Biliary Disease: Approach & Management

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Questions and Answers

What are the baseline investigations recommended for suspected biliary malignancies?

  • CBC, electrolytes, and kidney function (correct)
  • CBC and liver function tests
  • Liver function tests and biliary excretion products
  • Liver function tests and tumour markers

Which imaging modality is specifically used to assess the pancreas in suspected pancreatic cancer?

  • ERCP or PTC
  • CT pancreas protocol (correct)
  • MRI liver
  • CT chest

What is the primary purpose of ERCP or PTC in the investigation of biliary malignancies?

  • To assess for metastases
  • To biopsy mass or lymph node
  • To relieve biliary obstruction (correct)
  • To collect histological samples

Which tumour marker is associated with pancreatic cancer?

<p>CA 19-9 (D)</p> Signup and view all the answers

What is the general prognosis described for patients with pancreatic and biliary cancers?

<p>Shitty prognoses and survival rates (D)</p> Signup and view all the answers

In suspected cholangiocarcinoma, what procedure involves brushing the bile duct to collect samples for histology?

<p>ERCP or PTC (A)</p> Signup and view all the answers

What is the main treatment approach for pancreatic and biliary cancers?

<p>Resect if possible, systemic therapy otherwise (C)</p> Signup and view all the answers

What is a common symptom triad seen in cholangitis, which includes fever, RUQ pain, and jaundice?

<p>Fever, RUQ pain, and jaundice (D)</p> Signup and view all the answers

Which imaging technique is considered the gold standard for diagnosing and treating choledocholithiasis?

<p>Endoscopic retrograde cholangiopancreatogram (ERCP) (A)</p> Signup and view all the answers

What is a significant risk factor for biliary malignancies?

<p>Chronic inflammation of the biliary tree (D)</p> Signup and view all the answers

In gallstone pancreatitis, what causes inflammation and pain in the pancreas?

<p>Blockage of the pancreatic duct by gallstones (A)</p> Signup and view all the answers

What investigation is preferred if there is uncertainty in diagnosing gallstones and acute cholecystitis following an ultrasound?

<p>HIDA scan (A)</p> Signup and view all the answers

Which imaging method can assess for CBD stones and biliary strictures non-invasively without using radiation or anesthesia?

<p>MRCP (A)</p> Signup and view all the answers

What is considered the best diagnostic test for gallstones with 90% specificity but can lead to false negatives in certain conditions?

<p>RUQ ultrasound (D)</p> Signup and view all the answers

Which surgical procedure is considered the gold standard for gallbladder stones?

<p>Cholecystectomy (D)</p> Signup and view all the answers

What is the primary lining of the gallbladder and biliary tree?

<p>Cholangiocytes (B)</p> Signup and view all the answers

Which condition is closely associated with biliary cancers?

<p>Primary sclerosing cholangitis (A)</p> Signup and view all the answers

What are common symptoms of cholangiocarcinoma?

<p>Jaundice and generalized itching (C)</p> Signup and view all the answers

What is the elective surgical treatment for biliary colic?

<p>Cholecystectomy (B)</p> Signup and view all the answers

Which of the following is a risk factor for biliary malignancies?

<p>Obesity (D)</p> Signup and view all the answers

How is cholangiocarcinoma typically diagnosed?

<p>Imaging studies and biopsy (D)</p> Signup and view all the answers

Which of the following substances can contribute to the formation of mixed pigmented gallstones?

<p>Bilirubin breakdown products (D)</p> Signup and view all the answers

What is the most common cause of gallstones in the general population?

<p>Cholesterol precipitates (C)</p> Signup and view all the answers

Which symptom is classically associated with gallstones?

<p>RUQ abdominal pain after eating greasy food (B)</p> Signup and view all the answers

What is the main risk factor for gallstone disease?

<p>Obesity (B)</p> Signup and view all the answers

In the context of biliary malignancies, which presentation is suggestive of cholangiocarcinoma?

<p>Jaundice and weight loss (C)</p> Signup and view all the answers

What is the recommended investigation for suspected cholangiocarcinoma?

<p>Endoscopic retrograde cholangiopancreatography (ERCP) (B)</p> Signup and view all the answers

Which treatment modality is commonly used for pancreatic and biliary cancers?

<p>Surgical resection (A)</p> Signup and view all the answers

What is the term for gallstones hanging out in the gallbladder without causing any problems?

