GI liver and pancreas

Question 1

Alcohol causing pancreatitis?

Answer 1

CHRONIC USE!!!
CHOLELITHIASIS

Sulfa drugs and HIV drugs

remember lipids, serum calceum,

Question 2

Ranson criteria, dont stress numbers but know what you are looking for

Answer 2

GA LAW
Glucose
AST
LDH
AGE
WBC

CA HOBBS
Calcium
Hematocrit decrease
PO2
Base deficit
BUN increase
Sequestration of fluids

Question 3

Base deficit calculcation?

Answer 3

do i need to know it?

Question 4

Pleural effusion with pancreatitis might have what?

Answer 4

amylase in it

Question 5

Why do you use meperidine in pancreatitis?

Answer 5

less sphincter of oddi constriction when compared to morphine

(think P sounds like Pancrease in meperidine)

Question 6

Chronic pancreatitis symptoms?

Answer 6

Can have steatorrhea of cours

Question 7

Most specific test for chronic pancreatitis?

Answer 7

Low fecal elastase!!!

Might have mild up amylase and lipase

Question 8

Tx chronic pancreatitis?

Answer 8

Stop drinking, smoking

Give opioids, supplement pancreatic enzmes

Vitamin supplements, small meals low fats

Question 9

Pancreatic pseudocyst is what? When?

Answer 9

False cyst. Usually iasymptomatic. May have some epigastric duct.

Must rule out from neoplasm.

What to tell is by aspiration. If lots of amylase, it is pancreatic juice (pseudocyst).

Only do if there for 6 weeks, diagnostic reason, or if growing

Question 10

Tumor marker pancreatic cancer?

Answer 10

CEA or CA19-9

Question 11

Migratory thrombophlebitis was discovered by who?

Answer 11

Pancreatic cancer. Trousseau diagnosed himself

Question 12

Insulinoma drug treatment if difficulty resecting?

Answer 12

Diazoxide causes DIAbetes (dia and dia)

Or octreotide

Question 13

Awful rash on face and perineum, what do you consider? Painful and pruritic

Answer 13

Glucagonoma.

Necrolytic migratory something

Question 14

VIPoma is where?

Answer 14

Non beta islet cells. Watery diarrhea! High VIP. High stool osmolality.

Question 15

What is calculus cholecystisit? Who get it?

Answer 15

Inflammation of gall bladder who don’t have stones

Patients on TPN or critically ill

Question 16

HIDA does what?

Answer 16

Absorbed by liver and secreted into gall. If it doesn’t go into gall bladder, it is obstructred

Question 17

Cholecystitis tx?

Answer 17

Antibiotics then treat after about 2 days

Question 18

Cholangitis is what?

Answer 18

inflammation of bile ducts. Usually from obstruction

Question 19

Charcot triad is HIGH YIELD

Answer 19

RUQ jaundice, fever

cholangitis

You see AST, and ALT b/c it is ducts, so liver issues can happen

Question 20

Reynolds pentad?

Answer 20

Altered mental status and SHOCK

RUQ, jaundice, fever

Question 21

Dx for cholangitis?

Answer 21

HIDA

Question 22

Tx cholangitis?

Answer 22

Endoscopic biliary drainage, IV fluids, antibiotics

then surgery after it cools weeks later

Diff than cholecystitis which you can treat a few days later

Question 23

Gall bladder cancer presentation?

Answer 23

Same symptoms. But no white count. Still high bill and alk phos

Question 24

Primary Billiary Cirrhosis is what?

Tx?

Answer 24

Women love Primarily bitches Cirrhosis (IN WOMEN!)

Autoimmune: Antimitochondrial antibodies. in women (Ursula so give Ursodeoxycholic acid (also has the cholic part in there for biliary tract) and that delays progression.

Definitive tx? Liver transplant

Question 25

Primary Sclerosing Cholangitis?

Answer 25

You get destruction of bile ducts in liver and extra hepatic.

Fatigue, pruritis, hepatomegaly, jaundice

MORE COMMON IN MEN

Associated with Ulcerative Colitis

P Anca

Transplant only tx

Cholangiocarcinoma risk

Beads on String (sclerosinG)

Question 26

Crigler najar tx?

Answer 26

Type 1 is UDPGT issue. Give Plasmapheresis then eventually transplant

If type 2, barbiturates help create more UDPGT activity!!

Question 27

Goodpasture tx?

Answer 27

Plasmapheresis, steroids, immunosuppressants