biliary and pancreatic

Question 1

whta is cholecystitis

Answer 1

inflam of gallbladder commonlu secondary to gall stones

Question 2

symptoms of acute cholecystitis

Answer 2

fever, RUQ pain, N+V

Question 3

what sign is illicted in acute cholecystitis

Answer 3

Murphys sign

Question 4

dx of acute cholecystsitis and what would be seen what investigations can be used secondary

Answer 4

USS >4cm thickening = DISTENSION
HIDA or MRCP

Question 5

what is seen in chronic cholecystsits vs acute

what pathology is seen in gallbladder in chronic and not acute

Answer 5

chronic is thickened but not distended and
rokitansky aschkoff sinuses- kinda like diverticula

Question 6

management of acute cholecystitis - acute and surgical

Answer 6

conservative - nil by mouth
iv lfuids
iv abx
NG if vom

ERCP or LAP CHOLE

Question 7

common ascending cholangitis organisms

Answer 7

1. e.coli
2. klebsiella
3. enterococcus

Question 8

casues of ascending cholangitis

Answer 8

gallstone obstructing bile flow
ERCP related infection

Question 9

what is ascending cholangitis

Answer 9

infection and inflam of the bile ducts

Question 10

mangement of Ascending cholangitis

Answer 10

ERCP

Question 11

what is reynolds pentad

Answer 11

fever, pain , jaundice, confusion(hepatic encephalopathy) and hypotension

Question 12

what is courvoisiers law

Answer 12

painless palpable gallbladder and jaundice is probable pancreatic cancer

Question 13

complications of acute chilecystitis

Answer 13

mucocele
empyema
fistula
perforation
mirittzi syndrome - external compression of heaptic duct

Question 14

what conditions are assoc with cholangiocarcinoma

Answer 14

PSC, UC

Question 15

what is klatskin tumour

Answer 15

cholangiocarcinoma at the join of hepatic ducts

Question 16

what tumour marker is used for cholangiocarcinoma

Answer 16

CA 19-9

Question 17

pathophysiology of pancreatitis

Answer 17

autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis

Question 18

what are cullen and grey -turners sign

Answer 18

seen in pancreatitis
cullen - peri umbilical bruising
grey-tuenre- flank bruising

Question 19

investigations for pancretitis

Answer 19

amylase/lipase

USS - however can be diagnosed clinically

Question 20

which is more sensitive in pancreatitis amylase or lipase

Answer 20

lipase

Question 21

how raised is amylase in pancreatitis

Answer 21

3x upper limit

Question 22

what is better in delayed presentations of pancreatitis amylase or lipase and why

Answer 22

lipase - longer half lfe

Question 23

what scoring system is used to assess severity of pancreatitis

Answer 23

GLASGOW

Question 24

what is an indicator of severity in pancreatitis

Answer 24

age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

Question 25

what is involved in the glasgow scoring system

Answer 25

P – Pa02 < 8 KPa A – Age > 55 N – Neutrophils (WBC > 15) C – Calcium < 2 R – uRea >16 E – Enzymes (LDH > 600 or AST/ALT >200) A – Albumin < 32 S – Sugar (Glucose >10)

Question 26

what drugs casue pancreatitis

Answer 26

azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate, sitagliptin

Question 27

main treatment of pancreatitis

Answer 27

fluid resus

Question 28

complications of pancreatitis

Answer 28

pseudocysts Peripancreatic fluid collections necorsis abscess aemorrhage

Question 29

what is a systemi ccomplication of pacnreatitis

Answer 29

ARDS

Question 30

most common casue of chronic pancreatitis

Answer 30

alcohol

Question 31

features/symps of chronic pancreatitis

Answer 31

pain worse following meal steatorrhoea DM

Question 32

what is seen on the pancreas in chronic pancreatitis

Answer 32

calcification

Question 33

investigations for chronic pancreatitis

Answer 33

XRAY CT

Question 34

what test can be used to assess exocrine function of pancreas

Answer 34

faecal elastase

Question 35

management of chronic pancreatitis

Answer 35

creon - enzyme supplemet

Question 36

most common type of pancreatic tumour

Answer 36

adenocarcioma

Question 37

features of pancreatic cancer

Answer 37

weightloss, painless jaundice, steatorrhoea, jaundice, diabetes secondary to loss of endorine function

Question 38

investigation of choice for pancreatic cancer

Answer 38

CT

Question 39

what sign is seen on CT in pancreatic cancer

Answer 39

doubel duct

Question 40

treatment of pacreatic cancer

Answer 40

whipple

Question 41

complication of whipple

Answer 41

dumping syndrome and peptic ulcer

Question 42

what can be done in pancreatic cancer if surgery not suitable

Answer 42

ERCP for stent

Question 43

pancreatic cancer assoc with what conditions

Answer 43

smoking, DM, chronic pancreatitis, HNPCC, MEN , BRCA 2, KRAS gene