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Internal Medicine > HEPATOBILIARY/PANCREATIC > Flashcards

HEPATOBILIARY/PANCREATIC Flashcards

1
Q

Child’s classification?

A

stratifies risk of surgery in pts w/ liver failure

measure 3 labs (albumin, bilirubin, PT) and 3 clinical findings (encephalopathy, ascites, nutrition)

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2
Q

Varices ppx in pts w/ cirrhosis?

Tx for bleeding varices?

A

beta blockers

band the varices, correct coagulopathy, IV octreotide to lower portal pressure
(if bleeding continues, repeat banding; if more, TIPS or gastric balloon tamponade)

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3
Q

Pathophys of ascites in cirrhosis?

A

portal HTN + hypoalbuminemia

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4
Q

Hepatic encephalopathy:
pathophys?
presentation?
tx?

A

↓NH4 metabolism → ↑NH4 → CNS toxicity

∆MS, asterixis, rigidity, hyperreflexia, fetor hepaticus

lactulose (prevents NH4 absorption) + neomycin (kills GI flora that make NH4) + low • protein diet

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5
Q

Hepatorenal syndrome:
pathophys?
tx?

A

end-stage liver dz → renal vx vaso-constriction → progressive renal failure (despite normal kidneys)

Tx liver txp

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6
Q

Spontaneous bacterial peritonitis (SBP) =
presentation?
dx?
tx?

A

infx of ascitic fluid → abd pain, fever, n/v, rebound tenderness

Dx paracentesis (↑WBC)

Tx IV abx + repeat paracentesis in 2-3 days

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7
Q

Hyperestrinism in cirrhosis is a/w:

A

↓estrogen metabolism → ↑estrogen → spider angiomas, palmar erythema, gynecomastia, testicular atrophy

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8
Q

Wilson’s disease:
dx?
tx?

A

Dx ↓ceruloplasmin, ↑AST/ALT, liver bx

Tx D-penicillamine (copper chelating agent) + zinc (copper uptake competition)

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9
Q

Hemochromatosis:

dx?

A

Dx ↑ferritin, ↓TIBC, liver bx

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10
Q 
Hepatic adenoma:
presentation?
dx?
tx?
a/w...
A

usually asx, can present as hypovolemic shock and distended abdomen if ruptured

Dx CT scan or U/S

Tx d/c OCP, if it persists → resection due to possibility of rupture

a/w OCP and anabolic steroid use

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11
Q

Cavernous hemangioma:
dx?
tx?
etiology?

A

Dx CT scan or U/S

reassurance

VAT – vinyl chloride, aflatoxin, thorotrast

(MC benign liver tumor)

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12
Q

Focal nodular hyperplasia: what will imaging show?

A

CT scan = central stellate scar or sunburst pattern

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13
Q

Hepatocellular carcinoma:
presentation?
dx?
tx?

A

vague RUQ pain and mass + s/sx of chronic liver dz (portal HTN, ascites, jaundice)

Dx CT scan, ↑αFP

Tx resection w/ negative margins (as long as there’s no mets)

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14
Q

Gilbert’s disease:
pathophys?
presentation?

A

AD ∆UDP-glucuronyltransferase  

usually asx, but can present w/ mild jaundice after fasting

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15
Q

Hemobilia:
pathophys/presentation?
dx?
tx?

A

injury to liver or biliary tract → blood drains into duodenum via CBD → UGIB, jaundice, RUQ pain

Dx arteriogram (gold std); EGD shows bleeding from ampulla of Vater

Tx supportive care, stop bleeding if severe

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16
Q

Hydatid cysts: tx?

A

inject hypertonic saline inside cyst and • carefully excise it + post-op mebendazole

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17
Q

Budd-Chiari syndrome:
pathophys/presentation?
tx?
mcc?

A

occlusion of hepatic vein outflow → hepatic congestion + portal HTN → hepatomegaly, RUQ pain, ascites, jaundice

Transjugular Intrahepatic Portosystemic Shunt (TIPS) as a bridge to liver transplant

polycythemia vera

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18
Q

 ↑AST/ALT (ALT>AST) =

A

chronic viral hepatitis (virALT)

19
Q

↑AST/ALT (AST>ALT) =

A

acute alcoholic hepatitis (toAST)

20
Q

↑↑AST/ALT =

A

acute viral hepatitis

21
Q

↑↑↑AST/ALT =

A

severe hepatic necrosis

22
Q

↑AlkP + GGT nl =

A

pregnancy or bone dz (e.g. Paget’s)

23
Q

↑AlkPhos + ↑GGT =

A

biliary obstruction

24
Q

Etiology of…

↑bilirubin (conjugated 50%) =

A

↑bilirubin (conjugated 50%): obstructive jaundice (cancer, choledocholithiasis)

25
Q

↓albumin = due to…

A

chronic liver dz, nephrotic syndrome, malnutrition, inflammatory states

26
Q

Acute cholecystitis:

tx?

