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Flashcards in Liver, biliary and pancreatic pathology Deck (221):
1

Chronic liver disease lasted ___
Must have _+_

>6 months
stellate activation and cirrhosis

2

4 types of liver cells:

hepatocytes
Kupffer cells
endothelial cells of fenustrates
stellate cells

3

hepatic macrophages that breakdown RBCs

Kupffer cells

4

function of hepatocytes
near artery = __
near central vein = ___

artery = metabolic processes
central vein = toxin clearance

5

normally stellate cells are ___ and function =__

quiescent
store fat, vit. A and control sinusoid blood flow

6

Damage to the liver causes loss of ___ on hepatocytes, ___ activate, ___ are lost from epithelial cells and __ cells are activated

hepatic microvilli
Kupffer cells
fenustrates
Stellate

7

Liver damage=>
activated stellate cells: proliferate, become more ___, attract ___ and chemotaxis of __ => extracellular matrix degradation and ___ laid down = ___=>

contractile
leukocytes
stellate cells
collagen = fibrogenesis=> cirrhosis

8

Liver damage:
Causes stellate apoptosis which => ___

TIMP - tissue inhibitor of metalloproteases
resolution

9

What activates Kupffer cells?

product of damaged cells
activation factors eg. TGFB1, PDGF ...

10

Can diagnose steatosis by

US

11

2 hit theory for NASH:

1= too many tri.s to store = free FAs
2= ox. stress + lipid peroxidation due to MCD diets/pro-inflam cytokine release = reperfusion injury

12

Autoimmune disease characterised by +AMA antibodies, T cell CD4 mediated against intra-hepatic bile ducts, mostly in women

PBC (primary biliary cirrhosis)

13

Autoimmune hepatitis is more common in M/F?

females 4:1

14

Histology of autoimmune hepatitis shows:

piecemeal necrosis
interface hepatitis
numerous plasma cells

15

Type 2 AI hepatitis is more/less common than type one
Occurs usually in ___
+AI antibodies =

more
young adults / children
AMA, LKM-1

16

Type 1 AI hepatitis is associated with which +AI antibodies

ANA, ASMA, SLA(marks severity), IgG, AMA, pANCA

17

Diagnosis of AI hepatitis is based on which investigations?

increased AST and ALT in LFTs
Increased IgG, AI Igs
liver biopsy

18

treatment of AI hepatitis =

corticostreoids - prednisolone (start high dose then lower to maintenance dose)
azathioprine

19

PSC is more common in M/F?
+antibodies?
is AI destruction of ___
image of biliary tree shows ___
associated with ___

M 4:1
ANCA mainly
large and medium intra and extrahepatic bile ducts
onion skinning/ beading of biliary tree
UC

20

PBC or PSC increases risk of cholangiocarcinoma
If also have UC it increases risk of ___ too

PSC
colorectal carcinoma

21

Haemochromatosis=

autosomal recessive disease of Fe overload

22

___ mutations in __ gene =>___
In haemochromatosis

C282Y/H63D
HFE gene
=> liver doesnt signal enterocyte to stop absorbing Fe

23

bronzed diabetic has...

haemochromatosis

24

treatment of haemochromatosis =

venesection

25

Wilson's disease =

autosomal recessive condition where loss of function/protein in caeruloplasmin => copper deposits in tissues and basal ganglia

26

Kaiser fleischer rings =

Copper
Wilson's

27

Wilson's is associated with ____ and ___ problems

liver (cirrhosis, sub-fulminant liver failure)
neuro (Chorea)

28

If have chronic liver disease and emphysema you have ...

