Pancreas & Biliary Tree

Front 1

what organ gives deep epigastric pain radiating to the back

Back 1

pancreas:
- tumour
- inflam

Front 2

what's the prognosis for pancreatic cancer

Back 2

<3% 5yr
worst ca survivial rate
lymph node involvement = worse prognosis

Front 3

through what immediate duct does bile enter the duodenum at the major duodenal papillae

Back 3

ampulla of vater

Front 4

risk factors for gallstones (5F's)

Back 4

Female, Fat, Fourty, Fair, FH
DM
genetic high cholesterol

Front 5

what 4 components is bile made of

when does gallstones form

Back 5

BR, cholesterol, phospholipids & bile salts

when imbalance in ratio of cholesterol: BR: salts

Front 6

3 types of gallstones & cause for each

Back 6

PIGMENT: excess BR (haemolysis)
CHOLESTEROL: 5F's
MIXED

Front 7

gallstones can cause what 4+ syndromes/ diseases

Back 7

cholecystitis (acute/ chronic)
biliary colic
pancreatitis (acute/ chronic)
post-hepatic/ obstructive jaundice

(ascending cholangitis, gallstone ileus)

Front 8

how do gallstones normally present

Back 8

90% asymptomatic
others:
- biliary colic
- cholecystitis
- pancreatitis
- obstructive jaundice
- gallstone ileus
- ascending cholangitis

Front 9

what's cholecystitis

Back 9

inflammation of the GALLBLADDER, GS in cystic duct---> obstruction of bile outflow
commonly assoc with gallstones --> infection
can cause: empyema, rupture, peritonitis, intesne adhesions 2-3days

Front 10

S&Ss acute cholecystitis

Back 10

continuous EPIGASTRIC/ RUQ pain
vomiting
fever
local peritonitis
GB mass
MURPHY's sign (pain inspiration when palpating)

Front 11

differentiate biliary colic from cholecystitis

Back 11

cholecystITIS= inflammatory component;
- fever
- ↑WCC
- local peritonism

BILIARY COLIC: PAIN RUQ, radiates to back +/- jaundice

Front 12

Ix's & treatment for acute cholecystitis

Back 12

WCC, USS (thickened GB wall & stones)

NBM, analgesics, IVI, abx's
? cholecystectomy - perforation

Front 13

what is chronic cholecysitis
S&Ss (how different from acute cholecystitis)

Back 13

GS in cystic duct--> chronic inflammation of GB +/- colic
vague abdo discomfort
distention
nausea
flactulance
intolerance of fats

Front 14

Ix findings (USS) and treatment for chronic cholecystitis

Back 14

USS- gallstones, dilated bile ducts, thickened GB wall (not distended!)

ERCP+sphinctometry
CHOLECYSTECTOMY

Front 15

if s gallstone is impacted in the amuplla of vater, what does that cause

Back 15

pancreatitis

Front 16

gallstone impaction in the CBD causes post-hepatic obstruction. If these ducts are infected what disease ensues.

Back 16

ascending cholangitis

Front 17

how does the pain from biliary colic to acute cholecystitis change
does pain radite

Back 17

intermittent (stone in GB and obstructing ducts on contraction only) to constant (impacted in cystic duct)

if inflammation irritates inferior surface diaphragm, pain can radiate to R.shoulder tip.

Front 18

what's are the classic Ix's for gallstone related diseases

Back 18

BR, ALP, aminotransferase levels
USS
?MRCP
ERCP- interventional!

Front 19

what type of cancer is associates with the GB
- what is it associated with
- local invasion of where
- prognosis (good/bad)

Back 19

rare- ADENOCARCINOMA
associated with gallstones (end stage chronic cholecystitis)
invasion of LIVER
POOR prognosis

Front 20

what's cancer of the bile ducts called & type
associated with what 2 other diseases
presentation

Back 20

CHOLANGIOCARCINOMA- adenocarcinoma (rare)

assoc with PSC, UC

OBSTRUCTIVE jaundice

Front 21

presentation of acute pancreatitis:
- adults/ children?
- S&Ss?

