Pancreas, Biliary Tract, Liver and Spleen Flashcards
In annular pancreas, a band of pancreatic tissue encircles what part of the GI tract? What is it associated with?
second part of the Duodenum
Down Syndrome, duodenal stenosis or atresia
What are Ranson’s criteria?
WALLS FOr CHUB admission: WBC > 18 Age > 70 LDH > 400 Liver enzyme (AST) > 250 Sugar > 220
after 48 hours:
Fluid requirement
Oxygen < 60
Calcium < 8
Hematocrit fall > 10%
Urea increase > 5 mg/dL
Base deficit > 5mEq/L
_________ should be suspected in a patient with a history of liver trauma who later develops GI bleeding and abdominal pain.
Hemobilia
What is Felty’s syndrome?
rheumatoid arthritis, swollen spleen, decreased WBC
T/F: Percutaneous needle biopsy is contraindicated in hepatic hemangiomas and adenomas.
True
What is Pringle’s maneuver?
Occlusion of the porta hepatitis: portal vein, hepatic artery, and CBD. Used to control bleeding in hepatic procedures
What is the difference between class I, II, and III injuries to the spleen?
I = nonexpanding hematoma covering less than 10% of spleen
II = parcenchyma 1-3mm deep affectd
III major parenchymal injury
Continuous secretory diarrhea (even when not eating or with continuous NGT suctioning) and hypokalemia:
VIPoma (WDHA)
Migratory necrotizing dermatitis is associated with:
glucagonoma
T/F: Unlike in VIPoma, when you stop eating with ZES, your secretory diarrhea will stop.
True
What is the inheritance pattern of all of the MEN syndromes?
Autosomal dominant
MENI: parathyroid, pancreatic, pituitary tumors
MENIIa: medullary cancer of thyroid, pheo, hyperparathyroidism
MENIIb: medullary cancer of thyroid, pheo, neuromas/Marfanoid
What is the inheritance pattern of hereditary spherocytosis? What is the only treatment?
autosomal dominant; splenectomy
Target cells are indicative of
thalassemia
An anechoic area in hepatic ultrasound is suggestive of
benign liver cysts
T/F: Benign liver cysts and hydatid cysts are more common in the right lobe of the liver.
True
Why might amylase be normal in pancreatitis even if lipase is elevated?
Hyperlipidemia interferes with the chemical determination of amylase
T/F: If a large pseudocyst is present, it might cause anterior displacement of the stomach, transverse colon, or duodenum.
True
Smooth tapering of the CBD on cholangiogram may indicate
pancreatitis or biliary obstruction in pancreatitis
How might chronic pancreatitis lead to jaundice?
1) fibrosis compresses the CBD
2) pseudocysts
3) carcinoma of the head of the pancreas
Why is atelectasis related to pancreatitis?
The pancreas releases a factor that alters pulmonary surfactant
What does a Whipple entail?
pancreaticojejunostomy, gastrojejunostomy, and hepaticojejunostomy; cholecystectomy, and possible bilateral truncal vagotomy (but not if distal stomach and pylorus can be preserved)
When is a stent placed for pancreatic cancer?
Palliative care
A ratio of plasma insulin to glucose of greater than ____ is diagnostic of insulinoma.
> 0.3
T/F: Both CCK and vagal stimulation result in release of fluid with a high concentration of enzymes
True
Secretin causes release of what kind of fluid?
rich in bicarbonate and electrolytes. Released from duodenum and causes fluid release from pancreas and biliary epithelium
CCK is released wehre?
duodenum
Which pancreatic enzymes are released active? For those released as zymogens, where are they activated?
Amylase and lipase are released in their active forms
The zymogens are converted by enterokinase in the duodenum
SRS and endoscopic ultrasound can be used to locate
gastrinomas
Patients with biliary dyskinesia will show a basal sphincter pressure of __________ when evaluated via ERCP
> 40 cm of water
What is the treatment of biliary dyskinesia?
CCBs can be used to try to relax the sphincter of Oddi, but many patients require endoscopic sphincterotomy
How is the sphincter of Oddi released physiologically?
CCK via VIP
T/F: An acute episode of pancreatitis may cause lactescent (milky) serum
True
What is acalculous cholecystitis?
Inflammation of gallbladder secondary to ischemia (following major trauma, etc)
T/F: Alk phos rises before bilirubin in cholestatic jaundice.
True (it also falls before bilirubin once the obstruction is relieved; a rise in alk phos necessitate r/o obstruction)
T/F: Even though urine is darker in obstructive jaundice, it has a lower concentration of urobilin.
True! Bile must reach the intestine for this pigment to form (this is different from darker urine due to dehydration, which concentrates the urobilin).
What are the organisms most commonly involved in ascending cholangitis?
Gram negatives like E coli, Klebsiella, and Proteus
Charcot’s triad vs. Reynold’s pentad:
- fever
- jaundice
- RUQ pain
- altered mental status
- shock
What causes the gallbladder to contract?
CCK
What are Klatskin tumors?
cholangiocarcinomas of the bifurcation prior to CBD; most common cholangiocarcinoma
Intramural gas IN the GALLBLADDER indicates
emphysematous gallbladder, caused by gas-forming organisms; requires lap chole
How is the distended gallbladder seen in acalculous cystitis different from that seen in biliary carcinoma?
acalculous = THICK wall, carcinoma = thin walled
What is the triangle of Calot and which artery courses through it?
Triangle: cystic duct (inferior), common hepatic duct (medial), and liver (superior)
Cystic artery
What is selectively absorbed by the gallbladder mucosa?
sodium chloride and water
Cantile’s line, which divides the left and right liver, passes between the ____ and the ____
IVC and gallbladder
T/F: LFTs are elevated in both focal nodular hyperplasia of the liver and hepatic adenomas.
False! LFTs and AFP are normal
Which is more likely to cause symptoms or to hemorrhage: FNH or hepatic adenomas?
hepatic adenomas
Heterotopic liver transplant requires (high/low) outflow pressure.
Low. More likely to succeed if placed as proximally to heart as possible.
Portal vein thrombosis may occur in what clinical scenarios?
1) cirrhosis
2) OCP use
3) antithrombin III deficiency
4) trauma
Why does an umbilical infection at birth lead to portal vein thrombosis?
Ascending infection up remnant of left hepatic vein in round ligament, which communicates with the left portal vein. Can lead to malformations along the portal vein and UGI bleeding due to esophageal varices (from the portal hypertension due to the thormbosis)
The risk of OPSI (overwhelming post-splenectomy infection) is highest in patietns undergoing splenectomy for
lymphoma or thalassemia (vs ITP or trauma)
What is normal portal venous pressure?
5-10 mm Hg
In hereditary spherocytosis, the RBCs undergo lysis at a (higher/lower) oncotic pressure.
higher (earlier)
What can help distinguish between cholangitis and a liver abscess?
In a liver abscess, the right diaphragm is raised on Xray
What are clues that a liver abscess may be amebic?
1) visit to tropical country
2) abdominal pain or diarrhea
3) rapid response to metronidazole