α-1 anti-trypsin deficiency

29

Budd-Chiari syndrome =

thrombosis of the hepatic veins due to congenital webs + Protein C/S deficiency

30

__ used to diagnose Budd-Chiari
Treat with

US
recanalisation/TIPSS

31

Drug that causes liver fibrosis =
Drug is for:

methotrexate
psoriasis and rheumatoid arthritis

32

Cardiac cirrhosis of the liver is caused by :

increased R heart pressure

33

Cirrhosis =
1) liver ___ due to less ____
2) disruption of ___
3) generation of ____

dysfunction due to less hepatocytes
vasculature
abnormal signalling

34

Portal vein hypertension is defined as > ___mmHg OR a _:_ ratio of more than __

5-8mmHg
Portal:hepatic vein P >5mmHg leading to an increase in hydrostatic P in portal vein

35

normal portal vein + hepatic vein bp are _+_
gradient =>

7mmHg portal
4mmHg hepatic
pushes blood through liver

36

4 anastamoses of portal venous to hepatic venous system:

oesophageal+gastric venous plexus
umbilical vein reopens from L portal vein -> epigastric venous system
retroperitoneal collaterals behind the spleen
anal venous plexus

37

caput medusae is engorged ____

umbilical and epigastric veins

38

portal hypertension causes _+_ varices

oesophageal and anorectal

39

Prehepatic causes of portal hypertension are

thrombosis/occlusion of veins before liver

40

Intrahepatic causes of portal hypertension are

pre-sinusoidal: eg. schistosomiasis
post-sinusoidal eg. cirrhosis, alcoholic hepatitis
Budd-Chiari

41

Sinusoidal hypertension causes release of enogenous ___ eg.
=>

vasodilators eg. NO, CO, CGRP, glucagon
splanchnic and peripheral vascular resistance drops

42

Ascites occurs due blood pooling and systemic vasodilation =>
activates ___

hypodynamic circulation as decreased effective arterial blood volume
RAAS

43

End stage liver failure is due to ___ hepatocytes

insufficient

44

Signs of compensated liver failure:

spider naevi (blanch on pressure)
gynaecomastia
spleno/hepatomegaly
palmar erythema
NONE possibly

45

Signs of decompensated liver failure:

ascites
jaundice
encephalopathy
easy bruising

46

Treatment of ascites =

no NSAIDs
stop drinking alcohol
low salt
spironolactone and loop
paracentesis
TIPSS
transplant

47

Alcoholics get vitamin __ supplements to prevent __

B1 - thiamine
Wernicke-Korsakoff syndrome

48

In ascites you retain __ and ___

NaCl and H2O

49

treatment of spontaneous bacterial peritonitis due to ascites

antibiotics, terlipressin and maintain renal perfusion

50

encephalopathy occurs in liver disease due to :

NH3 is not removed from gut => brain and is deposited

51

treatment of liver related encephalopathy =

lactulose
rifaxamin

52

Prophylaxis for varices

variceal ligation
non-selective β-blockers (propranolol - best / carvidelol - best tolerated)

53

in acute variceal bleed treatment =

terlipressin (vasoconstrict)
sclerotherapy/balloon tamponade (bridge)
ligation
TIPSS

54

If have liver disease put on an ___ as clotting factor balance is off

anti-coagulant

55

UKELD score of >__ is needed to be listed as have a _% 1yr mortality risk
Unless have ___ in which go on list with score

49
9%
HCC/other syndrome
49

56

As the degree of liver dysfunction increases what happens to the markers (ascites, bilirubin, albumin, PT and encephalopathy)

increase: ascites, bilirubin, PT, encephalopathy
decease: albumin

57

3 major factors of portal hypertension: reduced_+_+_

liver blood flow
metabolic function
plasma proteins

58

If oral dose is greater than IV dose this suggests

1st pass metabolism is important factor

59

endothelin and oestrogen levels in liver disease inc/decrease because ___

increase
not metabolised by liver

60

Activation of RAAS in liver disease => (3) electrolyte and fluid consequences

Na+ and H2O retention
K+ depleted

61

Hepatorenal syndrome =
is mainly caused by __
___ compensate for ____ vasoconstrition
therefore dont give ___ as make renal problems worse by decreasing ___

renal failure caused by hepatic disease
endothelin
renal prostaglandins compensate for endothelin
NSAIDs are a NO as decrease PGs

