Set 5 (10/14)

Question 1

Where are bile acids absorbed?

Answer 1

Terminal Ileum

Question 2

SSx of Obstructive Jaundice

Answer 2

Jaundice (bilirubin >2.5), Dark urine, clay-colored stools (acholic stools), pruritus (d/t bile salts in dermis), loss of appetite, nausea

Question 3

Choledochojejunostomy

Answer 3

anastomosis between common bile duct and jejunum

done to treat major CBD injury after lap chole

Question 4

Labs in Obstructive Jaundice

Answer 4

↑alk phos, ↑bilirubin, +/-↑LFTs

Question 5

Cholelithiasis

Answer 5

most are cholesterol stones (75%); 25% are pigment stones; 80% are aSx

Question 6

Complication of ERCP

Answer 6

Pancreatitis

Question 7

Cholangitis

Answer 7

• 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

Question 8

Sclerosing Cholangitis

Answer 8

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

Question 9

Carcinoma of Gallbladder

Answer 9

• 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

Question 10

Cholangiocarcinoma

Answer 10

• 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

Question 11

Exocrine pancreas hormones

Answer 11

amylase, lipase, trypsin, chymotrypsin, carboxypeptidase

Question 12

Causes of Pancreatitis

Answer 12

I GET SMASHED

Idiopathhic, Gallstones, EtOH, Trauma, Scorpion bite, Mumps, Autoimmune, Steroids, Hyperlipidemia/ Hypercalcemia, ERCP, Drugs

Question 13

Labs for pancreatitis

Answer 13

amlase and lipase (both elevated)

Question 14

Extraintestinal Manifestations of IBD

Answer 14

A PIE SACK

Aphthous ulcers, Pyoderma gangrenosum,Iritis, Erythema nodosum, Sclerosing cholangitis, Arthritis, Ankylosing spondylitis, Clubbing of fingers, Kidney (nephrotic syndrome, amyloid deposits)

Question 15

Most common skin cancers

Answer 15

Basal cell carcinoma (75%), SCC (20%), Melanoma (4%)

Melanoma is most common fatal skin cancer

Question 16

Skin SCC

Answer 16

• Head, neck, hands
• raised slightly pigmented lesions; ulceration/ exudate, chronic scab, itching
• Tx: small (<1cm): excise w/ 5mm margin; large: 10-20mm margin

Question 17

Skin Basal Cell Carcinoma

Answer 17

• sun exposed areas: head, neck, hands
• slow growing, scab, ulceration, “pearl-like”
• Tx: resection w/ 5mm margins

Question 18

Actinic Keratosis

Answer 18

precursor for skin SCC

Question 19

Seborrheic keratosis

Answer 19

benign pigmented lesion; Tx: excision

Question 20

Melanoma

Answer 20

• eyes, skin, anus
  
  • African Americans typically have on palms/ soles
• pigmented lesion w/ irregular ABCDE’s

Question 21

Superficial Spreading Melanoma

Answer 21

most common type; sun and non-sun exposed areas

Question 22

Lentigo Maligna Melanoma

Answer 22

elderly patient w/ superficial malignant cells; least aggressive, good prognosis; on head/ neck

Question 23

Acral Lentiginous Melanoma

Answer 23

palms, soles, subungual areas, mucous membranes

most common melanoma in African Americans

Question 24

Nodular Melanoma

Answer 24

vertical growth predominates; very dark; most aggressive, worst prognosis

Question 25

Melanomin Tumor Marker

Answer 25

S-100

Question 26

Margins in Melanoma

Answer 26

• =<1 mm thick = 1 cm margins
• 1-4 mm thick = 2 cm margins
• 4+ mm thick = 3 cm margins

Question 27

Kehr’s sign

Answer 27

left shoulder psin with splenic rupture