GI 2 (Step up son)

Question 1

What causes acute pancreatitis?

Answer 1

BAD HITS

B-Biliary obstruction*
A-Alcohol*
D-Drugs
H-Hypercalcemia and Hypertrigylceridemia
I-Idiopathic
T-Trauma
S-Scorpion sting

Question 2

What are s/s on admission that a patient with acute pancreatitis is at increased risk of mortality?

Answer 2

Ranson criteria: GA LAW

G-Glucose >200
A-AST >250
L-LDH >350
A-Age > 55
W-WBC > 16,000

Mortality increased with 3+

Question 3

What are s/s during initial 48hrs of an acute pancreatitis that the patient has an increased risk of mortality?

Answer 3

Ranson criteria: CHOBBS

C-Calcium less than 8
H-Hct decrease > 10%
O-Oxygen  5
B-Base deficit > 4
S-Sequestration of fluid > 6L

Question 4

Increased CEA and CA-19-9 is seen with what?

Answer 4

Exocrine pancreatic cancer…adenocarcinoma of the pancreatic head

Question 5

If multiple insulinomas are found, what does the patient probably have?

Answer 5

MEN1

Question 6

A patient comes with watery diarrhea, no cholera exposure…bacterial workup is negative. What should be considered?

Answer 6

Vasoactive Intestinal Peptide (VIP) producing tumor…of non-beta islet cells

Question 7

What should be considered with a calcified (porcelain) gallbladder?

Answer 7

Adenocarcinoma of the gallbladder

Question 8

What is a positive antimitochondrial antibodies test indicative of? How is it treated?

Answer 8

Primary biliary cirrhosis (increased GGT, Alk Phos, cholesterol and bilirubin…normal ALT and AST)

Ursodeoxycholic acid improves liver function and reduces symptoms
Colchicines or methotrexate can be added in more severe cases
Liver transplant needed if really bad

Question 9

A guy comes in and has pruritus, RUQ pain, and jaundice and is found to have increased GGT, Alk Phos, cholesterol, and bilirubin with normal ALT and AST. What does he likely have? What special lab/imaging should be done?

Answer 9

This is likely Primary Sclerosing Cholangitis…PBC is for women

Could check a pANCA…might be positive
Get an ERCP –> pearls on a string

Question 10

How is Primary Sclerosing Cholangitis treated?

Answer 10

Ursodeoxycholic acid, methotrexate, corticosteroids
Stent strictures
Resection of affected ducts and liver transplant if really bad

Question 11

Crigler-Najjar type I has CNS involvement (kernicterus). How can this be treated?

Answer 11

Phtotherapy, plasmapheresis, calcium phosphate + orlistat

Liver transplant is an option

Question 12

What can reduce jaundice with Crigler-Najjar type II?

Answer 12

Phenobarbital induces hepatic synthesis of glucuronyltransferase

Question 13

SAAG less than 1.1?

Answer 13

Think neoplasm

Question 14

How is hemochromatosis diagnosed?

Answer 14

Genetic testing…mutations in HFE gene

Question 15

How is Wilson disease treated?

Answer 15

Trientine or penicillamine (copper chelation)
Lifelong zinc for maintenance therapy
Supplementary B6
Decreased copper (no organ meats, shellfish chocolate, nuts, or mushrooms)