62

NSAIDs in liver disease cause

1) less renal PGE synthesis =>worsen renal impairment, Na retention, worsen CHF
2) more cirrhosis peptic ulcers

63

codeine doesnt work in liver disease patients because

it is a pro drug and liver no longer activates it

64

Don't give __/__ in liver disease as worsens encephalopathy

sedatives/opioids

65

Highly reactive intermediate in paracetamol metabolism =

N-acetyl-p-benzoquinamine

66

highly reactive intermediate in paracetamol metabolism is removed by ___

glutathione

67

Running out of ___ in paracetamol overdose causes liver necrosis by ___

glutathione
N-acetyl-p-benzoquinamine

68

Pain relief in liver disease

give paracetamol 1mg bds - dont exceed 3g per day
codeine 30mg tds - watch for sedation
NO NSAIDs

69

Are thiazide diuretics used in ascites? Why/why not?

no
worsens hypokalaemia and hypomagnesaemia

70

Are loop diuretics used in ascites? Why/why not?

no
reduces intra-vascular volume
worsens hypokalaemia and hypomagnesaemia

71

Which diuretic is used for ascites? Why?

Spironolactone in big doses+ fluid restriction

72

How much water loss do you aim for per day when using diuretics for ascites?

1kg/day

73

Forms of sedation used in liver disease

Phase II metabolised benzodiazepines in low doses
eg. lorazepam, oxazepam, lormetazepam

74

Are antibiotics safe to give in liver disease?

Yes, mostly.
Aminoglycosides = nephrotoxic
quinolones = epileptogenic
metronidazole = reduced metabolism by liver disease

75

To measure drug levels in liver disease must measure

free drug level
not just plasma levels as lots are unbound

76

In liver disease use drugs with ___ excretion
avoid __-drugs
Drugs to be wary of:

renal
pro-drugs
CNS drugs, sedatives, anticoagulants, NSAIDs, theophyllines, aminoglycosides

77

Acute liver disease defintion

rapid development of liver dysfunction wo prior liver disease
less than 6 months in duration

78

LFTs that is raised shows liver damage

ALT and AST

79

LFT that is more specific for liver damage

ALT>AST

80

LFT found in liver bile duct and bone

ALP

81

Cholestatic LFTs =

GGT and ALP

82

LFT that monitors cirrhosis due to alcohol =

GGT

83

GGT is made in cells __+__

hepatocytes around intrahepatic bile ducts
bile duct cells extrahepatically

84

bilirubin is raised in __/__/__

bile obstruction
liver damage
increased RBC breakdown

85

albumin is decreased in (5)

liver disease
Fe deficiency
infection
poor diet
diarrhoea

86

PT increases in __+__
Is the best test to monitor for

vitamin K deficiency
liver disease
monitor liver function - do every 6 hrs

87

causes of acute liver disease =

Hepatitis viruses
CMV
EBV
toxoplasmosis
drugs
shock
cholangitis
alcohol
cancer
Budd-Chiari
Pregnancy

88

Investigations for acute liver disease =

LFTs, PT, Hx (itch, jaundice, exposure)
examine
US
Virology

89

For itch in liver disease give (3)

Na bicarbonate bath, cholestyramine or ursodeoxycholic acid

90

_/_/_ (electrolytes) are usually low in liver disease so monitor and maybe supplement

Mg
K PO4

91

Drugs that cause acute liver disease =

paracetamol
co-amoxiclav
flucloxacillin
NSAIDs
"protein powder"

92

Fulminant hepatic failure = __+__ in previously normal liver

jaundice and encephalopathy

93

Causes of fulminant hepatic failure = (7)

paracetamol + other drugs
Hep A+B
Budd Chiari
Pregnancy
Cancer
Wilson's
mushrooms

94

treatment of fulminant hepatic failure =

supportive
inotropes and fluids
manage increased intracranial P
may need transplant

95

Hep A is spread by ___
causes acute/chronic hepatitis
vaccine?
Investigations?

faeco-oral
acute - CANNOT cause chronic
vaccine given to travellers
serology and Hep A IgM