Back 21

adults
gradual or sudden SEVERE EPIGASTRIC/ central pain (general or localised)
RADIATES to BACK
nausea & VOMITING relieved by SITTING forwards/ heat
periumbilical DISCOLOURATION
↑HR, hypotension, fever, jaundice, shock

reduced/ no BS

Front 22

causes of pancreatitis

Back 22

"I GET SMASHED" + shock
Infection
Gallstones
Ethanol
Trauma
Steroids
Mumups
Auto-immune
Scorpion vemon
Hyperlipidaemia
ERCP (iatrogenic) & Emboli
Drugs

Front 23

key findings in tests / Ix's for ACUTE pancreatitis

Back 23

serum ↑AMYLASE (acutely only)
urinary ↑amylase
serum ↑LIPASE
↑CRP
↑glucose
↑ca

Front 24

pathogenesis of pancreatitis

Back 24

no outflow- AUTODIGESTION of pancreatic acini (eg lipase, amylase, proteases...)
- fat necrosis
- tissue destruction & haemorrhage

Front 25

complications of ACUTE pancreatitis (6)

Back 25

infection of nectrotic pancreas---> sepsis---> SHOCK ---> DEATH

PSEUDOCYSTS (peripancreatic fluid collections surrounded by granulation tissue)

ABSCESS

HYPOCALCAEMIA
HYPERGLYCAEMIA (no insulin released to store glucose)

Front 26

causes of CHRONIC pancreatitis

Back 26

ALCOHOL
genetic (autosomal dom)= increase ca risk
autoimmune
CF
duct obstruction

Front 27

clinical features S&Ss of CHRONIC pancreatitis

Back 27

epigastric pain --> back (severe episodic/ chronic)
wt loss (anorexia/ low lipase)
fatigue/ DM (low insulin & glucagon)
malabsorption (low enzymes)
steatorrhoea (low lipase)
jaundice in obstruction

Front 28

pancreatic ca:
- type tumour
- associated risk factors
- presentation age & sex

Back 28

ADENOCARCINOMA- ductal origin (rarely- carcinoid)

smoking, alcohol, DM 1+2, obesity

M>60yrs

Front 29

S&Ss pancreatic ca
- characteristic features

Back 29

ANOREXIA, WT LOSS, DM, ACUTE PANCREATITIS

head: PAINLESS obstructive JAUNDICE, palpable GB

body/tail:dull EPIGASTRIC pain---> BACK
relieved by sitting FORWARD

Front 30

Ix's in pancreatic ca

Back 30

LFTs- cholestatic jaundice, FBC- anaemic
USS
★CT★
ERCP
MRI
biopsy?

Front 31

prognosis of acute pancreatitis is directly related to what

Back 31

SYSTEMIC inflammatory response--> multiple organ failre

Front 32

what surgery is performed for pancreatic ca

Back 32

WHIPPLE's op

(pancreatectomy: total, distal, midsegment)
(bypass)

Front 33

which hormone stimualtes pancreas to release proteases and collipase

Back 33

CCK from I cells of duodenum & pranceras

Front 34

secretin:
-released from which cells, where
- direct effect on pancreas?
- effect of pancreas secretion in response?

Back 34

S cells in duodenum secrete SECRETIN-->
pancreatic HCO3 release ---> reduced gastric emptying & secretions, ↑bile secretion

Front 35

which hormone secreted from which cells INHIBIT pancreatic acinar cells

Back 35

SOMATOSTATIN released from islets and D cells of pyloric gland area.

Front 36

what dig enzymes does the exocrine pancreas (acinar & ductal cells) secrete

Back 36

amylase, lipase, colipase, phospholipase,

proteases:
-trypsinogen
-chymotrypsinogen
- procarboxypeptidase

Front 37

GLASGOW prognostic score fro acute pancreatitis 3+= acute severe
what 8 critera are scored ("PANCREAS"0

Back 37

PaO2
Age >55
Neutrophils
Ca
Renal function (urea high)
Enzymes: AST/ALT high
Sugar glucose high

Front 38

treatment for acute pancreatitis complicated by pseudocyst or abscess (2)

Back 38

majority spontaneously resolve

- large ones >6wks --> USS-guided ENDOSCOPIC DRAINage

- SURGICAL DRAINage (when cyst anatomy complicated)

CONTROL sepsis

Front 39

treatment of pancreatitis complicated by INFECTED necrosis (2)

Back 39

drainage or
necrosectomy & lavage

setrile necrosis: conservative mangement

Front 40

Ix findings in chronic pancreatitis (CT/ USS) -(3)

Back 40

DILATED pancreatic duct
CALCIFICATION
intrapancreatic FLUID collection

Front 41

treatment of CHRONIC pancreatitis

Back 41

ALCOHOL & smoking abstinence
pain control
STENTING
bypass/ resection- PUESTOW procedure
DRAINAGE (of pseudocysts, fluid)

Front 42

what's Zollinger-Ellison syndrome

Back 42

gastrinoma (endocrine tumour of the pancreas)
↑gastrin = ↑stomach acid = peptic ulceration

Front 43

what is the TNM staging of a tumour

Back 43

T= size
1- mucosa
2- submucosa
3- muscle
4- adventitia / peritoneum