Gallbladder and Pancreatic Disorders

Question 1

Define cholelithiasis

Answer 1

Gallstones

Question 2

Define choledocholithiasis

Answer 2

Bile duct stones

Question 3

Populations affected by cholelithiasis

Answer 3

• Native and Mexican Americans

- Fat Fertile Female Forties

Question 4

Define biliary colic

Answer 4

Episodic pain attributed to gallstones WITHOUT evidence of cholecystitis

Question 5

What confirms diagnosis of cholelithiasis?

Answer 5

RUQ ultrasound

Question 6

Treatment of gallstones

Answer 6

• Asymp = no treatment (dietary modifications, pain management for biliary colic episodes)
• Elective surgery

Question 7

Define cholecystitis

Answer 7

Acute or chronic inflammation of gallbladder

Question 8

Causes of cholecystitis

Answer 8

• 90% d/t gallstones

- 10% acalculous

Question 9

What is best for diagnosing cystic duct obstruction?

Answer 9

HIDA scan

Question 10

Treatment of cholecystitis

Answer 10

• Analgesics/antiemetics
• IV abx
• Surgical resection or stent placement

Question 11

Define porcelain gallbladder

Answer 11

• Calcified, non-functional

- Caused by chronic cholecystitis (persistent inflammatory state)

Question 12

Define emphysematous cholecystitis and treatment

Answer 12

• Cholecystitits a/w gas-forming bacteria (clostridia, E. coli, Klebsiella)
• Requires emergent resection

Question 13

Define cholangitis

Answer 13

Common bile duct infection secondary to choledocholithiasis (bile duct stones)

Question 14

Define primary sclerosing cholangitis

Answer 14

Common bile duct infection a/w IBD (NOT STONE)

Question 15

Presentation of cholangitis

Answer 15

• Charcot triad (RUQ pain, fever, jaundice)

- Reynolds pentad (Charcot + AMS and hypotension)

Question 16

Describe MRCP vs. ERCP

Answer 16

• Both used to diagnose cholangitis

- ONLY ERCP can be used as treatment too (sphincterotomy and stone retrieval)

Question 17

MC cause of acute pancreatitis

Answer 17

Stones

Question 18

Presentation of acute pancreatitis

Answer 18

Constant “boring” epigastric pain (gets better with leaning forward)

Question 19

How to assess severity of acute pancreatitis

Answer 19

Ranson criteria:

• WBC 16+
• Age 55+
• Glucose 200+
• AST 250+
• LDH 350+

Question 20

What does x-ray show for acute pancreatitis?

Answer 20

• Sentinel loop (LUQ air filled small bowel)

- Colon cutoff sign (gas filled transverse colon)

Question 21

Treatment of acute pancreatitis

Answer 21

Bowel rest!

Question 22

Define necrotizing pancreatitis

Answer 22

• Complication of acute pancreatitis
• Tissue destruction and hemorrhage resulting in Turner’s sign (hematoma in flanks) and Cullen’s sign (periumbilical discoloration)

Question 23

MC cause of chronic pancreatitis

Answer 23

Chronic ETOH

Question 24

How to diagnose chronic pancreatitis?

Answer 24

• Secretin stimulation test (pancreatic secretions are diminished)
• Fecal elastase test
• Xray, US, CT

Question 25

Treatment of chronic pancreatitis

Answer 25

- ETOH avoidance, low fat diet - Pain management with non opioids preffered - Pancreatic enzyme supplement

Question 26

Complication of chronic pancreatitis

Answer 26

Development of DM (80% within 25 yrs)

Question 27

Definition of pancreatic pseudocyst

Answer 27

- Sterile, localized fluid collection in or on pancreas - Surrounded by fibrous or granulation tissue - Usually contains amylase or lipase

Question 28

Who gets pancreatic pseudocysts?

Answer 28

- 20-40% chronic pancreatitis | - 10-25% acute pancreatitis

Question 29

Treatment of pancreatic pseudocysts

Answer 29

- Supportive if asymptomatic | - Drainage if persistent symptoms, infection, hemorrhage, etc.