96

Hep E is spread by ___
vaccine?
acute/chronic

faeco-oral/zoonosis - british pigs/abroad in tropics
no vaccine
acute unless IC

97

Hep D is ony found with ___
= _/_ infection

Hep B
co/superinfection

98

Hep B is spread by _/_/_
acute/chronic
vaccine?

sex, blood, mother to child
chronic usually
yes vaccine

99

HBsAg =
HBeAg =
HB DNA =
HB IgM =
HB IgG =

HBsAg = current infection - present in all infected
HBeAg = present in highly infectious
HB DNA = increased level =increased infectivity and worse prognosis - monitors therapy
HB IgM = recently infected
HB IgG = immunity

100

Hep C is spread by _/_/_
acute/chronic?
vaccine?
investigation

sex (less effectively than B), blood, mother and child
chronic in 75%
no vaccine
+ve antibody alwats present
PCR for RNA +ve = active, -ve = previous infection

101

Treatment of acute viral hepatitis

monitor
notify public health
immunise contacts

102

chronic viral hepatitis treatment =

antivirals (8 for HCV - if RNA +ve and genotype known, 6 for HBV - if HBsAg and DNA +ve)
vaccinate for other HVs, pneumococcal and influenza
less alcohol
screeen for HCC - serum AFP and US

103

Interferon α =

human protein that's part of immune response to viral infection
Injected as PEG-interferon α = antiviral

104

Sustained virological response (SVR) after Hep C therapy is declared when _

no HCV RNA after 6 moths of stopping therapy

105

Chronic HCV patients (even if cured) get __ screening every ___

HCC - US
6 months

106

3 zones from portal triad >> central vein =
___ most susceptible to injury as receives least O2

periportal>mid-acinar>pericentral
pericentral

107

Cirrhosis induced by alcohol is ___nodular

micronodular

108

Intense drinking of alcohol
2-3days =
4-6wks =
months-yrs =
yrs =

fatty liver
hepatitis
fibrosis - irreversible
cirrhosis

109

characteristics of alcoholic hepatitis:

hepatocyte necrosis, neutrophils, mallory bodies, pericellular fibrosis

110

Mason's triad seen in cirrhosis =

blue collagen, white fat, red hepatocytes

111

Viral hepatitis causes =

Hep ABCDE viruses
δ agent
EBV
yellow fever
HSV
CMV

112

Hepatitis A is directly/indirectly cytopathic

directly

113

Chronic viral hepatitis on histology =

interface hepatitis
piecemeal necrosis
councilman bodies - lobular inflam

114

Chronic hepatitis causes =

Hep B and C
PBC
PSC
AI or drug induced hepatitis

115

PBC main autoantibodies =

AMA

116

PBC/PSC is predominant in females

PBC = 90% females
PSC = 70% males

117

AI hepatitis is more common in M/F
characteristic findings =

Females
usually triggered
ass with other AIs
SM/nuclear/LKM autoantibodies
Increased IgG
numerous plasma cells

118

PSC/PBC is associated with onion skinning of bile ducts

PSC

119

PSC/PBC is associated with granuloma wreaths around bile ducts

PBC

120

Autosomal recessive cause of iron overload
worse in M/F?
Fe confirmed in liver by ___

Primary Haemochromatosis
Males (and females post-menopause)
Perls stain

121

Risk factors for gallstones

Fat, fair, female, Forty, fertile (5Fs)
diabetic
Crohn's (bile salt loss)
dysmotility of GB
prolonged fasting
TPN

