Pancreatic & Biliary Disease

Question 1

What are the early complications (< 4 weeks) of pancreatitis?

Answer 1

• Interstitial edematous pancreatitis
• Acute peripancreatic fluid collection
• Pancreatic necrosis
• Acute necrotic collection
• Infected pancreatic necrosis

Question 2

What are the late manifestations (> 4 weeks) of acute pancreatitis?

Answer 2

Pseudocysts
Pancreatic Abscess
Walled-off pancreatic necrosis

Question 3

What are the classic findings of autoimmune (IgG4) pancreatitis on imaging?

Answer 3

Sausage Pancreas

Biliary Strictures

Question 4

What is the workup for chronic pancreatitis?

Answer 4

• Ca, triglycerides, IgG subclasses
• Medication review
• Consider MRCP to rule out divisum, stricture, tumour, stone
• possibly a genetics workup in younger patients

Question 5

What is Reynaud’s Pentad?

Answer 5

Fever
Abdominal Pain
Jaundice
Hypotension
Confusion

Question 6

What are the disease manifestations of IgG4-related disease?

Answer 6

Autoimmune Pancreatitis
Biliary Sclerosis
Retroperitoneal Fibrosis
Chronic Sclerosing Aortitis
Thyroiditis
Interstitial Pneumonitis
Tubulointerstitial Nephritis

Question 7

How are patients diagnosed with primary sclerosing cholangitis followed/treated?

Answer 7

ERCP as needed for symptomatic strictures.

MRCP Q1 year to screen for GB cancer and cholangiocarcinoma

Question 8

What do you need to rule out if you suspect primary sclerosing cholangitis?

Answer 8

2 things:
If PSC confirmed, rule out IBD (UC)
Need to also r/o cholangiocarcioma with ERCO and brushing for dominant strictures.

Question 9

What does the diagnosis of PBC require?

Answer 9

2 of 3 Criteria:

(1) Persistent elevation in ALP > 6 months
(2) AMA antibody titre > 1:40
(3) Liver biopsy confirming the Dx (if Dx otherwise unclear)

Question 10

How do you treat patients with PBC?

Answer 10

Urodeoxycholic acid 15 mg/kg