<p>Cholelithiasis (A)</p> Signup and view all the answers

Which of the following is a risk factor for pigment gallstones?

<p>Cirrhosis (C)</p> Signup and view all the answers

What is the typical duration of pain in biliary colic?

<p>&lt; 6 hours (D)</p> Signup and view all the answers

Which condition presents with gallstones in the common bile duct?

<p>Choledocholithiasis (B)</p> Signup and view all the answers

What is a common medication known to cause gallstones?

<p>Hormones &amp; oral contraceptives (D)</p> Signup and view all the answers

What is the term for inflammation of the gallbladder that does not resolve like biliary colic?

<p>Cholecystitis (C)</p> Signup and view all the answers

What is a common presentation of cholangiocarcinoma?

<p>Jaundice and weight loss (D)</p> Signup and view all the answers

What is a common investigation for suspected cholangiocarcinoma?

<p>ERCP (Endoscopic Retrograde Cholangiopancreatography) (C)</p> Signup and view all the answers

Which of the following is a treatment option for pancreatic cancer?

<p>Surgery or chemotherapy (C)</p> Signup and view all the answers

What is a common treatment approach for biliary cancers?

<p>Surgical resection or liver transplant (D)</p> Signup and view all the answers

Which of the following substances contribute to the formation of mixed pigmented gallstones?

<p>Bile salts (D)</p> Signup and view all the answers

In biliary malignancies, which presentation is suggestive of cholangiocarcinoma?

<p>Jaundice and pruritus (A)</p> Signup and view all the answers

Which medication is known to cause gallstones?

<p>Ceftriaxone (C)</p> Signup and view all the answers

Which imaging modality is used to assess the pancreas in suspected pancreatic cancer?

<p>EUS (D)</p> Signup and view all the answers

Which of the following is a risk factor for biliary malignancies?

<p>Obesity (D)</p> Signup and view all the answers

What is the relationship between cholesterol and bile salts in gallstone formation?

<p>Bile salts increase cholesterol solubility in bile (A)</p> Signup and view all the answers

Which of the following imaging methods can assess for metastases in suspected pancreatic cancer?

<p>CT chest, abdo, pelvis (A)</p> Signup and view all the answers

Which imaging modality is considered the gold standard for both diagnosing and treating choledocholithiasis?

<p>ERCP (B)</p> Signup and view all the answers

What imaging technique is specifically recommended to assess for common bile duct (CBD) stones and biliary strictures non-invasively, without using radiation or anesthesia?

<p>MRCP (B)</p> Signup and view all the answers

Which medication is commonly known to cause gallstones?

<p>Ceftriaxone (D)</p> Signup and view all the answers

What presentation type is typically suggestive of cholangiocarcinoma in the context of biliary malignancies?

<p>Painless jaundice (D)</p> Signup and view all the answers

What is the primary purpose of Endoscopic Retrograde Cholangiopancreatography (ERCP) or Percutaneous Transhepatic Cholangiography (PTC) in the investigation of biliary malignancies?

<p>Histological sampling (A)</p> Signup and view all the answers

Which substance can significantly contribute to the formation of mixed pigmented gallstones?

<p>Bilirubin (C)</p> Signup and view all the answers

What is considered the best diagnostic test for gallstones with 90% specificity but can lead to false negatives under certain conditions?

<p>Ultrasound (C)</p> Signup and view all the answers

Which of the following is a risk factor for gallstone disease as described in the text?

<p>High levels of calcium in the bile (A)</p> Signup and view all the answers

What is a possible clinical presentation of gallstones according to the text?

<p>RUQ abdominal pain after eating greasy food (B)</p> Signup and view all the answers

According to the information provided, what role does cholesterol play in the formation of gallstones?

<p>Cholesterol precipitates to form gallstones (A)</p> Signup and view all the answers

Which medication, as indicated in the text, is known to cause gallstones?

<p>Oral contraceptives (D)</p> Signup and view all the answers

What imaging technique is suggested in the text for assessing CBD stones and biliary strictures non-invasively?

<p>MRI scan (D)</p> Signup and view all the answers

What is a plausible risk factor for gallstone disease based on the text?

<p>Biliary obstruction such as bile duct strictures (B)</p> Signup and view all the answers

What is a risk factor for biliary malignancies according to the text?

