Pancreatic and billiary disease

Question 1

Ranson criteria for acute pancreatitis

Answer 1

On admission within 48 hours
Age>55 years Hematocrit decrease=10%
WBC>16000 BUN increase=5
Glucose >200mg/dL Calcium <8
Lactate dehydrogenase Po2<60 mmHg
>350 U/L Base deficit>4mEq/L
Aspartate aminotransferase Fluid deficit>6L
>250 U/L

3 or more criteria indicate severe diease

Question 2

Antibiotics for necrotizing pancreatitis with sepsis

Answer 2

imipenem and meropenem

Question 3

Complications of chronic pancreatitis

Answer 3

abdominal pain
Pancreatic insufficiency
Pseudocyst
ascites
Billiary obstruction

Question 4

Diagnostic test for pancreatic cancer

Answer 4

CT scan

Question 5

risk factors for cholethiasis

Answer 5

Genetic predisposition (pima indians, other native americans, mexican americans, scandinavians), Older age (>50 years), Obesity, pregnancy, Medications(e.g. oral contraceptives, octreotide, ceftriaxone), Prolonged total parenteral nutrition, Rapid weight loss, diseases of terminal ileum causing decreased reabsorption of bile acids

Question 6

Complications of cholecystitis

Answer 6

Gangrenous cholecystitis, emphysematous cholecystitis,perforation, gallstone ilieus

Question 7

Organisms in acute cholecystitis and acute cholangitis

Answer 7

E.Coli, Klebsiella spp.. Group D streptococcus, staphylococcus, Clostridium spp.

Question 8

Asymptomatic+incidental finding of gallstone disease treatment

Answer 8

Cholecystectomy in patients with sickle cell disease, in Native americans, or if calcified gall bladder

Question 9

Treatment of Acute cholecystitis

Answer 9

Hospitalization, hydration, antibiotics, early cholecystectomy

Question 10

HIDA scan on acute cholecystitis

Answer 10

no uptake in gall bladder

Question 11

treatment of cholangitis

Answer 11

Urgent ERCP with billiary sphincterotomy and stent placement

Percutaneous radiologic drainage or surgery necessary if ERCP unsuccessful

Question 12

Risk factors for cholangiocarcinoma

Answer 12

Primary sclerosing cholangitis
chronic parasitic infection of billiary tree with clonorchis sinensis, opisthorchis spp., Ascaris and other parasites
exposure to thorium dioxide
choledochal cysts
oriental cholangiohepatitis
multiple nopolyposis papillomatosis
HNPCC(lynch syndrome)
increasing age, male gender

Question 13

predisposing factors for gall bladder cancer

Answer 13

Female, obese, cholelithiasis, older age, gall bladder adenomas/polyps, chronic cholecystitis(e.g. large gallstones), chronic salmonella typhi infection, calcified gall bladder, carcinogenic occupational chemical exposures

Question 14

acute pancreatitis

Answer 14

as evidenced by his symptoms and elevated amylase and lipase. Cytomegalovirus is the most commonly reported viral infection that can involve the pancreas. HIV and many AIDS-related infections can affect the pancreas (e.g., Cryptococcus, Mycobacterium tuberculosis, Candida, and Toxoplasma gondii). Numerous medications may also cause acute pancreatitis (e.g., ddI, pentamidine, trimethoprim-sulfamethoxazole, and metronidazole).