Random Facts Flashcards
What metabolic abnormality is a secondary cause of acute pancreatitis?
Hyperlipidemia
Proposed mechanism: high free fatty acids leads to premature activation of trypsinogen
What is the most common pancreatic malignancy?
Pancreatic adenocarcinoma
= tumor of gland-forming (exocrine) tissue
-60% of cases (most frequently) in the HOP
Most common endocrine neoplasm
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
Describe the sequence of colorectal adenocarcinoma development (Vogelgram)
Normal –> (mutation in APC) –> Early adenoma –> (mutation in KRAS) –> Late adenoma –> (mutation in p53) –> Adenocarcinoma
Staging for Cancer
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
What is iron deficiency in and older man automatically suggest?
Iron deficiency in older man = GI cancer until proven otherwise
What is the most important determinant of crystal formation in bile?
Cholesterol saturation
Most common GI reason for hospitalization in the US
gallstone disease
Gallstone disease more common in which gender?
2x more common in female
Distinguish black and brown pigment bile stones
-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
What type of gall stones are closely associated w/ infection?
Brown pigment stones
-always associated w/ colonization of bile by enteric organisms or ascending cholangitis
When is gallbladder removal suggested w/ gallstone disease?
When it’s symptomatic- b/c that is when it’s aggressive and will be recurrent
Acute cholecystitis
= infection of the gall bladder
=> leukocytosis
-50% of cases resolve spontaneously
What are the lab findings in most ppl w/ biliary pain?
usually normal lab findings
Choledocholithiasis
= stones in the common bile duct
-elevated bilirubin and alk phos
Cholangitis
= infection of the biliary tract
- leukocytosis
- alkphos elevation
- medical emergency
Differentiate cholecystitis and cholangitis
Cholecystitis = infection of gall bladder
Cholangitis = infection of the biliary tract
What is the best test for stones in the gallbladder
Ultrasound
What is the best diagnostic test for choledocholithiasis?
Endoscopic ultrasound is the best way to see if there are gall stones in the common bile duct
What is MRCP useful for?
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
Describe the details of an ERCP?
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)
Distinguish treatment for stone in the gall bladder vs. stone in the bile duct
-only intervene on both if symptomatic
stone in gall bladder => surgery (cholecystectomy)
stone in bile duct => endoscopy (ERCP)
Treatment for acute cholecystitis
-cholecystecomy
Treatment for cholangitis
emergency ERCP
What is emphysematous cholecystitis?
Infection of the gall-bladder w/ gas-forming organisms
Treatment of choledochal cysts
Surgical excision most of the time
-may require liver transplant for the 20% of choledochal cysts that are intrahepatic
What diagnosis has a typical “onion skin” appearance on histology?
PSC = primary sclerosing cholangitis
- destruction of both intra and extra-hepatic ducts
- beaded appearance of stricture and proximal dilation
If a ulcerative cholitis pt has elevated alkphos, what do you want to think about?
PSC
- 80% of pts w/ PSC develop IBD (particularly UC)
- about 4% of IBDs develop PSC
What is cholangiocarcinoma?
Cancer arising from the epithelial cells of the intra- or extra-hepatic bile ducts
-rapid clinical deterioration
What type of cancers are the majority of cholangiocarcinomas?
90% are adenocarcinomas- mostly nodular
