Cholestatic Diseases

Question 1

What is Cholestasis?

Answer 1

Reduced bile flow

Question 2

Chronic Cholestasis is often caused by what general things?

Answer 2

Cancer
Strictures
Autoimmune conditions

Question 3

Chronic Cholestasis will present as Obstructive Jaundice. List signs.

Answer 3

• Jaundice
• Pruritus
• Xanthelasma
• Clay-colored stools

Question 4

Chronic Cholestasis will present as Obstructive Jaundice. List signs.

Answer 4

• Jaundice
• Pruritus
• Xanthelsama
• Clay-colored stool

Question 5

In general what 3 diagnostic tests should be done with signs of Obstructive Jaundice are present?

Answer 5

1. MRCP
2. CT with IV contrast
3. Biopsy

Question 6

What are 2 risk factors for a Pancreatic Adenocarcinoma?

Answer 6

Smoking
Chronic Pancreatitis

Question 7

Where in the pancreas must the Pancreatic Adenocarcinoma be to cause Obstructive Jaundice?

Answer 7

Head

Question 8

What mutations are commonly present with Pancreatic Adenocarcinomas?

Answer 8

KRAS
CDKN2A

Question 9

What 3 tests should be done for a Pancreatic Adenocarcinoma?

Answer 9

1. MRCP
2. CT with IV contrast
3. Endoscopic ultrasound biopsy

Question 10

What is the treatment for a Pancreatic Adenocarcinoma?

Answer 10

Whipple surgery

Question 11

Describe the Whipple surgery?

Answer 11

Removes:
- Distal stomach/pylorus
- Duodenum
- Pancreas
- Proximal jejunum
- Gallbladder and common bile duct

Question 12

What is a Cholangiocarcinoma?

Answer 12

Bile duct malignancy

Question 13

What are 2 risk factors for a Cholangiocarcinoma?

Answer 13

• Liver flukes in southeast Asia
• Primary Sclerosing Cholangitis

Question 14

Most of the conditions in this deck will present with?

Answer 14

Obstructive jaundice signs
= Jaundice, itching, clay-colored stool, xanthelasma

Question 15

Where does Hepatopancreatic Ampulla cancer occur?

Answer 15

Intraluminal mass at the ampulla of Vater

Question 16

What are the results of the fecal occult blood test and colonoscopy with Hepatopancreatic Ampulla Cancer?

Answer 16

(+) fecal occult blood test
(-) colonoscopy

Question 17

What is the treatment for Hepatopancreatic Ampulla Cancer?

Answer 17

Whipple surgery

Question 18

What causes Gallbladder cancer?

Answer 18

Chronic gallstones

Question 19

Describe what will be present with Gallbladder cancer

Answer 19

Distended and palpable gallbladder that is NONtender

Question 20

Will the distended gallbladder be tender with Gallbladder cancer?

Answer 20

NO

Question 21

How does the Gallbladder look on imaging with gallbladder cancer?

Answer 21

“Porcelain gallbladder” – calcified

Question 22

What is Mirizzi’s Syndrome?

Answer 22

Gallstones in the cystic duct leads to Common Bile Duct proximal occlusion

Question 23

Gallstones in the cystic duct leads to Common Bile Duct proximal occlusion

Answer 23

Mirizzi’s Syndrome

Question 24

What general signs will be present with Mirizzi’s Syndrome?

Answer 24

Cholecystitis findings + Choledocholithiasis findings

Question 25

What are 3 risk factors for Acute Pancreatitis?

Answer 25

High triglycerides Alcohol Gallstones

Question 26

What occurs with Acute Pancreatitis?

Answer 26

Autodigestion of the pancreas due to early activation of the zymogens (enzymes)

Question 27

What symptoms will be present with Acute Pancreatitis?

Answer 27

Epigastric pain that radiates to the back - pain is worse with eating - N/V

Question 28

What symptoms will be present with Acute Pancreatitis?

Answer 28

Epigastric pain that radiates to the back - Pain is worse with eating - N/V

Question 29

To diagnose Acute Pancreatitis, you must have 2/3 of the following:

Answer 29

1. Epigastric pain 2. Lipase that is > 3x the upper limit of normal 3. CT changes consistent with pancreatitis

Question 30

What CT changes are consistent with Acute Pancreatitis?

Answer 30

Peripancreatic fat stranding

Question 31

What is the treatment for Acute Pancreatitis?

Answer 31

NPO, IVF and pain control until able to tolerate food

Question 32

What causes Chronic Pancreatitis?

Answer 32

Repeated bouts of Acute Pancreatitis

Question 33

What are the signs of Chronic Pancreatitis?

Answer 33

- Chronic epigastric pain - Diabetes Mellitus - Malabsorption

Question 34

What will be seen on MCRP with Chronic Pancreatitis?

Answer 34

Chains of lakes

Question 35

What will be seen on CT with Chronic Pancreatitis?

Answer 35

Atrophy and calcifications

Question 36

What is the treatment for Chronic Pancreatitis?

Answer 36

Pain control, Insulin for DM, enzymes for malabsorption

Question 37

What are those with Chronic Pancreatitis at an increased risk for?

Answer 37

Pancreatic Adenocarcinoma

Question 38

In order to diagnose Acute Pancreatitis, the patient must have 2/3 of the following:

Answer 38

1. Epigastric pain 2. Lipase > 3x the upper limit of normal 3. CT changes

Question 39

What is Primary Sclerosing Cholangitis and in what gender is it more common?

Answer 39

Fibrosis/strictures of the intrahepatic AND extrahepatic bile ducts -- More common in Males

Question 40

What other disease process does Primary Sclerosing Cholangitis often present with?

Answer 40

Ulcerative colitis

Question 41

Describe the symptoms of Primary Sclerosing Cholangitis?

Answer 41

**Like Ascending Cholangitis** - RUQ pain - Fever - Jaundice - Hypotension - Altered mental status

Question 42

What is Primary Biliary Cholangitis and what gender does it more commonly present in?

Answer 42

Autoimmune attack against intrahepatic bile ducts only -- More common in Females