HPB

Question 1

which scoring system is best for acute pancreatitis?

Answer 1

glasgow

Question 2

what test is most sensitive for acute pancreatitis?

Answer 2

serum lipase
(amylase can give false positive and negative results and doesn't correlate with disease severity)

Question 3

management of acute pancreatitis due to gallstones

Answer 3

early cholecystectomy

Question 4

management of obstructed biliary system due to stones

Answer 4

early ERCP

Question 5

what is most suitable test for hep b screening?

Answer 5

HBsAg

Question 6

positive anti-Hbs

Answer 6

immunity (immunisation/previous infection)

*s - successful

Question 7

positive HBsAg

Answer 7

acute or chronic hep b

Question 8

positive anti-HBc

Answer 8

previous/current infection

*c for caught it

Question 9

positive HbeAg

Answer 9

marker of infectivity

Question 10

what might you see on inspection in a case of pancreatitis?

Answer 10

cullen’s sign - periumbilical discolouration
grey turners sign - flank discolouration

CULlen - umbiliCAL

Question 11

bilirubin, ALT/AST, ALP in prehepatic jaundice?

Answer 11

bilirubin - normal-high
ALT/AST - normal
ALP - normal

Question 12

bilirubin, ALT/AST, ALP in hepatic jaundice?

Answer 12

bilirubin - high
ALT/AST - (v) high
ALP - moderately elevated

Question 13

bilirubin, ALT/AST, ALP in post hepatic jaundice?

Answer 13

bilirubin - high-v high
ALT/AST - moderately raised
ALP - (v) high

Question 14

what element in a history points to post hepatic jaundice?

Answer 14

pale stools

Question 15

what can cause cholecystitis?

Answer 15

gallstones

Question 16

what is charcots triad and when is it seen?

Answer 16

cholangitis (usually e coli)

fever, RUQ pain, jaundice

Question 17

how does pancreatic cancer present?

Answer 17

painless jaundice + palpable gallbladder

Question 18

what investigation is used for jaundice?

Answer 18

USS liver + biliary tree

Question 19

what investigation for pancreatic cancer?

Answer 19

CT

Question 20

what investigation for hepatic cancer or cholangiocarcinoma?

Answer 20

MRI/MRCP

Question 21

51y f. recurrent episodes epigastric pain radiating to back, brought on by heavy meals. drinks 20u/wk. current episode - yellow sclera. diagnosis?

Answer 21

common bile duct stones

pts often complain of epigastric pain rather than RUQ (so oft mistaken for dyspepsia).

Question 22

commonest cause of ascending cholangitis

Answer 22

gallstones

Question 23

ascending cholangitis - investigations + common results

Answer 23

inflammatory markers + bloods

USS abdo - dilatation of biliary duct

Question 24

ascending cholangitis - management

Answer 24

IV broad spec abx

ERCP after 24-48h to relieve obstruction

Question 25

what complication can result from chronic pancreatitis?

Answer 25

diabetes

Question 26

causes of chronic pancreatitis

Answer 26

80% alcohol | 20% idiopathic

Question 27

features of chronic pancreatitis

Answer 27

pain 15-30min after meals | steatorrhoea (late stage)

Question 28

chronic pancreatitis - investigations + results

Answer 28

CT - pancreatic calcification | faecal elastase

Question 29

chronic pancreatitis - mgmt

Answer 29

pancreatic enzyme supplements | analgesia

Question 30

acute cholecystitis - presentation + examination finding?

Answer 30

``` RUQ pain vomiting fever local peritonitis murphy's sign ``` jaundice is not common

Question 31

GETSMASHED

Answer 31

``` Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion Hypertriglyceride, calcaemia, hypothermia ERCP Drugs ```

Question 32

which drugs can cause acute pancreatitis?

Answer 32

steroids furosemide + bendroflumethiazide azathioprine sodium valproate

Question 33

acute alcoholic hepatitis - presentation

Answer 33

ill pt fever jaundice leucocytosis

Question 34

primary biliary cholangitis - diagnosis

Answer 34

positive anti-mitochondrial antibodies