Small group GB + Panc

Question 1

Lipase

Answer 1

made by pancreas

• high sensitivity and specificity for acute pancreatitis
• rises within 4-8 hours
• elevated for 8-14 days

Question 2

Amylase

Answer 2

also made in pancreas (lipase), but also in small bowel and salivary glands

• lower sensitivity
• rises 6-24 hours/elevated for 3-7 days

Question 3

Why would you have reduced vitamin K in chronic pancreatitis?

Answer 3

Fat soluble vitamins like vit K are poorly absorbed bc they have greater affinity for non-absorbed fat in intestinal lumen than for their muscosal receptors leading to steatorrhea

Question 4

Salt and pepper chromatin patter and moderate amt of cytoplasm surrounded by fibrovascular core

Answer 4

Neuroendocrine neoplasm

Question 5

painless jaundice

Answer 5

very concerning for pancreatic neoplasm

Question 6

Advantages of EUS guided FNA

Answer 6

less invasive

• pot dx, lower incidence of bleeding
• lower risk of seeding cancer cells than w/ percutaneous biopsy
• more effective staging of cancer

Question 7

Ca19-9

Answer 7

can be associated with pancreatic carcinoma tumor marker (if combined with other findings)

Question 8

acute bacterial cholangitis

- presentation

Answer 8

charcots triad

• pain
• jaundic
• fever

PLus

• hypotension
• altered mental status

Question 9

Which type of gallstones are visible by x ray?

Answer 9

Pigment stones (50-75%)

Cholesterol (20%)

Question 10

AST can indicate what in:
Skeletal muscle -
Cardiac muscle -
RBCs -

Answer 10

Skeletal muscle - rhabdomyolysis
Cardiac muscle - MI
RBCs - Hemolysis

Question 11

Alk phos can indicate what in
Bone -
PLacenta -
Intestine -

Answer 11

Bone - metastatic dis, fracture
PLacenta - pregnancy
Intestine - bowel perforation

Question 12

abnormalities assoc with prolonged PTT or INR

Answer 12

Malabsorption: no correction with subcut. vit K

Synthetic dysfxn:
correction with subcu vit K

Question 13

Cholestatic patttern of injury shows elevation of what levels?

Answer 13

Alk phos

hepatocellular injury or necrosis is predom AST & ALT elevation

Question 14

Which Hep is assoc. with shellfish?

Answer 14

Hep A

Question 15

ground glass

Answer 15

suggestive of HBV surface antigen storage.

Question 16

AST>ALT (ratio 2)

Elevated GGT

Answer 16

likely alcohol use causing liver injury

Question 17

Mallory bodies

Answer 17

aggregates of keratin

strongly associated with Alcoholic liver disease
- steatohepatitis

Question 18

fatigue
pruritus
scleral icterus
RA

Answer 18

Primary biliary cirrhosis

• AMA strongly suggestive of PBC

Question 19

tx and test for PBC

Answer 19

Ursodiol, liver transplant

AMA +

Question 20

onion skin fibrosis

Answer 20

PSC

• scant inflammatory cells
• no granulomas/duct lesions

Question 21

PSC or PBC assoc with IBD?

Answer 21

Primary sclerosing cholangitis:

PSC - associated with IBD - UC

Question 22

do more pts with UC get PSC or more pts with PSC have UC?

Answer 22

70-80% of PSC pts have or develop UC

Question 23

Benign neoplasm +
Malignant neoplasm assoc w/
- Hepatocyte

Answer 23

Benign: Focal nodular hyperplasia adenoma

Malignant: Hepatocellular Carcinoma

(adenoma benign, carcinoma not)

Question 24

Benign neoplasm +
Malignant neoplasm assoc w/
- Biliary Duct epithelial cell

Answer 24

Benign:
- Bile duct adenoma

Malignant
- Cholangiocarcinoma

(Adenoma benign, carcinoma not)

Question 25

Benign neoplasm +

Malignant neoplasm assoc w/

Answer 25

Benign:
Hemangioma

Malignant:
Angiosarcoma,
Kaposi sarcoma

Question 26

SAAG

Answer 26

serum albumin - ascites albumin