Chapter 79: Pancreatitis and Cholecystitis

Question 1

True or False
Most cases (~80%) involve only mild inflammation of the pan- creas, a disease state with a mortality rate of <1%, which generally resolves with only supportive care

Answer 1

True
Most cases (~80%) involve only mild inflammation of the pan- creas, a disease state with a mortality rate of <1%, which generally resolves with only supportive care

Question 2

True or False
About 5% of all patients who undergo endoscopic retrograde cholangio- pancreatography for treatment of gallstones develop pancreatitis within 30 days

Answer 2

True
About 5% of all patients who undergo endoscopic retrograde cholangio- pancreatography for treatment of gallstones develop pancreatitis within 30 days

Question 3

Medications associated with acute pancreatitis can be categorized into three groups

Answer 3

• Antiretrovirals
• Chemotherapy
• Immunosuppressants

Question 4

Can cause potentially fatal pancreatitis

Answer 4

2’,3’-Dideoxyinosine

Question 5

Antiretrovirals that has lower risk of pancreatitis

Answer 5

• Lamivudine

- Nelfinavir

Question 6

Most common cause of acute pancreatitis

Answer 6

Gallstone

Question 7

True or False

Pain described as lower abdominal pain or dull or colicky pain is highly unlikely to be pancreatitis

Answer 7

True

Pain described as lower abdominal pain or dull or colicky pain is highly unlikely to be pancreatitis

Question 8

Bluish discoloration around the umbilicus signifying hemoperitoneum

Answer 8

Cullen’s sign

Question 9

Reddish-brown discoloration along the flanks signifying retroperitoneal blood or extravasation of pancreatic exudate

Answer 9

Grey-Turner sign

Question 10

True or False

The gold standard laboratory diagnosis for acute pancreatitis is lipase

Answer 10

False

There is no gold standard laboratory diagnosis for acute pancreatitis

Question 11

True or False

Amylase rises within a few hours after the onset of symptoms, peaks within 48 hours, and normalizes in 3 to 5 days

Answer 11

True

Amylase rises within a few hours after the onset of symptoms, peaks within 48 hours, and normalizes in 3 to 5 days

Question 12

This laboratory test predicts gallstone pancreatitis

Answer 12

Alanine aminotransferase (ALT) >150U/L

Question 13

Characteristic findings in IV contrast abdominal CT

Answer 13

(1) pancreatic parenchymal inflammation with or without peripancreatic fat inflammation
(2) pancreatic parenchymal necrosis or peripancreatic necrosis
(3) peripancreatic fluid collection
(4) pancreatic pseudocyst

Question 14

How fluids prevents complications in pancreatitis?

Answer 14

The benefit of fluid resuscitation may result from increased micro- and macrocirculatory support of the pancreas, which prevents complications such as pancreatic necrosis

Question 15

Which fluid will you give in acute pancreatitis?

Answer 15

PLR. Because PNSS may cause a nongap hyperchloremic acidosis and can worsen pancreatitis

Question 16

Complication of acute pancreatitis that is characterized by transient organ failure (<48 hours), local complications, or systemic complications

Answer 16

Moderately severe acute pancreatitis

Question 17

When is the best time to do CT scan in acute pancreatitis?

Answer 17

At least 72hours after the onset of symptoms

Question 18

True or False
Systemic inflammatory response syndrome at admission and persistent at 48 hours predicts severe acute pancreatitis more simply and as accurately as the various scoring systems

Answer 18

True
Systemic inflammatory response syndrome at admission and persistent at 48 hours predicts severe acute pancreatitis more simply and as accurately as the various scoring systems

Question 19

Progression of acute to chronic pancreatitis is common in what population?

Answer 19

Alcoholic

Question 20

Most common symptoms of gallstone?

Answer 20

Asymptomatic

Question 21

The most common complication of gallstone disease

Answer 21

Biliary colic

Question 22

Primary choledocholithiasis

Answer 22

Gallstones within the common bile duct arising from within the bile duct

Question 23

Secondary choledocholithiasis

Answer 23

Gallstone within the common bile duct that formed in the gallbladder and then migrating to the common bile duct

Question 24

Microlithiasis composed of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts

Answer 24

Biliary sludge

Question 25

True or False
Acute acalculous cholecystitis is more common than acute calculous cholecystitis and it is less likely to result in complications

Answer 25

False
Acute acalculous cholecystitis is less common than acute calculous cholecystitis and it is more likely to result in complications

Question 26

Classification of gallstone?

Answer 26

• Pigment stone (brown and black)

- Cholesterol stone

Question 27

Most common pathogen seen in acute cholecystitis

Answer 27

Polymicrobial infection

Question 28

Most common classification of stone in gallstone?

Answer 28

Cholesterol stone which is radioluscent

Question 29

Classification of stone in gallstone that more common in asian

Answer 29

Brown stone

Question 30

Biliary colic demonstrates significant circadian periodicity, with a peak in symptom occurrence around ____

Answer 30

Biliary colic demonstrates significant circadian periodicity, with a peak in symptom occurrence around midnight

Question 31

Diagnostic criteria for acute cholecystitis

Answer 31

Local signs:
Murphy’s sign
Right upper quadrant mass, pain, or tenderness

Systemic signs:
Fever
Elevated C-reactive protein
Elevated WBC count

Suspected: One local sign and one systemic sign
Definite: One local sign, one systemic sign, and imaging findings of acute cholecystitis

Question 32

The most sensitive and specific serum marker of choledocholithiasis

Answer 32

Abnormal γ-glutamyl transpeptidase is the most sensitive and specific serum marker of choledocholithiasis

Question 33

The imaging modality of choice for acute cholecystitis

Answer 33

Abdominal US

Question 34

Normal diameter of common bile duct

Answer 34

<5mm

Question 35

First line of therapy in acute cholecystitis inn treating pain

Answer 35

NSAIDS IV

Question 36

The classic radiographic appearance of gallstone ileum?

Answer 36

Rigler’s triad: a small bowel obstruction, pneumobilia, and an ectopic gallstone

Question 37

Complications of acalculous cholecystitis

Answer 37

Gangrene and perforation

Question 38

A common cause of postcholecystectomy pain

Answer 38

Choledocholithiasis