Random Facts

Question 1

What metabolic abnormality is a secondary cause of acute pancreatitis?

Answer 1

Hyperlipidemia

Proposed mechanism: high free fatty acids leads to premature activation of trypsinogen

Question 2

What is the most common pancreatic malignancy?

Answer 2

Pancreatic adenocarcinoma

= tumor of gland-forming (exocrine) tissue
-60% of cases (most frequently) in the HOP

Question 3

Most common endocrine neoplasm

Answer 3

Insulinoma is the most common islet cell tumor
-pts present w/ hypoglycemia corrected w/ PO glucose

-but endocrine tumors account for only 2% of pancreatic malignancies

Question 4

Describe the sequence of colorectal adenocarcinoma development (Vogelgram)

Answer 4

Normal –> (mutation in APC) –> Early adenoma –> (mutation in KRAS) –> Late adenoma –> (mutation in p53) –> Adenocarcinoma

Question 5

Staging for Cancer

Answer 5

Stage 0: hasn't penetrated mucosa
Stage I: in the muscularis
Stage II: penetrated the muscularis
Stage III: lymph node involvement
Stage IV: distant metastasis

Question 6

What is iron deficiency in and older man automatically suggest?

Answer 6

Iron deficiency in older man = GI cancer until proven otherwise

Question 7

What is the most important determinant of crystal formation in bile?

Answer 7

Cholesterol saturation

Question 8

Most common GI reason for hospitalization in the US

Answer 8

gallstone disease

Question 9

Gallstone disease more common in which gender?

Answer 9

2x more common in female

Question 10

Distinguish black and brown pigment bile stones

Answer 10

-both uncommon (cholesterol is the common one), black more common than born

• black: pure calcium bilirubinate
• brown: calcium salts of unconjugated bilirubin
• black: cirrhosis and chronic hemolytic states
• brown: think infection

Question 11

What type of gall stones are closely associated w/ infection?

Answer 11

Brown pigment stones

-always associated w/ colonization of bile by enteric organisms or ascending cholangitis

Question 12

When is gallbladder removal suggested w/ gallstone disease?

Answer 12

When it’s symptomatic- b/c that is when it’s aggressive and will be recurrent

Question 13

Acute cholecystitis

Answer 13

= infection of the gall bladder

=> leukocytosis
-50% of cases resolve spontaneously

Question 14

What are the lab findings in most ppl w/ biliary pain?

Answer 14

usually normal lab findings

Question 15

Choledocholithiasis

Answer 15

= stones in the common bile duct

-elevated bilirubin and alk phos

Question 16

Cholangitis

Answer 16

= infection of the biliary tract

• leukocytosis
• alkphos elevation
• medical emergency

Question 17

Differentiate cholecystitis and cholangitis

Answer 17

Cholecystitis = infection of gall bladder

Cholangitis = infection of the biliary tract

Question 18

What is the best test for stones in the gallbladder

Answer 18

Ultrasound

Question 19

What is the best diagnostic test for choledocholithiasis?

Answer 19

Endoscopic ultrasound is the best way to see if there are gall stones in the common bile duct

Question 20

What is MRCP useful for?

Answer 20

noninvasive look at the pancreatic and bile ducts

-now can use the more risky ERCP just for treatment (remove stones from bile duct) b/c MRCP can be used for diagnosis

Question 21

Describe the details of an ERCP?

Answer 21

Endoscopy down to the duodenum then make a 90 degree turn to pass wire into the biliary tree or pancreatic duct (thru the ampulla of vater)

Question 22

Distinguish treatment for stone in the gall bladder vs. stone in the bile duct

Answer 22

-only intervene on both if symptomatic

stone in gall bladder => surgery (cholecystectomy)

stone in bile duct => endoscopy (ERCP)

Question 23

Treatment for acute cholecystitis

Answer 23

-cholecystecomy

Question 24

Treatment for cholangitis

Answer 24

emergency ERCP

Question 25

What is emphysematous cholecystitis?

Answer 25

Infection of the gall-bladder w/ gas-forming organisms

Question 26

Treatment of choledochal cysts

Answer 26

Surgical excision most of the time

-may require liver transplant for the 20% of choledochal cysts that are intrahepatic

Question 27

What diagnosis has a typical “onion skin” appearance on histology?

Answer 27

PSC = primary sclerosing cholangitis

• destruction of both intra and extra-hepatic ducts
• beaded appearance of stricture and proximal dilation

Question 28

If a ulcerative cholitis pt has elevated alkphos, what do you want to think about?

Answer 28

PSC

• 80% of pts w/ PSC develop IBD (particularly UC)
• about 4% of IBDs develop PSC

Question 29

What is cholangiocarcinoma?

Answer 29

Cancer arising from the epithelial cells of the intra- or extra-hepatic bile ducts

-rapid clinical deterioration

Question 30

What type of cancers are the majority of cholangiocarcinomas?

Answer 30

90% are adenocarcinomas- mostly nodular