Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
3 GI, Gallbldr 3/5
Step Up to Medicine Chap 3: Gallbldr, Appendix, Pancreas
| Question | Answer |
|---|---|
| Name 2 viral infections causing acute pancreatitis. | Mumps, cocksackie B virus |
| MCC of pancreatitis in children? | Blunt abdominal trauma |
| How do gallstones cause pancreatitis? | Stone passes into bile duct and blocks ampulla of Vater |
| Epigastric pain radiating to back. Worse in supine position and post-prandially. Nause, vomiting, and anorexia. Dx? | Acute pancreatitis |
| What are bowel sound findings in acute pancreatitis? | Decreased or absent indicating ileus |
| Name and describe 3 signs seen in hemorrhagic pancreatitis. | 1. Grey Turner's sign (flank echymoses) 2. Cullen's sign (periumbilical echymoses) 3. Fox's sign (inguinal ligament echymoses) |
| How is acute pancreatitis diagnosed? | Clinically. Lab studies are supportive. CT is confirmatory. |
| Can amylase and lipase be used to predict the severity of the disease? | No! |
| What causes hypocalcemia in acute pancreatitis? | Fat saponification (fat necrosis binds calcium) |
| Which is more specific for pancreatitis: amylase or lipase? | Lipase |
| When is a CT scan of the abdomen indicated in a pt presenting with S/S of acute pancreatitis? | When disease is severe |
| When is ECRP indicated in a pt presenting with S/S of acute pancreatitis? | Severe gallstone pancreatitis with biliary obstruction. Also to ID uncomon causes of acute pancreatitis if disease is recurrent. |
| Treatment for infected pancreatic necrosis? | Surgical debridement and abx (high mortality rate with multiple organ failure in 50% of cases; compared to sterile pancreatic necrosis in which half of all cases resolve spontaneously) |
| How to distinguish sterile from infected pancreatic necrosis? | CT-guided percutaneous aspiration with Gram stain and culture of aspirate |
| Encapsulated fluid collection that appears 2-3 weeks after an acute attack of pancreatitis? Where does its name come from? | Pancreatic pseudocyst. Pseudo b/c has no epithelial lining |
| How are pancreatic pseudocysts managed? | <5cm: observe >5cm: surgial or percutaneous drainage |
| Dx test of choice for hemorrhagic pancreatitis? | CT scan w/IV contrast |
| Ranson's criteria for admission w/acute pancreatitis? | Glucose >200, Age >55yo, LDH>350, AST>250, WBC>16,000 |
| What causes ascending cholangitis in pancreatitis? | Gallsotne blockage in ampulla of Vater-> infection of biliary tract |
| Name 7 complications of acute pancreatitis. | 1. Pancreatic necrosis, 2. Pancreatic pseudocyst, 3. Hemorrhagic Pancreatitis, 4. ARDS, 5. Pancreatic ascites/pleural effusion, 6. Ascending cholangitis, 7. Pancreatic abscess (4-6 weeks later; rare) |
| Tx for acute pancreatitis? | Bowel rest, IV fluids, pain control, NG tube for n/v or ileus |
| When should acute pancreatitis pts be moved to ICU for observation? | If they have more than 3-4 Ranson's criteria. |
| MCC of chronic pancreatitis? | Chronic alchoholism |
| Chronic epigastric pain with calcifications on plain film abd X-rays is diagnostic of which disease? | Chronic pancreatitis |
| What is the classic triad for chronic pancreatitis (diagnostic)? | 1. Steatorrhea, 2. DM, 3. Pancreatic calcification on plain films or CT scan (CT is initial study of choice) |
| MC complication of chronic pancreatitis? | Narcotic addiction |
| T or F: Pts with chronic pancreatitis are at an increased risk for developing pancreatic carcinoma. | True |
| Non-surgical tx for chronic pancreatitis? | Narcotics for pain, bowel rest, pancreatic enzymes + H2 blockers, insulin, alcohol abstinence, and small-volume frequent low-fat meals |
| Why give pancreatic enzymes and H2 blockers in chronic pancreatitis? | Pancreatic enzymes ihibit CCK release-> decreases secretion of pancreatic enzymes after meals. H2 blockers pervent gastric acid secretion, so there is no breakdown of the pancreatic enzyme supplements in the stomach. Smart! |
| Name two populations in which pancreatic cancer is more common. | 1. Elderly (rare b/f age 40) 2. AA |
| Where are the majority of pancreatic cancers located? | Pancreatic head (75%) |
| Name 5 risk factors for pancreatic cancer. Which is most clearly established. | 1. Smoking (most established), 2. Chronic pancreatitis, 3. DM, 4. Heavy alcohol use, 5. Exposure to benzidine and beta-naphthylamine |
| What is Courvoisier's sign? | Palpable gallbladder (seen in 30% of pts with pancreatic cancer in head of pancreas); painless |
| Most sensitive test for dx pancreatic cancer? | ECRP (CT is preferred for diagnosis and assessment of spread of disease) |
| Name two tumor markers for pancreatic cancer. | CA 19-9 and CEA (lower sens and spec) |
| MC pathogenesis for acute appendicitis? | Obstruction of lumen by hperplasia of lymphoid tissue |
| Risk factors for perforation of appendix? | Delay in tx (>24h) and extremes of age |
| High fever, tachycardia, marked leukocytosis, peritoneal signs, and toxic appearance in pt with appendicitis | Appendiceal rupture |