122

Pigment gallstones =

excess bilirubin due to haemolysis = black stones

123

soft white gallstones are caused by too much

cholesterol

124

Mucocoele =

gallbladder gets blocked eg. by gallstone = fills with mucus

125

inflammation of the gallbladder =

cholecystitis

126

Acute cholecytitis is indicated by presence of ___ causes intense __ in 2-3 days

neutrophils (pus)
adhesions

127

Chronic cholecystitis causes wall to be __ but not ___
have ___ sinuses

thickened but not distended
Rokitansky-Aschoff sinuses

128

carcinomas of the gallbladder =

adenocarcinomas - poor prognosis

129

adenocarcinoma of the bile ducts =
present with __

cholangiocarcinoma
obstructive jaundice - poor prognosis - rarely resectable

130

tumour at confluence of R and L hepatic ducts =

klatskin tumour

131

Increased serum __ indicates pancreatitis

AMYLASE

132

Causes of acute pancreatitis =

(GET SMASHED)
alcohol and cholelithiasis (mainly), shock, mumps, hyperparathyroidism, hypothermia, trauma, iatrogenic

133

In pancreatitis pancreas releases __+__ consequences =

proteases - tissue destruction and haemorrhage
lipases - intra+peripancreatic fat necrosis - may bind Ca2+

134

Acute pancreatitis complications include hypo___ and hyper ___

hypocalcaemia
hyperglycaemia

135

Treatment of acute pancreatitis

monitor and modify cause to prevent recurrence

136

Causes of chronic pancreatitis

GET SMASHED
alcohol
gallstones
CCF
familial, hyperparathyroidism

137

Autodigestion of pancreatic acinar cells occurs in __

pancreatitis

138

Carcinoma of the pancreas =
histologically looks like :

adenocarcinoma
irregular abortive glands in a dense stroma

139

RBCs lifespan =

100-120 days

140

In small intestine bacteria convert colourless __/___ to brown stercobilirubin

stercobilinogen/urobilinogen

141

Yellow colour in urine =

urobilin

142

Limiting factor in bilirubin conjugation that results in pre-hepatic jaundice due to unconjugated bilirubin

glucaronyl transferase

143

There is no increase in ___ bilirubin in pre-hepatic jaundice

urinary

144

In pre-hepatic jaundice LFTs are __

normal

145

Jaundice is less marked in which cause of jaundice out of the 3?

Pre-hepatic

146

In pre-hepatic jaundice urine and faeces are

normal colour

147

In hepatic jaundice ___ hyperbilirubinaemia predominates
associated symptoms = stools are ___ ; + ___

conjugated
stools normal but may be pale if excretion is significantly impaired
tender hepatomegaly

148

___ jaundice causes pale stools and dark orange urine

post-hepatic - conjugated bilirubin

149

In abscence of liver disease ____ liver cancer is more common

metastatic

150

Commonest liver tumour =
affects females or males more

haemangioma
females

151

Appearance of liver haemangioma
symptoms
Diagnosis investigations
Treatment

single small wall demarcated capsule that is surrounded by hypervascularisation
asymptomatic
US - CT - MRI - no need for FNA
NO need for treatment

152

Focal Nodular Hyperplasia (FNH) classic appearance

central scar with a large artery with branches radiating to the peripheries = hub+spokes

153

FNH is due to a congenital ___ abnormality
associated with __+__
it is a ___ response to abnormal ____ flow

vascular
Osler-Weber-Rendu and liver haemangioma
hyperplastic response
arterial flow

154

Benign liver lesion that is isointense on sulfur colloid scan and has sinusoids, bile ductules and Kupffer cells present on histology

FNH - focal nodular hyperplasia

155

FNH is more common in ___ (demographic)

young and middle aged women

156

FNH symptoms
malignancy risk?
Diagnosis investigations
treatment

asymptomatic - min. pain and bleeding risk
no malignancy risk
US - CT - MRI - may need FNA (normal hep.s and Kuppfer w. central core)
no treatment

157

Appearance of hepatic adenoma

normal hepatocytes with no portal tract, central veins of bile ducts.
Usually are solitary fat containing lesions

158

Benign liver lesion that is associated with contraceptive hormones and is more common in females

liver adenoma

159

Hepatic adenoma is usually found in the __ lobe
symptoms =
malignancy risk?

