39&40: GI Problem 2

Question 1

Involuntary guarding is a sign of ____ when generalised it is ____

Answer 1

Peritonism

Peritonitis

Question 2

Cholesterol gallstones form in the gall bladder not the bile duct. Why?

Answer 2

• Cholesterol stored in gall bladder
• Abnormal emptying leads to inc. concentration of cholesterol
• Pigmented stones often form in bile duct

Question 3

What initiates emptying of the gall bladder?

Answer 3

Cholecystokinin

Question 4

What is an important consequence of cholangitis?

Answer 4

Pancreatitis

Question 5

What are the components of charcot’s triad?

Answer 5

• Fever
• Jaundice
• RUQ pain

Question 6

What is the difference between MRCP and ERCP?

Answer 6

MRCP = magnetic resonance cholangiopancreatography, imaging tool

ERCP = endoscopic retrograde cholangiopancreatography, diagnostic and therapeutic, risk of complications

Question 7

What is involved in ERCP?

Answer 7

• Endoscopic retrograde cholangiopancreatography

- Cannulation of the bile duct and removal of stones with a basket or balloon (used for common bile duct stones)

Question 8

What is the commonest feature of bile duct obstruction?

Answer 8

Dilated bile duct

Question 9

Primary biliary cirrhosis affects ____ bile ducts whereas primary sclerosing cholangitis affects ____

Answer 9

PBC - intrahepatic

PSC - intra and extraheptatic

Question 10

How do you diagnose primary biliary cholangitis?

Answer 10

• High ALP
• +ve mitochondrial antibody
• Liver biopsy

Question 11

Which conditions are associated with primary biliary cholangitis?

Answer 11

• Dyslipidaemia
• Osteopenia/osteoperosis
• Hypothyroidism

Question 12

Which conditions are associated with primary sclearosing cholangitis?

Answer 12

• Recurrent infection

- Ulcerative colitis

Question 13

How do you treat primary biliary cholangitis?

Answer 13

• UDCA (non toxic bile acid)
• NOT curative
• Increases rate of bile flow, inhibits production of toxic bile acids, inhibit apoptosis, inhibit liver immune response

Question 14

What are the clinical signs/symptoms of a biliary or pancreatic tumour?

Answer 14

• Painless jaundice
• Palpable epigastric mass
• Palpable gall bladder