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Pancreas & biliary tree flashcards

12 high-yield MRCP Part 1 cards from the Intellect Medicos Gastroenterology & Hepatology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. What is the first-line investigation for suspected gallstone disease (biliary colic or cholecystitis)?

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   Abdominal ultrasound.

   Why? Ultrasound shows stones and, in cholecystitis, a thick-walled (over 3 mm) gallbladder, pericholecystic fluid and a sonographic Murphy's sign.

2. What is the definitive management of acute calculous cholecystitis?

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   Early laparoscopic cholecystectomy (NICE: within 1 week of diagnosis), after IV fluids, analgesia and antibiotics.

   Why? Early surgery shortens hospital stay and prevents recurrent attacks compared with delayed surgery.

3. Charcot's triad of ascending cholangitis is fever, RUQ pain and jaundice; Reynolds' pentad adds ______.

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   hypotension and confusion

   Why? Reynolds' pentad signals septic shock from an obstructed, infected biliary tree.

4. Besides IV antibiotics, what is the key treatment of ascending cholangitis?

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   Urgent biliary decompression, usually by ERCP.

   Why? Antibiotics cannot sterilise an obstructed system; the pus must drain. E. coli is the commonest organism (piperacillin–tazobactam or ceftriaxone + metronidazole are typical choices).

5. What does Courvoisier's law state?

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   In a jaundiced patient, a palpable, non-tender gallbladder is unlikely to be due to gallstones.

   Why? Stones cause chronic fibrosis, so the gallbladder cannot distend; a distal malignant obstruction (pancreatic head cancer, cholangiocarcinoma) can.

6. What are the diagnostic criteria for acute pancreatitis?

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   Two of three: typical epigastric pain, serum lipase or amylase at least 3 × upper limit of normal, and imaging consistent with pancreatitis.

   Why? Lipase is preferred: it is more specific and stays raised longer than amylase.

7. In the Glasgow (Imrie) score for acute pancreatitis, how many positive criteria within 48 hours predict severe disease?

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   3 or more.

   Why? The score uses age and blood results in the first 48 hours to flag patients who need HDU/ICU-level care.

8. Name four drugs that can cause acute pancreatitis.

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   Any four of: azathioprine, mesalazine/sulfasalazine, thiazides (bendroflumethiazide), furosemide, sodium valproate, GLP-1 agonists, corticosteroids, oestrogens, octreotide, didanosine, pentamidine.

   Why? Always take a drug history; stopping the culprit prevents recurrence.

9. In severe pancreatitis, flank bruising is ______ sign (periumbilical bruising is Cullen's sign).

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   Grey Turner's

   Why? Both reflect retroperitoneal haemorrhage tracking through tissue planes.

10. In chronic pancreatitis, which stool test shows exocrine insufficiency and what is the treatment?

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    Low faecal elastase; treat with pancreatic enzyme replacement (pancreatin, e.g. Creon) taken with meals and snacks.

    Why? Enzyme replacement treats steatorrhoea and fat-soluble vitamin deficiency. Alcohol causes about 70% of cases; CT shows pancreatic calcification.

11. What is the gold-standard imaging test for pancreatic cancer?

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    Contrast-enhanced (pancreatic protocol) CT abdomen.

    Why? It diagnoses and stages the tumour and shows resectability. A head-of-pancreas tumour may show a 'double duct sign' (dilated CBD and pancreatic duct).

12. What is the classic triad of a VIPoma, and which drug class controls symptoms?

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    Watery diarrhoea, hypokalaemia and achlorhydria (WDHA); somatostatin analogues (octreotide, lanreotide).

    Why? VIP drives massive intestinal secretion. Surgical resection is the mainstay of treatment for localised tumours.