Clinical Aspects of Pancreatico-Biliary Disease Flashcards Preview

Gastoenterology > Clinical Aspects of Pancreatico-Biliary Disease > Flashcards

Flashcards in Clinical Aspects of Pancreatico-Biliary Disease Deck (14):
1

What are the clinical features of gallstones?

- RUQ pain

- Most are cholesterol, minority are pigment

- Abdominal US will detect 90%

- EUS can detect microlithiasis

2

What are the clinical features of biliary colic?

- Gallstones usually present (stone obstructing GB neck or cystic duct)

- Acute onset severe RUQ/epigastric pain lasting 4-6hrs

- Pain is usually steady (colic is misnomer)

- Pain relieved as stone passes

3

What are the clinical features of acute cholecystitis?

- 90% secondary to gallstones

- Risk factors include being female, fat, increasing age, rapid weight loss, pregnancy and drugs (hormonal therapy)

- Pain in epigastrium/RUQ that may worsen on inspiration (Murphy's sign)

- Associated with fever and nausea

- LFTs often deranged (elevated transaminases and ALP, mild hyperalbuminaemia and hyperamylasaemia)

- Jaundice if CBD obstruction

- Usually resolves in 4 days (antibiotics and analgesia)

- GB wall thickened on US

4

What are the clinical features of biliary sepsis?

- Charcots triad (fever, jaundice, RUQ pain)

- Reynolds pentad includes mental confusion and septic shock

- Causes include gallstones, biliary manipulation and hepatobiliary malignancy

- Obstructive LFTs with raised bilirubin

- May have raised amylase

- Broad spectrum antibiotics and ERCP/PTC

5

What are the clinical features of acute pancreatitis?

- Acute severe upper abdominal pain, 50% radiates to back and partially relieved by bending forwards

- In severe cases multi organ failure, pleural effusions and ascites

- Jaundice may be present (gallstone disease)

- Cullen's sign (bruising on umbilical region)

- Grey Turner's sign (bruising on flanks)

6

How is acute pancreatitis diagnosed?

- Elevated serum amylase >3x ULN

- Amylase half-life short so may be on way back down by time measured

- Alcoholic pancreatitis and hypertriglyceridaemia pancreatitis may have lower amylase

- Serum lipase elevated for longer

- Imaging involves CT

7

What is the aetiology of acute pancreatitis? I GET SMASHED

- Idiopathic

- Gallstones

- Ethanol

- Trauma

- Steroids

- Mumps/malignancy

- Autoimmune

- Scorpion sting

- Hyperlipidaemia/hypercalcaemia

- ERCP/EUS

- Drugs (azathioprine)

8

What are the clinical features of chronic pancreatitis?

- Inflammatory condition

- Parenchyma replaced with fibrous tissue

- Pain

- Malnutrition

- Diabetes

- Increased risk of pancreatic cancer

- Erythema ab igne seen in patients using hot water bottle for pain

9

What is the aetiology of chronic pancreatitis? TIGARO

- Toxic/metabolic (alcohol, tobacco, hyperlipidaemia, CKD)

- Idiopathic

- Genetic (PRSS1, CTFR, SPINK1)

- Autoimmune

- RAP/SAP associated (post-necrotic, vascular, post-irradiation)

- Obstriction

10

How is chronic pancreatitis diagnosed?

- Calcification on imaging (100% specific)

- Aspiration of duodenal secretions post secretin/CCK at ERCP

- Secreting enhanced MRCP

- EUR (Rosemount criteria)

- Labelled carbon breath test (test for PEI)

- Wedge biopsy or section of resected pancreas

11

How is chronic pancreatitis treated?

- Potent analgesia

- Duct drainage

- Address exocrine and endocrine needs

- Smoking cessation

- Alcohol cessation

- Surgery

12

What is the pathogenesis of pancreatic exocrine insufficiency?

- Reduced secretion due to pancreatic disease

- Low CCK due to duodenal disease

- Acidic duodenal pH due to gastric hypersecretion or low bicarbonate secretion

- Abnormal transit due to surgery

13

How is pancreatic cancer graded?

- PDAC grading

- A and B are resectable

- C are borderline

- D1, D2 and E are irresectable

14

What genetic risk factors are associated with pancreatic cancer?

- PRSS1

- BRCA2

- Peutz-Jeughers

- HNPCC

- FAP