Case 16-20

Question 1

SAAG >1.1 indicated for portal hypertension seen in

Answer 1

Cardiac ascites, cirrhosis, Budd-Chiari syndrome

Question 2

SAAG <1.1 g/dl (absence of portal hypertension) SEEN IN

Answer 2

TB, peritoneal carcinomatosis, pancreatic ascites, nephrotic syndrome

Question 3

This patient v,ith chronic alcohol misuse and epigastric pain that vvorsens postprandially, suggestive of …..

Answer 3

chronic pancreatitis

Question 4

Chronic pancreatitis most commonly occurs in patients with ……

Answer 4

chronic alcohol use disorders

Question 5

Pancreatic ascites is a rare complication of …….

Answer 5

chronic pancreatitis

Question 6

Pancreatic ascites is typically

Answer 6

serosanguinous or straw-colored with analysis showing
high amylase (often >1000 U/L), high total protein (> 2.5 g/dl ), and low serum-ascites albumin gradient (SAAG) (<1.1, indicating the absence of portal hypertension).

Question 7

is straw yellow with normal amylase, low total protein, and high SAAG.

Answer 7

Ascites from cirrhosis

Question 8

Budd-Chiari syndrome (ie, hepatic venous obstruction) can cause ascites but it is usually straw yellow with

Answer 8

normal amylase, high total protein, and high SAAG.
Patients typically have severe right upper quadrant pain with jaundice, hepatic encephalopathy, and possibly variceal bleeding.

Question 9

present with malignant ascites, which is typically bloody (not serosanguinous) with normal amylase, high total protein, and low SAAG.

Answer 9

Hepatocellular carcinoma

Question 10

Pancreatic ascites results from

Answer 10

damage to the pancreatic duct with leakage of pancreatic juice into the peritoneal space.

Question 11

Paracentesis findings of pancreatic ascites include

Answer 11

serosanguinous or yellow fluid with high amylase, high total protein, and low serum-ascites albumin gradient

Question 12

constant epigastric pain and weight loss require further evaluation with

Answer 12

CT scan of the abdomen

Question 13

is used in the initial evaluation of patients with painless jaundice, anorexia, or weight loss.

Answer 13

Abdominal ultrasound

Question 14

Approximately 25° /o of pancreatic cancer is heralded by a recent (<2 years) diagnosis of ……

Answer 14

diabetes mellitus

Question 15

Risk factors of Acalculous cholecystitis

Answer 15

Severe trauma or recent surgery
• Prolonged fasting or TPN
• Critical illness (eg, sepsis, ICU)

Question 16

Clinical presentation

Answer 16

Fever, leukocytosis, ⬆️LFTs, RUQ pain , Jaundice & RUQ mass less common

Question 17

Diagnosis of a calculus cholecystitis

Answer 17

. Abdominal ultrasound (preferred)
•HIDA or CT scan if needed

Question 18

is most often seen in hospitalized patients who are critically ill

Answer 18

Acalculous cholecystitis

Question 19

Cause of males ant biliary obstruction

Answer 19

Cholangiocarcinoma
Pancreatidhepatocellular carcinoma
• Metastasis (eg, colon, gastric)

Question 20

Manifestations of males ant biliary obstruction

Answer 20

. Jaundice, pruritus, acholic stools, dark urine
• Weight loss
. RUQ pain
• RUQ mass or hepatomegaly
• i Direct bilirubin, ALP, GGT

Question 21

highly lethal malignancy of the bile duct epithelium.

Answer 21

Cholangiocarcinoma

Question 22

Is transaminases elevated in Cholangiocarcinoma ¿

Answer 22

Normal / mildly elevated

Question 23

CEA , CA19-9 are ………… in Cholangiocarcinoma but ……. In HCC

Answer 23

Elevated , normal

Question 24

Risk of Cholangiocarcinoma is great in

Answer 24

Fibropolycystic liver disease or
Primary sclerosing cholangitis
95% with Ulcerative colitis

Question 25

In Choledocholithiasis CEA and CA-19 are……. , and cachexia is ……..

Answer 25

not typically elevated , unusual