R
usually asymptomatic - maybe haemorrhage/RUQ pain
malignancy development risk

160

Multiple hepatic adenomas =
rare condition associated with ___

adenomatosis
Glycogen storage disease

161

Investigations for hepatic adenoma
treatment

US (filling defect)
CT (diffuse arterial enhancement)
MRI - may need FNA
stop hormones - observe every 6mnths - if no regression then excise

162

Benign liver lesions =

Cystic lesions
Hepatic adenoma
haemangioma
FNH - focal nodular hyperplasia

163

4 cystic liver lesions =

simple
hydatid
polycystic liver disease
liver abscess

164

Characteristics of simple cystic liver lesion =

liquid collection lined by an epithelium, no biliary tree communication, solitary and unloculated

165

Symptoms of simple cystic liver lesion
treatment

asympt - but sympt.s if haemorrhages, ruptures, infection, compresses
none - if symptomatic then open drainage

166

Hydatid cysts in the liver are caused by ___ from ___(geog)

Echinococcus granulosus
E. Europe, America and Africa

167

Treatments for hydatid cysts in liver =

conservative = open cystectomy
radical = lobectomy/pericystectomy
medical = albendazole
percutaneous drainage
PAIR

168

Polycystic liver disease is due to __

embryonic ductal plate malformation of intrahepatic biliary tree

169

3 types of polycystic liver disease

Von Meyenburg Complexes (microhamartomas)
Polycystic liver disease
ADPKD - auto dom polycystic kidney disease

170

In Von Meyenburg Complexes are due to remnants of ___ causing small cysts
symptoms =
not ___ genetically linked

cystic bile duct malformations
asymptomatic
germline

171

In Polycystic liver disease liver and renal function is ___
___+__ genes related

preserved
PRKC5H
SEC63

172

In ADPKD ____+___ symptoms are common
potential ___
genes=

renal failure and extra-hepatic symptoms
massive hepatic enlargement
PKD1+2

173

Presentation of polycystic liver diseases

abdominal pain and distension
compression symptoms
failure of affected organ

174

treatment of polycystic liver diseases

conservative = somatostatin analogues - sympt relief and decrease liver volume
in advanced = aspiration/transplant

175

Liver abscesses present with
Hx may include:

high fever, leukocytosis, abdominal pain, complex lesion
Hx = dental procedure, abdo/biliary infection

176

Treatment of liver abscess =

broad sprectrum antibiotics 4wks with repeat imaging
aspiration
echocardiogram (check for endocarditis
no regression = open drainage

177

Malignant primary liver lesions =

HCC - hepatocellular cancer
fibro-lamellar carcinoma
hepatoblastoma
intrahepatic cholangiocarcinoma

178

Most common malignant primary liver cancer =
most common in M/F

HCC - hepatocellular caracinoma
Males

179

Biggest risk factor for HCC and what causes it

cirrhosis
eg. NASH, alcohol, HBV, HCV, aflatoxin

180

Marker for HCC
may not be raised in___

AFP - alphafetoprotein
small HCC

181

Investigations to diagnose HCC

blood = LFT, clotting tests, AFP
US
triphasic CT (v. early arterial perfusion)
MRI
Biopsy

182

Treatment of HCC

small, single and preserved liver function = curabel resection
3 or fewer nodes/less than 5cm = transplant
worse = chemo + palliative
local ablation - temporary measure
TACE
Sorafenib

183

Fibro-lamellar carcinoma is commonest in which age range?
It is not ___ related and __ is normal

5-35yos
not cirrhosis related
AFP normal

184

CT for fibro-lamellar carcinoma shows

stellate scar with radial septa

185

Treatment for fibro-lamellar carcinoma=

resection/transplant
otherwise TACE

186

TACE stands for
Indication =
Procedure =

Trans-arterial chemoembolism
for early cirrhosis
inject chemo and then embolic agent into hepatic artery

187

Gold standard test for diagnosis of gallstones =

US

188

Treatment for biliary colic =

analgesics and low fat diet/lose wt if obese for 3-6months
if recurrent = ursodeoxycholic acid (for 2yrs)/cholecystectomy

