Set 5 (10/14) Flashcards
Where are bile acids absorbed?
Terminal Ileum
SSx of Obstructive Jaundice
Jaundice (bilirubin >2.5), Dark urine, clay-colored stools (acholic stools), pruritus (d/t bile salts in dermis), loss of appetite, nausea
Choledochojejunostomy
anastomosis between common bile duct and jejunum
done to treat major CBD injury after lap chole
Labs in Obstructive Jaundice
↑alk phos, ↑bilirubin, +/-↑LFTs
Cholelithiasis
most are cholesterol stones (75%); 25% are pigment stones; 80% are aSx
Complication of ERCP
Pancreatitis
Cholangitis
- infection of gallbladder
- Causes: choledocholithiasis, stricture, neoplasm, ERCP, biliary stent
- Charcot’s Triad/ Reynold’s Pentad
- Organisms: Gram (-)(E Coli, Klebsiella, enterobacter, proteus, serratia)
- Tx: IVF + Abx +/- decompression (yes if suppurative) via ERCP
Sclerosing Cholangitis
multiple inflammatry fibrous thickenings of bile duct walls → biliary strictures
10% will develop cholangiocarcinoma
Ulcerative Colitis is risk factor
Sx of obstructive jaundice
ERCP reveals beads on string appearance
Carcinoma of Gallbladder
- adenocarcinoma
- Risks: gallstones, porcelain gallbladder, cholecystenteric fistula
- Sx: biliary colic, weight loss, anorexia, aSx until late, jaundice, RUQ mass
- Tx: cholecystectomy +/- wedge resection of overlying liver if spread to serosa +/- chemo
- Prognosis: <5% survive 5 years
Cholangiocarcinoma
- primary bile duct cancer; adenocarcinoma
- most common in proximal bile duct
- Risks: choledocholithiasis, UC, Thorotrast contrast (used in 1950s), sclerosing cholangitis, liver flukes, toxins (Agent Orange)
- Dx: US, CT, ERCP, MRCP (MRI), biopsy
- Tx: resection w/ Roux-en-Y hepaticojejunostomy if proximal; Whipple if distal
Exocrine pancreas hormones
amylase, lipase, trypsin, chymotrypsin, carboxypeptidase
Causes of Pancreatitis
I GET SMASHED
Idiopathhic, Gallstones, EtOH, Trauma, Scorpion bite, Mumps, Autoimmune, Steroids, Hyperlipidemia/ Hypercalcemia, ERCP, Drugs
Labs for pancreatitis
amlase and lipase (both elevated)
Extraintestinal Manifestations of IBD
A PIE SACK
Aphthous ulcers, Pyoderma gangrenosum,Iritis, Erythema nodosum, Sclerosing cholangitis, Arthritis, Ankylosing spondylitis, Clubbing of fingers, Kidney (nephrotic syndrome, amyloid deposits)
Most common skin cancers
Basal cell carcinoma (75%), SCC (20%), Melanoma (4%)
Melanoma is most common fatal skin cancer
Skin SCC
- Head, neck, hands
- raised slightly pigmented lesions; ulceration/ exudate, chronic scab, itching
- Tx: small (<1cm): excise w/ 5mm margin; large: 10-20mm margin
Skin Basal Cell Carcinoma
- sun exposed areas: head, neck, hands
- slow growing, scab, ulceration, “pearl-like”
- Tx: resection w/ 5mm margins
Actinic Keratosis
precursor for skin SCC
Seborrheic keratosis
benign pigmented lesion; Tx: excision
Melanoma
- eyes, skin, anus
- African Americans typically have on palms/ soles
- pigmented lesion w/ irregular ABCDE’s
Superficial Spreading Melanoma
most common type; sun and non-sun exposed areas
Lentigo Maligna Melanoma
elderly patient w/ superficial malignant cells; least aggressive, good prognosis; on head/ neck
Acral Lentiginous Melanoma
palms, soles, subungual areas, mucous membranes
most common melanoma in African Americans
Nodular Melanoma
vertical growth predominates; very dark; most aggressive, worst prognosis
Melanomin Tumor Marker
S-100
Margins in Melanoma
- =<1 mm thick = 1 cm margins
- 1-4 mm thick = 2 cm margins
- 4+ mm thick = 3 cm margins
Kehr’s sign
left shoulder psin with splenic rupture
