Hepatobiliary Problems

Question 1

What is biliary colic?

Answer 1

Sudden, severe abdominal pain felt in the epigastric region. The pain is intermittent and can be brought on by eating fatty foods.

Question 2

What is acute cholecystitis?

Answer 2

Inflammation of the gallbladder

Question 3

What is ascending cholangitis?

Answer 3

Inflammation of the biliary tree causing RUQ pain, fever and jaundice (Charcot’s triad) and potentially hypotension and confusion (Reynaud pentad)

Question 4

How is acute cholecystitis treated?

Answer 4

IV antibiotics and laparoscopic cholecystectomy within 1 week of diagnosis

Question 5

How is ascending cholecystitis treated?

Answer 5

IV antibiotics, ERCP and fluids

Question 6

Give 5 risk factors for developing gallstones

Answer 6

Obesity 
Female 
Over 40 
COPD
Cirrhosis
Crohn's disease
IBS
Family history 
Weight loss 
Ceftriaxone

Question 7

What is Murphy’s sign?

Answer 7

Pressing down on the right hypochondrium and asking the patient to breath in. The gallbladder becomes exposed and the hand touches it so the patient feels pain. Positive in acute cholecystitis

Question 8

What size does a gallstone need to be to pass naturally?

Answer 8

<5mm

Question 9

Give 2 conservative ways to manage gallstones

Answer 9

Avoid fatty foods
Eat a healthy diet
Stop smoking
Avoid alcohol

Question 10

How are gallstones managed medically?

Answer 10

Ursodeoxycholic acid

Pain killers

Question 11

How are gallstones managed surgically?

Answer 11

Laparoscopic cholecystectomy

ERCP

Question 12

Give 4 risks of ERCP

Answer 12

Bleeding
Duodenal perforation
Pancreatitis
Cholangitis

Question 13

What is porcelain gallbladder?

Answer 13

Calcium deposits build up on the inside of the gallbladder usually after recurring inflammation of the gallbladder.

Question 14

What is Courvoisier’s law?

Answer 14

Jaundice with a painless, palpable gallbladder is unlikely to be gallstones

Question 15

What is the most common type of gallbladder cancer?

Answer 15

Adenocarcinomas

Question 16

Give 4 symptoms of gallbladder cancer

Answer 16

Abdominal pain 
Nausea
Jaundice
Distended abdomen 
Weight loss 
Loss of appetite

Question 17

Give 4 risk factors for developing gallbladder cancer

Answer 17

Obesity 
Smoking 
Unhealthy diet 
Gallstones 
Cholecystitis
Diabetes 
Family history 
Porcelain gallbladder

Question 18

What is gallstone ileus?

Answer 18

Fistula forms between the gallbladder and the bowel and large gallstones can exit the gallbladder and block the bowel. Needs urgent treatment due to risk of bowel perforation

Question 19

Give 6 causes of acute pancreatitis

Answer 19

Gallstones 
Ethanol 
Trauma 
Steroids
Mumps
Autoimmune
Scorpion bite 
Hyperlipidaemia 
ERCP
Drugs

Question 20

Give 3 drugs which can cause pancreatitis

Answer 20

Azathioprine 
Thiazide
Sulfasalazine 
Trimethoprim 
Tetracycline 
Sodium valproate

Question 21

Give 4 symptoms of acute pancreatitis

Answer 21

Severe, dull epigastric pain worse on eating and drinking and radiating to the back 
Nausea
Diarrhoea
Indigestion 
Fever 
Jaundice

Question 22

What are the factors involved in the GLASGOW score for pancreatitis?

Answer 22

PaO2 (<8 kPa) 
Age (>55 years) 
Neutrophils (>15 x 10^9/L) 
Calcium (<2 mmol/L)
Renal function (urea >16mmol/L)
Enzymes (LDH >600 or AST >2000) 
Albumin (<32g/L) 
Sugar (glucose >10mmol/L)

Question 23

How is acute pancreatitis managed?

Answer 23

Treat underlying cause
Fluids
Oxygen
Analgesia

Question 24

Give 4 potential complications of acute pancreatitis

Answer 24

Chronic pancreatitis
Sepsis
Infected pancreatic necrosis
Pseudocysts

Question 25

Give 4 symptoms of chronic pancreatitis

Answer 25

``` Abdominal pain radiating to the back Worse 15-20 minutes after eating Greasy, foul-smelling stools Nausea Vomiting Weight loss Loss of appetite Jaundice Symptoms of diabetes ```

Question 26

Give 3 causes of chronic pancreatitis

Answer 26

``` Excessive alcohol Autoimmune pancreatitis Trauma Smoking Radiotherapy side effect ```

Question 27

How is chronic pancreatitis diagnosed?

Answer 27

``` Stool sample (fecal elastase) Ultrasound CT scan MRCP X-ray (can see calcification of pancreas) ```

Question 28

How is chronic pancreatitis treated?

Answer 28

``` Avoid alcohol Stop smoking Low fat diet Enzyme supplements Corticosteroids Pain relief ```

Question 29

Where in the pancreas does a cancer normally affect?

Answer 29

Head of the pancreas

Question 30

Why is the prognosis for pancreatic cancer so poor?

Answer 30

Diagnosed late due to vague symptoms and ability for the cancer to grow into the space without consequence

Question 31

Give 3 risk factors for developing pancreatic cancer

Answer 31

``` Smoking Alcohol Previous cancer Diet Previous radiotherapy Obesity Old age MEN BRCA2 gene ```

Question 32

Give 3 causes of pancreatic cancer

Answer 32

Chronic pancreatitis Stomach ulcer H. pylori Hepatitis

Question 33

Give 3 symptoms of pancreatic cancer

Answer 33

``` Dull epigastric pain radiating to the back Worse when lying down Jaundice Weight loss Symptoms of diabetes Itching Nausea and vomiting Steatorrhoea Fever Indigestion ```

Question 34

How is pancreatic cancer diagnosed?

Answer 34

USS and CT

Question 35

How is pancreatic cancer treated?

Answer 35

Chemotherapy | Surgery --> total pancreatectomy, Whipple's procedure

Question 36

What is liver cirrhosis?

Answer 36

Chronic scarring of the liver which prevents the liver from functioning normally

Question 37

Give 4 symptoms of liver cirrhosis

Answer 37

Fatigue, nausea, loss of appetite, loss of sex drive, jaundice, haematemesis, itchy skin, melaena, bruising, oedema, ascites

Question 38

Give 4 signs of liver cirrhosis

Answer 38

``` Leukonychia Clubbing Palmar erythema Spider naevi Gynaecomastia Loss of body hair ```

Question 39

Give 3 causes of liver cirrhosis

Answer 39

Alcohol excess Hepatitis Non alcoholic fatty liver disease

Question 40

How is liver cirrhosis treated?

Answer 40

Stop drinking alcohol, treat hepatitis, treat cause Cholestyramine, interferon alpha, spironolactone Liver transplant

Question 41

What 5 factors does the Child-Pugh score take into consideration?

Answer 41

``` Serum bilirubin Serum albumin Presence of ascites Encephalopathy INR ```