<p>Obesity (C)</p> Signup and view all the answers

What type of presentation is usually associated with cholangiocarcinoma in its early stages?

<p>Jaundice (B)</p> Signup and view all the answers

Which medication, as per the text, is known to contribute to the formation of gallstones?

<p>Estrogen therapy (B)</p> Signup and view all the answers

How is bile related to cholesterol according to the text?

<p>Bile aids in the digestion and absorption of dietary cholesterol (D)</p> Signup and view all the answers

Which imaging method is not invasive and does not use radiation or anesthesia to assess for CBD stones and biliary strictures?

<p>Ultrasound (B)</p> Signup and view all the answers

What is a common symptom associated with gallstones in the text?

<p>Abdominal pain (usually in the RUQ) (C)</p> Signup and view all the answers

Which condition is closely associated with biliary cancers?

<p>Chronic IBD, particularly UC (D)</p> Signup and view all the answers

Which risk factor contributes to the formation of cholesterol gallstones?

<p>Family history (A)</p> Signup and view all the answers

How does dyslipidemia contribute to the formation of gallstones?

<p>By decreasing biliary secretion of cholesterol (C)</p> Signup and view all the answers

Which medication is NOT associated with an increased risk of gallstone formation?

<p>Proton pump inhibitors (D)</p> Signup and view all the answers

What is the primary imaging modality used to diagnose gallstones in the common bile duct?

<p>ERCP (D)</p> Signup and view all the answers

Which presentation is characteristic of choledocholithiasis?

<p>Persistent right upper quadrant pain without vomiting or fever (C)</p> Signup and view all the answers

How does rapid weight loss contribute to the formation of gallstones?

<p>By causing biliary stasis (A)</p> Signup and view all the answers

Which factor increases the risk of pigment gallstones?

<p>History of Crohn's disease (C)</p> Signup and view all the answers

How do hormones and oral contraceptives contribute to gallstone formation?

<p>By increasing biliary secretion of cholesterol (C)</p> Signup and view all the answers

What imaging modality is commonly used to assess for gallstones within the gallbladder?

<p>Ultrasound (B)</p> Signup and view all the answers

What is a possible consequence of biliary colic that transforms into cholecystitis?

<p>Fever and right upper quadrant pain (D)</p> Signup and view all the answers

Flashcards

Baseline Investigations for Suspected Biliary Malignancies

CBC, electrolytes, and kidney function tests.

Imaging Modality for Pancreatic Cancer Assessment

Specifically used to visualize and assess the pancreas for tumors or abnormalities.

Purpose of ERCP or PTC in Biliary Malignancies

To relieve any blockages in ducts that may cause biliary obstruction.

Tumour Marker for Pancreatic Cancer

Associated with pancreatic cancer, useful as a tumour marker.

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Main Treatment Approach for Pancreatic/Biliary Cancers

Resect if resectable, consider systemic therapy if not.

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Cholangitis Symptom Triad

Fever, right upper quadrant (RUQ) pain, and jaundice.

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Cause of Gallstone Pancreatitis

Blockage of the pancreatic duct by gallstones.

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MRCP Use

To assess for CBD stones and biliary strictures without surgery.

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Gold Standard for Gallbladder Stones

Surgical removal of the gallbladder.

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Common Cholangiocarcinoma Symptoms

Jaundice and generalized itching (pruritus).

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Cholelithiasis

Gallstones hanging out in the gallbladder without causing any problems.

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Classic Gallstone Symptom

RUQ abdominal pain after eating greasy food.

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Cholecystitis

Inflammation of the gallbladder that does not resolve like biliary colic.

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Typical Duration of Pain in Biliary Colic

The duration of pain is less than 6 hours.

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Choledocholithiasis

Gallstones present in the common bile duct.

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Common Presentation of Cholangiocarcinoma

Jaundice and weight loss.

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Common Investigation for Suspected Cholangiocarcinoma

ERCP (Endoscopic Retrograde Cholangiopancreatography).

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Treatment Option for Pancreatic Cancer

Surgery or chemotherapy.

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Cholesterol/Bile Salts in Gallstone Formation

Bile salts increase cholesterol solubility in bile.

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Imaging Methods to Assess for Metastases in Suspected Pancreatic Cancer

CT chest, abdomen and pevis

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Suggestive Presentation of Cholangiocarcinoma

Painful jaundice.

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