| What symptom is always present in appendicitis? | Anorexia (if pt is hungry, it's NOT appendicitis) |
| What is Rovsing's sign? | Deep palpation in LLQ causes referred pain in RLQ w/appendicitis |
| What is psoas sign? | RLQ pain when R thigh is extended as pt lies on L side |
| What is obturator sign? | Pain in RLQ when flexed R thigh is internally rotated when pt is supine |
| How is acute appendicitis diagnosed? | Clinically (labs=leukocytosis only supportive. Imaging not necessary unless dx uncertain or presentation is atypical) |
| Tumors originating from neuroendocrine cells that secrete serotonin. | Carcinoid tumors |
| MC site for carcinoid tumors? | Appendix |
| Cutaneous flushinig, diarrhea, sweating, wheezing, abdominal pain, and heart valve dysfunction | Serotonin syndrome (carcinoid syndrome) |
| Which type of carcinoid tumor is more likely to be malignant? | Ileal tumors. Appendiceal tumors rarely metastasize. Increased tumor size=increased risk of mets. |
| Tx for carcinoid syndrome? | Surgical resection |
| Black pigment gallstones are suggestive of which two conditions? | Hemolysis (sickle cell, thalassemias, hereditary spherocytosis, artificial cardiac valves) or alcoholic cirrhosis |
| Which type of stones are associated with Native Americans, pregnancy/OCPs, obesity/DM/hyperlipidemia, cystic fibrosis, and Crohn's? What color are they? | Cholesterol stones. Yellow-green color. |
| Brown pigment gallstones indicate which condition? Where are they usually found? | Infection of biliary tract; usually found in bile ducts. |
| Most stones are of which type: cholesterol, pigment, or mixed? | Mixed |
| What is the classic report of pain from pt's with biliary colic from gallstone obstruction of cystic duct? | Pain after eating (gallbladder contracting against obstruction) and at night |
| What is Boas' sign? | Referred R subscapular pain of biliary colic |
| Dx test of choice for cholelithiasis? | RUQ ultrasound (high sens and spec for stones >2mm) |
| Difference in length of pain between biliary colic and acute cholecystitis? | Biliary colic only lasts a few hours. Cholecystitis pain persists for days. |
| Signs of biliary tract obstruction (list 6). | 1. Elevated alk phos, 2. Elevated GGT, 3. Elevated conj bilirubin, 4. Pruritus, 5. Clay-colored stools, 5. Dark urine |
| What effect does a normal HIDA scan have on making the dx of acute cholecystitis? | Normal HIDA scan rules OUT cholecystitis |
| Which test is the gold std for choledocholithiasis? | ECRP (both diagnostic and therapeutic); should follow US |
| What is Charcot's triad? What disease is it seen in? | Triad: RUQ pain, jaundice, fever. Present in cholangitis (50-70% of cases) |
| What is Reynold's pentad? What disease is it seen in? | Charcot's triad (RUQ pain, jaundice, and fever) + septic shock and AMS (CNS depression: coma, disorientation). It is a medical EMERGENCY! |
| When should ERCP or PTC be used in cholangitis? | After the acute phase has resolved w/pt afebrile for >48h |
| When do you use ERCP vs PTC in cholangitis? | ERCP for normal duct system. PTC when duct system is dilated. |
| Tx for cholangitis? | IV fluids and IV abx . Decombress CBD via PTC, ERCP, or laparotomy once pt is stabilized or emergently if pt doesn't respond to abx |
| Most serious and dreaded complication of cholangitis? | Hepatic abscess. HIGH mortality rate. |
| Name 3 risk factors for gallbladder carcinoma. | 1. Gallstones (most cases), 2. cholecystenteric fistula, 3. porcelain gallbladder |
| What is the recommended treatment for pts with porcelain gallbladder (intramural calcification of gallbladder wall)? | Prophylactic cholecystectomy (b/c 50% of pts will eventually develop gallbladder carcinoma) |
| Which type of IBD has a closer association with primary sclerosing cholangitis (PSC)? | UC |
| Name 2 complications of PSC. | 1. Recurrent bouts of cholangitis. 2. Cholangiocarcinoma |
| Name 3 things PSC can progress to. | 1. Secondary biliary cirrhosis, 2. Portal HTN, 3. Liver failure |
| Dx study of choice in PSC? What does it show? | ERCP and PTC: multiple areas of bead-like stricturing and dilations of the intrahepatic and extrahepatic ducts |
| Symptomatic relief of pruritus in PSC? | cholestyramine |
| Cure for PSC? | Liver transplantation (ECRP w/stent in case of cholestasis relieves sx but isn't curative) |
| Chronic and progressive cholestatic liver disease characterized by destruction of intrahepatic bile ducts with portal inflammation and scarring. | Primary Biliary Cirrhosis (PBC) |
| In which population is PBC most common? | Middle-aged women (auto-immune etiology) |
| Which serum test is the hallmark of PBC? | POsitive antimitochondrial antibodies (AMA). If AMA+, do liver bx to dx. Also see IgM elev. |
| What role does ursodeoxycholic acid play in the treatment of PBC? | Slows progression of disease |
| How is biliary dyskinesia diagnosed? | HIDA scan: give CCK IV, measure EF. If EF is low, dyskinesia is likely. |
| How does CCK affect the gallbladder? | Relaxes sphincter of Oddi and contracts the gallbladder |
Created by:
sarah3148
Popular USMLE sets