A

NPO, IVF, abx → lap chole within 24 hrs

27
Q

Choledocholithiasis:

pathophys?

A

stones in CBD

NPO, IVF, ±abx → ERCP to remove stone

28
Q

Gallstone pancreatitis:
pathophys/presentation?
tx?

A

impacted stone in pancreatic duct → reflux of pancreatic enzymes → midepigastric pain

if amylase returns to normal → Tx lap chole
if amylase elevated → ERCP to remove stone

29
Q

Acute cholangitis:
pathophys/presentation?
tx?

A

impacted stone in CBD → infx → Charcot triad → Reynold pentad

NPO, IVF, abx → ERCP to decompress CBD • → finally lap chole

30
Q

Boas sign =

Charcot triad =

Reynold pentad =

A

referred right scapular pain of biliary colic

RUQ pain, fever, jaundice

Charcot triad + ∆MS, hypotension

31
Q

Gallstone ileus =

A

gallstone enters bowel through cholecystenteric fistula → gets stuck in terminal ileum → SBO

32
Q

Acalculous cholecystitis:
MC population?
tx?

A

ICU pts

NPO, IVF, abx → lap chole within 24 hrs; perc drain w/ cholecystostomy if nonsurgical • candidate

33
Q

GB adenocarcinoma:
presentation?
dx?
tx?

A

mass in GB fossa

CT

adical cholecystectomy (GB + hilar LN + • liver resection w/ negative margins)

34
Q

Porcelain GB =

tx?

A

dystrophic calcification of GB has 50% risk of adenocarcinoma

take it out

35
Q 
1° sclerosing cholangitis (PSC):
pathophys/presentation?
dx?
tx?
a/w...
A

thickening of bile duct walls → narrowed lumens → gradual jaundice and pruritus → liver failure, cirrhosis, portal HTN

Dx ERCP (beading of bile ducts)

Tx cholestyramine (helps w/ pruritus), liver txp (definitive)

UC

36
Q

1° biliary cirrhosis (PBC):
pathophys/presenatition?
tx?
causes of 2° BC?

A

+anti-mitochondrial antibody → destruction of intrahepatic bile ducts → gradual jaundice and pruritus → liver failure, cirrhosis, portal HTN

screen w/ AMA, confirm w/ liver bx

ursodeoxycholic acid

biliary obstruction, sclerosing cholangitis, cystic fibrosis, or biliary atresia

37
Q 
Cholangiocarcinoma:
location?
presentation?
dx?
tx?
A

bile ducts

s/sx of obstructive jaundice (dark urine, clay stools, pruritus)

Dx ERCP

Tx Whipple if resectable

(MCC US = PSC, MCC China = Chlonorchis sinensis)

38
Q

Choledochal cysts:
presentation?
dx?
tx?

A

cystic dilation of biliary tree → RUQ mass/pain, jaundice, fever

Dx ERCP

Tx resection

39
Q

Biliary stricture:
dx?
complications?

A

ERCP

2° biliary cirrhosis, acute cholangitis, liver abscess

40
Q

Biliary dyskinesia =
dx?
tx?

A

motor dysfxn of sphincter of Oddi → recurrent biliary colic w/o stones

Dx HIDA scan (fill up GB w/ contrast and give CCK to determine ejection fraction)

Tx lap chole

41
Q

Etiology of pancreatitis

A

I GET SMASHED – idiopathic, gallstones (#1), EtOH (#2), trauma, steroids, mumps, autoimmune, scorpion sting, hypertriglyceridemia (#3), hypercalcemia, ERCP, drugs

42
Q

Dx chronic pancreatitis?

A

stool elastase test

43
Q

Trousseau phenomenon:

Courvoisier sign:

A

Trousseau phenomenon: migratory SVT in 10% of pancreatic cancer pts

Courvoisier sign: palpable GB w/o pain in 30% of cancer pts

Internal Medicine (15 decks)

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