Mehlman pancreatitis (both), choled. cyst, liver hyperplasia 10-26 (1)

Question 1

gallstone pancreatitis. mechanism

Answer 1

stone obstructs HEPATOPANCREATIC AMPULA!!!!!!! (not stone in ductus choledocus)

stone itseft in ductus would not cause. it causes when obstructs ampulla.

Question 2

gallstone pancreatitis. CP?

Answer 2

obstructive jaundice: incr. ALP + incr. direct bilirubin
+ incr. PANCREATIC ENZYMES (incr. amilase/lipase)

Question 3

gallstone pancreatitis.
2 CK Dx?

Answer 3

DO CT of abdomen (not ERCP)
in this case we also look for fluid collection, not only stone

Question 4

acute pancreatitis. presenctation cp+ lab?

Answer 4

abdominal pain + increased amylase and/or lipase

pain need not radiate to the back

Question 5

acute pancreatitis. biggest risk factors?

what other 2 causes?

Answer 5

alcohol and gallstones

hyperlipidemia and hypercalcemia

Question 6

acute pancreatitis. what drugs can cause?

Answer 6

didanosine is HIV NRTI;
exenatide is a GLP1 analogue for diabetes

Question 7

yra Ranson criteria - to determine prognosis in pancreatitis. bet visu ju nereikia zinot. yra keli pointai.

Answer 7

.

Question 8

Ranson to know.
what bad indicators?

Answer 8

decr. serum calcium and incr. glucose are bad prognostic indicators.

Question 9

Ranson to know. what labs levers are not important?

Answer 9

degree of lipase/amylase elevations does not correlate with prognosis.

tipo ar 1200 ar 10k, pohuj visai for outcome

Question 10

which is more specific for pancreatitis?

Answer 10

lipase more specific. but questions can only mension amylase, and nothing about lipase.

Question 11

HY 2ck management triad?

Answer 11

1. NPO (can be mentioned as bowel rest)
2. NG decompression
3. IV fluids with normal saline

Question 12

management triad –> next best step?

Answer 12

after triad do CT abdomen scan

Question 13

what to look for on abdomen CT scan?

Answer 13

fluid collection

Question 14

abdomen CT scan –> fluids are present –>

Answer 14

do ERCP to drain this collection

fluid collection aka pseudocyst

Question 15

what abs if needed? why?

Answer 15

carbapenems - have fantastic penetration of pancreatic tissue

Question 16

• A 2CK NBME Q gives pancreatitis + CT scan su didele cista, and the
  answer is just ERCP (for drainage of the pseudocyst within black circle).

Answer 16

UW yra tipo < 6cm + < 6 weeks - observe
jeigu > 6cm or > 6 weeks ERCP

mehlman nebuvo specifiskai pagal dydi

Question 17

Acute pancreatitis yra HY cause of ARDS.

Answer 17

.

Question 18

whats about necrosectomy?

what supplements?

Answer 18

A necrosectomy is removal of pancreatic tissue in the setting of high fraction of necrosis.
Patients with pancreatectomy require enzyme replacement (pancrelipase).

Question 19

UW. diagnosis requires 2 of the following?

Answer 19

Acute epigastric pain (often radiating to back, bet nebutinai)

Amylase/lipase > 3 times normal limit

Abdominal image (CT) showing pancreatitis

Question 20

UW CP. What is Cullen sign?

Answer 20

periumbilical bluish coloration indicating hemoperitoneum

Question 21

UW CP. What is Grey-Turner sign?

Answer 21

Reddish-brown coloration around flanks indicating retroperitoneal bleed

Question 22

UW CP. if ALT levels > 150 =?

Answer 22

its biliary pancreatitis

Question 23

Chronic pancreatitis. indicating CP?

Answer 23

steatorrhea in alcoholics or inpatients with recurrent acute pancreatitis.

Question 24

Chronic pancreatitis.

results in pancreatic burnout with –> production of pancreatic
enzymes –> decr. proteases/lipases
–> malabsorption.

Answer 24

.

Question 25

Chronic pancreatitis. pancreatic enzyme level?

Answer 25

NORMAL!!!! ie. not elevated

Pancreas is exhausted
no enzymes –> malabsorbtion

Question 26

Chronic pancreatitis. xylose test result?

Answer 26

D-xylose test is normal. This is a monosaccharide that is readily absorbed
by the small bowel insofar as the intestinal lining is intact. So if we get steatorrhea + normal D-xylose, this can be due to pancreatic insufficiency or lactose intolerance.

Question 27

Chronic pancreatitis. steatorrhea + normal D-xylose?

Answer 27

can be due to pancreatic insufficiency or lactose intolerance.

Question 28

Chronic pancreatitis. if steatorrhea + D-chylose ABNORMAL?

Answer 28

If D-xylose test is abnormal, we know the
malabsorption is due to an intestinal lining issue, such as Celiac or Crohn.

Question 29

Chronic pancreatitis. usmle gives CT - what see?

Answer 29

calcifications

Question 30

Chronic pancreatitis. Tx?

Answer 30

Pancreatic enzyme supplementation (pancrelipase)

dar is UW: smoking/alcohol cessation, pain management, frequent small meals

Question 31

Sphincter of Oddi dysfunction. how case sounds?

Answer 31

• The answer on USMLE if the Q sounds like gallstone pancreatitis (i.e., ­ ALP, ­ direct bilirubin, ­ pancreatic enzymes) but the patient hasn’t had a gallbladder for many years (so it can’t be a stone causing the obstruction).

Question 32

Choledochal cyst. 2 ck surgery.

Case: incr. ALP, incr. direct bilirubin + CT scan cystic structure in biliary tree. what Tx?

Answer 32

simple cyst excision

Question 33

Focal nodular hyperplasia. Case: adult + done abdominal CT (no specific reason why) = detected 1-2 cm lesion with CENTRAL SCAR in liver –> further Dx?

Answer 33

This is a lesion of hepatocellular hyperplasia that does not require
treatment. This is the answer on NBME, where they tell you CT shows hepatic lesion with central scar. Answer = “no further diagnostic studies indicated.”