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GI Clin Med > Pancreas, Biliary Tract, Liver, Appendix, > Flashcards

Pancreas, Biliary Tract, Liver, Appendix, Flashcards

1
Q

Most common abdominal surgical emergency

A

Appendicitis - affects 10% population

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2
Q

Percentage of patients w appendicitis that progress to perforation / peritonitis

A

20%

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3
Q

Pain timeline in appendicitis

A

12 hours - starts periumbilical and/or epigastric and intermittent, moves to Mcburney’s point and becomes constant.
Worse with movement, rebound tenderness.

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4
Q

Patient with a retrocecal appendicitis likely to feel pain

A

On rectal exam

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5
Q

Preferred method to confirm diagnosis of appendicitis

A

Abdominal CT

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6
Q

Most common causes of pancreatitis

A

Cholelithiasis
Alcohol abuse

also 
Hyperlipidemia (hypertriglyceridemia)
Trauma
Drugs
Hypercalcemia 
Penetrating PUD
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7
Q

Grave prognosis of pancreatitis indicated with

A

Shock!

Sever hypovolemia,
ARDS,
Tachy >130bpm

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8
Q

Bruising of the flanks, known as ____ and indicative of ____

A

Grey Turner Sign, hemorrhagic pancreatitis (or other retroperitoneal hemorrhage)

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9
Q

Superficial edema and bruising around the umbilicus is known as ____ and indicative of ____

A

Cullen’s sign, hemorrhagic pancreatitis (severe, acute)

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10
Q

Most sensitive and specific lab for pancreatitis

A

Serum lipase, with elevations of threefold or greater

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11
Q

Ranson Criteria for poor prognosis of pancreatitis

A 
WBC count > 16,000
Glucose > 200mg
LDH > 350
AST >250
Arterial PO2 <60
Calcium Falling
BUN rising
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12
Q

90% of chronic pancreatitis cases in US caused by

A

Alcohol abuse

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13
Q

Classic triad of chronic pancreatitis

A

Pancreatic calcification
Steatorrhea
Diabetes mellitus

(only occurs in 20%)

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14
Q

Clinical feature of chronic pancreatitis that’s different from acute

A

Fat malabsorption and steatorrhea (late in disease)

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15
Q

Diagnosis of chronic pancreatitis

A

Abdominal plain film reveals calcification of 20-30% of pancreas

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16
Q

5th leading cause of cancer death in US

A

pancreatic cancer

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17
Q

Risk factors for pancreatic cancer

A 
increased age
obesity
tobacco
chronic pancreatitis 
previous abdominal radiation
family history
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18
Q

Jaundice and palpable gallbladder (Courvoisier sign) may be seen inpatients with

A

Cancer of the pancreatic hea

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19
Q

palpable gallbladder is known as

A

Courvoisier sign

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20
Q

Treatment for pancreatic cancer

A

Whipple surgery (if no metastases)

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21
Q

Prevalence of gallstones

A

By age 75, 35% of women and 20% of men have gallstones

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22
Q

percentage of ppl with gallstones that develop disease

A

30%

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23
Q

Complications of choledocholithiasis

A

Cholecystitis, pancreatitis, acute cholangitis

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24
Q

cause of acute cholecystitis

A

obstruction of bile duct by gallstone, causing inflammation

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25
Q

What can identify cause, location, and extent of biliary obstruction - event treat

A

ERCP (endoscopic retrograde cholangiopancreatography)

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26
Q

Treatment for cholecystitis

A

Surgical

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27
Q

Potentially deadly condition of common bile duct obstruction combined with ascending infection - can lead to sepsis and death

A

Acute cholangitis

28
Q

Most common cause of infection in acute cholangitis

A

E. coli,

Enterococcus, Klebsiella, Enterobacter

29
Q

Charcot’s triad, indicative of

A

RUQ tenderness, jaundice, fever (present in 50-70%)

Indicative of Acute Cholangitis

30
Q

In addition to Charcot’s triad, acute cholangitis may present with

A

Reynold’s pentad:
altered mental status
hypotension
(plus RUQ tenderness, jaundice, fever)

31
Q

Reynold’s pentad

A

Presentation of acute cholangitis

RUQ tenderness
Jaundice
Fever
Hypotension
Altered mental status
32
Q

Initial test for acute cholangitis

A

RUQ ultrasonography

will show biliary dilation or stones

33
Q

Labs to support diagnosis of cholangitis

A

Leukocytotis w left shift
Increased bilirubin
mildly increased Transaminase

34
Q

Optimal procedure for both diagnosis and treatment of acute cholangitis

A

ERCP

should not be done unless patient is stable, unless urgent decompression is needed

35
Q

Initial medical treatment for acute cholangitis

A

Antibiotics
IV fluids
Analgesics

36
Q

Chronic thickening of bile duct walls of unknown etiology - often associated with inflammatory bowel disease (UC)

