is cholelithiasis?

Answer 3

Stones in the gallbladder

Question 4

What is choledocholithiasis?

Answer 4

Stones in the common bile duct

Question 5

What are the predisposing factors to gallstones?

Answer 5

Older, female
Obesity, diabetes, high fat diet
High oestrogen
Gall bladder hypomobility

Question 6

What are the causes of gall bladder hypomobility?

Answer 6

Low CCK due to rapid weight loss, bariatric surgery

Question 7

What conditions cause gallstones to be predominantly bilirubin/pigment stones?

Answer 7

Crohn’s disease (both bilirubin and cholesterol stones)
Cirrhosis
Haemolysis
Parasites

Question 8

What are the symptoms of gallstones?

Answer 8

Biliary colic
RUQ or epigastric pain lasting 30 mins to 4 hours
Radiating to back and right shoulder

Question 9

What is the differential for gallstones?

Answer 9

Dyspepsia
Peptic ulcer disease
Acute pancreatitis
Oesophageal pain
MI

Question 10

What are the complications associated with gallstones?

Answer 10

Acute cholecystitis
CBD obstruction
Mirizzi syndrome
Gall bladder adenocarcinoma

Question 11

What are the consequences of CBD obstruction?

Answer 11

Obstructive jaundice
Ascending cholangitis
Acute pancreatitis

Question 12

What is Mirizzi Syndrome?

Answer 12

Obstruction to CBD by external compression from impacted gallstones

Question 13

What is acute cholecystitis?

Answer 13

Cystic duct obstruction causes stasis in the gall bladder and secondary infection

Question 14

What are the signs and symptoms of acute cholecystitis?

Answer 14

Fever, high WCC
Nausea, vomiting and RUQ pain for days
Positive Murphy’s sign
No jaundice

Question 15

What is the treatment for acute cholecystitis?

Answer 15

Fluid, analgesia, antibiotics

Cholecystectomy

Question 16

What complications are associated with acute cholecystitis?

Answer 16

Empyema, mucocoele
Risk perforation and peritonitis
Fistula with duodenum

Question 17

What is chronic cholecystitis?

Answer 17

At autopsy gallbladder is chronically inflammed
Shrunken with thick muscle
Never symptomatic

Question 18

What is the treatment for gallstones?

Answer 18

If symptomatic remove laproscopically

Question 19

What are the causes of extrahepatic bile duct obstruction?

Answer 19

Gall stones in CBD
Tumour
Benign strictures (PSC)
Mirizzi syndrome

Question 20

Which tumours can obstruct bile ducts?

Answer 20

Pancreatic adenocarcinoma
Extra-hepatic bile duct adenocarcinoma
Lymph node mets

Question 21

How is extrahepatic bile duct obstruction investigated?

Answer 21

Dilated ducts can be seen above obstruction on ultrasound

MRCP (MRI for hepatic system)

Question 22

What is the treatment for extrahepatic bile duct obstruction?

Answer 22

Remove stones or put in stent

Question 23

What is ascending cholangitis?

Answer 23

Infection of static bile

Question 24

What is Charcot’s triad of ascending cholangitis?

Answer 24

Fever
Pain
Jaundice

Question 25

What is Reynold's pentad of ascending cholangitis?

Answer 25

Charcot's triad Hypotension Altered mental state

Question 26

What are the causes of hepatic abscesses?

Answer 26

Biliary tract disease with ascending infection | Septic emboli

Question 27

What are the effects of acute pancreatitis?

Answer 27

SIRS Hypocalcaemia, hyperglycaemia Ileus Extensive necrosis, pseudocysts, fistula

Question 28

What are the causes of acute pancreatitis?

Answer 28

``` Gall stones Alcohol Post ERCP Trauma, ischaemia, major surgery Drugs, viral Hyper calcium or lipids ```

Question 29

What pain is associated with acute pancreatitis?

Answer 29

Epigastric pain radiating to back

Question 30

What is the differential for acute pancreatitis?

Answer 30

MI Ruptured AAA Ischaemic organs

Question 31

What blood test shows acute pancreatitis?

Answer 31

Amylase 3x higher than normal

Question 32

What is the treatment for acute pancreatitis?

Answer 32

Resuscitate Analgesia, fluids nil PO Treat complications, antibiotics, debridement

Question 33

What is chronic pancreatitis?

Answer 33

Fibrosis and inflammation of pancreas | Function impaired and ducts distorted

Question 34

What are the causes of chronic pancreatitis?

Answer 34

Alcohol | CF

Question 35

What are the symptoms of chronic pancreatitis?

Answer 35

Dull epigastric pain radiating to back Weight loss, steatorrhoea Secondary DM

Question 36

What is the treatment of chronic pancreatitis?

Answer 36

Analgesia | Enzyme supplements

Question 37

Why is a pancreatic pseudocyst not a true cyst?

Answer 37

Not lined by epithelium

Question 38

What are the causes of pancreatic pseudocyst?

Answer 38

Pancreatitis Pancreatic surgery Trauma

Question 39

What complications are associated with pancreatic pseudocyst?

Answer 39

Pain/pressure Infection Erosion: blood vessel damage, fistula

Question 40

What can be seen on histology in chronic pancreatitis?

Answer 40

Fibrosis Cysts Loss of functional acini