189

Treatment of cholecystitis

IV antibiotics and fluids
nil by mouth
US to confirm diagnosis and if need be cholecystectomy

190

Treatment of gallstones causing acute pancreatitis

cholecystectomy within 2wks if fit
if frail = ERCP sphincterotomy

191

Gallstone ileus occurs when

GB is inflamed>sticks to duodenum>erodes = fistula>large gallstone through and obstructs small intestine

192

Treatment of gallstone ileus =

urgent laparotomy to remove stone
cholecystecctomy in 3 months time

193

Treatment for cholangiocarcinoma

resection is only cure
palliative = biliary stent = survive 1-6months

194

1st line to assess cholangiocarcinoma =

duplex US

195

Endocrine cells of the pancreas and their secreetions

α=glucagon
β = insulin
δ = somatostatin
PP = pancreatic polypeptide

196

Function of pancreatic polypeptide

self-regulates pancreatic secretion+activities+hepatic glycogen levels

197

Predominant feature in mild acute pancreatitis=

interstitial oedema
minimal organ dysfunction

198

In sever acute pancreatitis its ass. with ___
___ may be present

organ failure+/local complication
pancreatic necrosis

199

3 most common causes of acute pancreatitis

biliary disease
alcohol
post ERCP

200

Painless jaundice =

pancreatic cancer

201

Bloods for acute pancreatitis

AMYLASE
glucose
Ca2+
CRP - U+Es - clotting - FBC - LFTs

202

acute pancreatitis signs on AXR =

sentinel loop / pleural effusion

203

Imaging for acute pancreatitis

A/CXR
US - check for biliary cause)
CT - assess severity and can see complications

204

Only use ERCP to treat acute pancreatitis due to obstruction if ___

patient is jaundiced

205

If have necrosis associated with acute pancreatitis :
Do a ___ to culture
only operate if necrosis is ___

FNA
infective

206

Chronic pancreatitis definition =

progressive and irreversible destruction of pancreatic tissue leading to permanent loss of exo+endocrine function

207

Hereditory exocrine pancreatic insufficiency makes you 53x more likely to get a ___

pancreatic ductal adenocarcinoma

208

hyper___ in hyperparathyroidism/renal failure can cause chronic pancreatitis

hypercalcaemia

209

Imaging for chronic pancreatitis

C/AXR (pancreatic calcification and duct dilatation)
AUS
CT (dilated ducct, calcification, intrapanc fluid collection)
M/ERCP
MRI

210

Most effective treatment for chronic pancreatitis

Analgesics
Pustow / Frey / Beger procedures - drain it into duodenum

211

95% of pancreatic cancers are ___

exocrine - adenocarcinomas - occur anywhere in pancreas

212

___crine tumours of the pancreas are more likely to be treatable

endocrine

213

types of endocrine cancers of the pancreas

gastrinoma (=> ^HCl = ulcers)
insulinoma (=> store glucose = hypoglycaemia)
glucagonoma (hyperglycaemia)
somatosatinoma (diabetic steatorrhea)
vipoma (severe diarrhoea, hypoK+, achlorydria)

214

Risk factors for pancreatic cancer=

SMOKING
TI+IID
inactivity
obesity
charred meat

215

Investigations for pancreatic cancer

Bloods > US > CT (goldstandard can deduce if operable)
> ERCP and stent

216

cut off stage for surgery of pancreatic cancer

roughly T3 = more than 2cm and invaded surrounding tissue but not organs/vessels

217

Treatment of pancreatic cancer =

surgery (20-30%) whipple resection/pancreatectomy - curative
palliative = surgery - biliary/gastric/double bypass OR chemo+/ radio

218

Cullen's sign =
indicates

periumbilical bruising
pancreatitis

219

Grey Turner's sign =
indicates

flank bruising
pancreatitis

220

tenderness on percussion =

peritonism

221

Clinical signs differences between biliary colic and cholecystitis

colic = -ve Murphy's
cholycystitis = +ve Murphy's, leukocytosis, may have RUQ peritonitis