GB, Pancreas

Question 1

Why bile salts decr. gallstones?

Answer 1

Bind to cholesterol and make it water soluble.

Without enough bile salts, cholesterol can collect in the gallbladder to form stones.

Question 2

Gallstone 4 RF’s

Answer 2

Risk factors (4 F’s):

1. Female
2. Fat
3. Fertile (pregnant)
4. Forty

Question 3

Charcot Triad?

Answer 3

Charcot triad of cholangitis:

1. Jaundice
2. Fever
3. RUQ pain

Question 4

Medical term for gallstones

Answer 4

cholelithiasis

Question 5

Gallstones Tx.

Answer 5

ultrasound

Question 6

When do cholecystectomy for stones?

Answer 6

If symptoms present

Question 7

Hormone causes GB contraction after fatty meal?

Answer 7

CCK

Question 8

Cholecystitis–2 ways diagnose

Answer 8

1. ultrasound
   or
2. cholescintigraphy (HIDA, or hepatobiliary iminodiacetic acid scan).

Question 9

Porcelain gallbladder tx.

Answer 9

Treatment: prophylactic cholecystectomy due to high rates of gallbladder cancer (mostly adenocarcinoma).

Question 10

Acute Pancreatitis 11 causes: (Mnemonic)

Answer 10

Causes: I GET SMASHED

Idiopathic,

Gallstones,
Ethanol,
Trauma,

Steroids,
Mumps,
Autoimmune disease,
Scorpion sting, Hypercalcemia/Hypertriglyceridemia (> 1000 mg/dL),
ERCP,
Drugs (eg, sulfa drugs, NRTIs, protease inhibitors).

Question 11

Acute Pancreatitis Dg.

Answer 11

2 of 3 criteria:

1. acute epigastric pain often radiating to the back,
2. serum: amylase or lipase (more specific) to 3× upper limit of normal,
3. characteristic imaging findings.

Question 12

Acute Pancreatitis–5 Complications: Mnemonic

Answer 12

1. Pseudocyst B (lined by granulation tissue, not epithelium),
2. Necrosis,
3. Hemorrhage,
4. Infection,
5. Shock=Organ failure (ARDS, shock, renal failure),
6. Hypocalcemia (precipitation of Ca2+ soaps).

“C SHIPS”

Question 13

Chronic pancreatitis–tissue changes to pancreas

Answer 13

Chronic inflammation,
atrophy,
calcification of the pancreas

Question 14

cystic fibrosis=due to mutation in

Answer 14

CFTR

Question 15

Dz. can cause chronic pancreatitis

Answer 15

CF

Question 16

Pancreas insuff. from chr. pancreatitis 3 sxs.:

Answer 16

pancreatic insufficiency–>
steatorrhea,
fat-soluble vitamin deficiency,
diabetes mellitus

Question 17

Amylase and lipase in acute v. chronic pancreatitis?

Answer 17

acute-always increased

chronic-not always increased

Question 18

Adenocarcinoma

Answer 18

starts in mucus-producing glandular cells of your body.

Question 19

Pancreatic adenocarcinoma: Very aggressive tumor arising from

Answer 19

pancreatic ducts

Question 20

Pancreatic adenocarcinoma: more common in

Answer 20

pancreatic head

Question 21

Pancreatic adenocarcinoma in pancreatic head causes:

Answer 21

obstructive jaundice

Question 22

CA 19-9 tumor marker

Answer 22

Pancreatic Adenocarcinoma

Question 23

Pancreatic adenocarcinoma–5 Risk factors:

Answer 23

1. Tobacco use
2. Chronic pancreatitis (especially > 20 years)
3. Diabetes
4. Age > 50 years
5. Jewish and African-American males

Question 24

Trousseau

syndrome

Answer 24

Migratory thrombophlebitis—redness and tenderness on palpation of extremities in Pancreatic Adenocarcinoma

Question 25

Migratory thrombophlebitis

Answer 25

Red and tender on palpation of extremities in Pancreatic Adenocarcinoma

Question 26

Pancreatic adenocarcinoma sxs.:

Answer 26

1. Abdominal pain radiating to back
2. Weight loss (due to malabsorption and anorexia)
3. Migratory thrombophlebitis—redness and tenderness on palpation of extremities (Trousseau syndrome)
4. Obstructive jaundice with palpable, non-tender gallbladder (Courvoisier sign)

Question 27

Pancreatic adenocarcinoma Tx.:

Answer 27

1. Whipple procedure,
2. chemotherapy,
3. radiation therapy

Question 28

Whipple procedure entails removing?

Answer 28

(pancreaticoduodenectomy)
1. head of the pancreas,
2. duodenum
3. gallbladder
4. bile duct.