A

Primary Sclerosing Cholangitis (PSC)

37
Q

Most common presenting features of PSC

A

Jaundice and pruritis - with fatigue, malaise, weight loss

38
Q

Treatment for PSC

A

Balloon dilation and stent placement for localized strictures

Liver transplant only treatment with a known survival benefit

39
Q

first and second most common causes of hepatitis

A
  1. virus

2. alcohol

40
Q

Lab value which is elevated in all types of acute hepatitis, indicating hepatocellular damage

A

Aminotransferase (AST, ALT)

41
Q

Bilirubin level associated w scleral icterus and/or frank jaundice

42
Q

Hep A incubation period, after which HAV IgM is detectable

A

15-40 days

43
Q

HAV IgG indicates

A

resolved Hep A

44
Q

HBsAg positive, indicates

A

Ongoing infection of any duration (Hep B)

45
Q

anti-HBs indicates

A

Heb B immunity, via vaccination or past infection

46
Q

anti-HBc indicates

A

Acute hepatitis - present between disappearance of HBsAg and appearance of anti-HBs

47
Q

HBeAg indicates

A

Active infection, highly contagious

48
Q

anti-HBe

A

Indicates lower viral titer

49
Q

Indications of late stage cirrhosis

A 
Ascites
Pleural effusion
Ecchymoses
Esophageal varices
Hepatic encephalopathy
50
Q

Asterixis, tremor, dysarthria, delirium, eventually coma

A

hepatic encephalopathy

51
Q

Patient with advanced cirrhosis presents with Fever, chills, worsening ascites, abdominal pain. May lead to diarrhea and renal failure

A

Spontaneous bacterial peritonitis

52
Q

A significant complicating feature of decompensated cirrhosis and is responsible for the development of ascites and bleeding from esophagogastric varices

A

Portal hypertension

53
Q

two complications that signify decompensated cirrhosis

A

Ascites and esophageal varices

54
Q

liver biopsy in alcoholic cirrhosis

A

Liver biopsy can be helpful to confirm a diagnosis, but generally when patients present with alcoholic hepatitis and are still drinking, liver biopsy is withheld until abstinence has been maintained for at least 6 months to determine residual, nonreversible disease.

55
Q

inherited disorder of iron metabolism that results in a progressive increase in hepatic iron deposition, which, over time, can lead to a portal-based fibrosis progressing to cirrhosis, liver failure, and hepatocellular cancer.

A

Hemochromatosis

56
Q

Diagnosis and treatment of Hemochromatosis

A

Diagnosis is made with serum iron studies showing an elevated transferrin saturation and an elevated ferritin level, along with abnormalities identified by HFE mutation analysis.

Treatment is straightforward, with regular therapeutic phlebotomy.

57
Q

inherited disorder of copper homeostasis with failure to excrete excess amounts of copper, leading to an accumulation in the liver. Wilson’s disease typically affects adolescents and young adults.

A

Wilson’s disease

58
Q

Diagnosis and treatment of Wilson’s disease

A

Diagnosis requires determination of ceruloplasmin levels, which are low; 24-h urine copper levels, which are elevated; typical physical examination findings, including Kayser-Fleischer corneal rings; and characteristic liver biopsy findings.

Treatment consists of copper-chelating medications.

59
Q

inherited disorder that causes abnormal folding of the α1AT protein, resulting in failure of secretion of that protein from the liver. Patients are at greatest risk for developing chronic liver disease have the ZZ phenotype, but only about 10–20% of such individuals will develop chronic liver disease.

A

Alpha 1 antitrypsin deficiency

60
Q

Diagnosis and treatment of alpha 1 antitrypsin deficiency

A

Diagnosis is made by determining α1AT levels and phenotype. Characteristic periodic acid–Schiff (PAS)-positive, diastase-resistant globules are seen on liver biopsy.

The only effective treatment is liver transplantation, which is curative.

61
Q

Prehepatic causes of portal hypertension

A

Splenic vein thrombosis

Portal vein thrombosis

62
Q

Post hepatic causes of portal hypertension

A

Affects hepatic veins and venous drainage to heart

Budd Chiari syndrome
Venocclusive disease
Chronic right heart congestive failure

63
Q

Intrahepatic causes of portal hypertension

A

account for 95% of portal hypertension

Cirrhosis

presinusoidal, sinusoidal, and postsinusoidal causes. Postsinusoidal causes include venoocclusive disease, whereas presinusoidal causes include congenital hepatic fibrosis and schistosomiasis. Sinusoidal causes are related to cirrhosis from various causes.

64
Q

The three primary complications of portal hypertension

A

gastroesophageal varices with hemorrhage,
ascites
hypersplenism

65
Q

Benign liver neoplasms

A

Cavernous hemangioma
Hepatocellular adenoma
Infantile hemangioendothelioma

66
Q

Cancers that commonly metastasize to liver

A

Lung

Breast

GI Clin Med (3 decks)

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