Pancrease/Gallbladder/Liver 1

Question 0

Types of Necrosis in Acute Pancreatitis

Answer 0

Liquifactive
Fat necrosis (saponification)

Question 1

Activation of what enzyme leads to acute pancreatitis?

Answer 1

Trypsin

Question 2

Most common causes of Acute Pancreatitis

Answer 2

Alcohol and Gallstones

Alcohol causes contraction of the sphincter of oddi, causing inhibition of pancreatic drainage.
Gallstones does the same thing.

Question 3

Laboratory elevation in Acute Pancreatitis?

Answer 3

Elevation of serum lipase and amylase.
Hypocalcemia due to saponification using up calcium deposits in the fat.

In chronic pancreatitis, you’re not producing amylase and lipase anymore.

Question 4

Complications of Acute Pancreatitis

Answer 4

Shock
Pancreatic Pseudocyst
Pancreatic abscess
DIC and ARDS

Question 5

Most common cause of Chronic Pancreatitis in adults and children

Answer 5

Adults: Alcohol, and recurrent acute pancreatitis
Children: cystic fibrosis

Question 6

Which vitamins have difficulty being absorbed in Chronic Pancreatitis

Answer 6

A
E
D
K
fat soluble vitamins

Question 7

Findings for pancreatic carcinoma at HEAD of the pancreas

Answer 7

Obstructive Jaundice (causing leakage of conjugated bilirubin into the blood)
Pale stools (because bile is not reaching duodenum, which gives stools its color)
palpable gall bladder

Question 8

A thin elderly person with type 2 diabetes could be indicative of what?

Answer 8

Pancreatic Carcinoma.

Because most type 2 diabetics are middle aged and overweight

Question 9

Tumor marker for pancreatic carcinoma

Answer 9

CA 19-9

Question 10

Treatment for Pancreatic Carcinoma

Answer 10

Whipple Procedure

Head of pancreas
Duodenum
Gall bladder

Question 11

What is cholelithiasis? Two types

Answer 11

Gallbladder stones

Cholesterol
or
Bilirubin

Question 12

Why does Cholestyramine cause cholelithiasis?

Answer 12

Cholestyramine, a lipid lowering agent, binds bile acids and prevents it’s reabsorption in the ilieum. Phospholipids and bile acids help solubilize cholesterol, so it’s lack leads to cholesterol stones.

Question 13

Why are females are higher risk for cholelithiasis?

Answer 13

Estrogen, increase activity of HMGCoA reductase leading to increased cholesterol synthesis.
Also increases lipoprotein receptors on hepatocytes thus increasing cholesterol reuptake.

Question 14

Why does Crohn’s disease increase risk for gall stones?

Answer 14

Bile acid is taken up in the terminal ilium.

Question 15

Why does extravascular hemolysis cause gall stones? What type of gall stones?

Answer 15

Extravascular hemolysis is breakdown of blood by splenic macrophages. Hemoglobin broken down into heme and globin. Heme is broken down into Iron and Protoporforin. Protoporforin is converted into unconjugated bilirubin. Once the liver conjugates it, the extra bilirubin is thrown into bile, causing saturation, and thus risk for BILIRUBIN GALLSTONE.

Question 16

Why does bacterial infection cause gall stones? What type of stones? What type of bacteria?

Answer 16

Bacteria cause deconjugation, leading to precipitation of bilirubin.

E. Coli

Question 17

Acute Cholecystitis is

Answer 17

Inflammation of gall bladder wall due to stone in the cystic duct causing ischemia and bacterial growth

Question 18

Presentation of Cholecystitis

Answer 18

RUQ pain radiating to scapula***
Fever, elevated WBC
Nausea, vomiting
Increased serum Alkaline Phosphatase

Question 19

Chronic Cholecystitis cause

Answer 19

Chemical irritation

Usually from longstanding cholelithiasis

Question 20

What is a porcelain gallbladder?

Answer 20

Calcification from Chronic Cholecystitis

Question 21

Ascending Cholangitis is…

caused by…

Answer 21

Bacterial infection of bile ducts

Enteric gram-negative bacteria

Question 22

Gallbladder carcinoma is what type of cancer?

Risk factor

Answer 22

Adenocarcinoma, from the glandular epithelium of the gallbladder wall

Gall stones (cholecystitis in elderly woman)
Especially with porcelain gallbladder