Diseases Of The Biliary Tree And Pancreas

Question 1

Cholecystitis definition

Answer 1

inflammation of the gallbladder, usually associated with gallstones

Question 2

cholangitis definition

Answer 2

acute bacterial infection of biliary tree ususally secondary to obstruction by stones that leads to inflammation of bile ducts

Question 3

Cholelithiasis defined

Answer 3

abnormal presence of stones in the gallbladder

Question 4

Choledocholithiasis defined

Answer 4

gallstones lodged in the common bile duct

Question 5

what is biliary pancreatitits?

Answer 5

gallstone lodged in the pancreatic duct

Question 6

What population commonly gets cholecystitis?

Answer 6

Female
Fat
Fertile
Forties

Question 7

Gold standard for detecting cholecystitis

Answer 7

ultrasound shows fluid, inflammation, acoustic shadows, positive murphys sign

Question 8

When should you do a HIDA scan?

Answer 8

done when US is inconclusive and evaluates GB function as radio-nucleotides are taken up by hepatocytes but there is no filling of GB with radioactive bile

Question 9

80% of patients with cholelithiasis present as

Answer 9

asymptomatic

Question 10

most common type of gallstone

Answer 10

cholesterol stones (too much cholesterol, not enough bile salts)

Question 11

What is on your differential diagnosis for GB pain?

Answer 11

angina
pneumonia
kidney stone
peptic ulcers
esophagitis
spasm
gastric cancer
aneurysm
intestinal ischemia
obstruction

Question 12

Clinical presentation of choledocholithiasis

Answer 12

jaunice
liver damage
negative murphys sign

Question 13

Lab values in choledocholithiasis

Answer 13

early increase in AST/ALT

then alk phos, t. bili, and d. bili will elevate

Question 14

If the ampulla of vater is blocked by a gallstone, what will your lab values look like?

Answer 14

elevated amylase and lipase

Question 15

Choledocholithiasis treatment

Answer 15

ERCP for obstruction

cholecystectomy to precent future issue

Question 16

chronic obstruction lab values

Answer 16

high alk phos

ast and alt will taper off

Question 17

What are 3 common causes of cholangitis?

Answer 17

gram negative enteric bugs:
e coli
enterobacter
psuedomonas

Question 18

Charcot’s Triad

Answer 18

for cholangitis

1. RUQ pain
2. jaundice
3. fever and chills

Question 19

Reynold’s pentad

Answer 19

for cholangitis
1. RUQ pain, 2. jaundice, 3. fever chills from before
ADD
4. shock
5. altered mental status

Question 20

Lab values in cholangitis

Answer 20

leukocytosis

LFTs: high bilirubin and alk phos

Question 21

Cholangitis treatment

Answer 21

ICU admission w broad spectrum abx
ERCP for obstruction
cholecystectomy

Question 22

How do you decompress the biliary tree?

Answer 22

stent placement

Question 23

Risk factors for pancreatic cancer

Answer 23

Diet: animal fat, nitrosamines
Cigarettes
Hereditary
Peutz-Jeghers
chronic pancreatitis
DM

Question 24

most common location for pancreatic cancer

Answer 24

head of the pancreas, adenocarcinoma

Question 25

Clinical presentation of head of pancreas cancer

Answer 25

jaundice, gastric outlet obstruction

Question 26

What is a Virchow's node?

Answer 26

left supraclavicular

Question 27

what is a trousseau's sign?

Answer 27

migratory thrombophlebitis

Question 28

Courvoiser's Law

Answer 28

jaundice + palpable GB = CANCER, not stone

Question 29

What are indications for whipple or distal pancreatectomy?

Answer 29

small, no mets, no vessels

Question 30

Common causes of ACUTE pancreatitis

Answer 30

alcohol, gallstones, idiopathic, trauma

Question 31

Common causes of CHRONIC pancreatitis

Answer 31

``` alcohol #1 Cystic fibrosis altered enzyme activitiy (trypsinogen) metabolic (high TG) cigarettes ```

Question 32

Pathophysiology of acute pancreatitis

Answer 32

insult to pancreas leads to zymogen activation, generation of inflammatory mediators, and ischemia. so you get a systemic inflammatory response that can lead to multi organ failure necrosis and apoptosis

Question 33

An increase in what lab value is the best mortality predictor in acute pancreatitis?

Answer 33

BUN

Question 34

Common lab findings in diagnosing acute pancreatitis

Answer 34

``` elevated lipase (3x) and amylase, low Ca2+ high pancreatic specific amylase ```

Question 35

pancreatic spot on CT not taking up contrast is bad, this indicates

Answer 35

necrosis

Question 36

What is the prognostic indication criteria for pancreatitis called?

Answer 36

Ranson's

Question 37

Treatment for acute pancreatitis

Answer 37

``` supportive care (fluid recusitation, monitor vitals, urine output, BUN, Cr, HCT, LFTs, CRP) meperidine for pain abx to prevent cholangitis ***urgent ERCP if there is a stone ONLY nutrition (TPN until safe to eat) ```

Question 38

Why is enteral feeding used in pancreatitis?

Answer 38

we get less pancreatic stimulation less chance of infection shorter hospital stays

Question 39

In the ER, what is the most important thing you can do for a patient presenting with acute pancreatitis?

Answer 39

early fluid recusitation

Question 40

epigastric pain, radiating to the back combined with steatorrhea--- what is this?

Answer 40

chronic pancreatitis

Question 41

why is there steatorrhea in chronic pancreatitis?

Answer 41

absence of lipase

Question 42

The chain of lakes on CT scan is indicative of what?

Answer 42

pancreatitis calcification (chronic)

Question 43

Patient presents with colicky RUQ pain, radiating to shoulder worse will ingestion of fatty foods

Answer 43

cholelithiasis

Question 44

When is cholecystostomy used?

Answer 44

when patient is not surgical candidate OR used in meantime to drain fluid and decrease GB inflammation while waiting for surgery to be done

Question 45

Choledocholithiasis is commonly paired with what two diseases?

Answer 45

pancreatitis | hepatitis

Question 46

Abx regemin for GB diseases

Answer 46

cipro + MTZ | amp-genta + MTZ

Question 47

ERCP should only be done when gallstones ARE suspected due to this complication

Answer 47

pancreatitis

Question 48

US and MRCP are not good for diagnosing pancreatitis but they are good for determining which etiologies?

Answer 48

ES- stones | MRCP- stricture, malignancy

Question 49

Late complications of pancreatitis

Answer 49

abscess - drain it | pseudocyst- watch wait, drain, bx for cancer

Question 50

what causes biliary colic?

Answer 50

CCK after eating fatty meal triggers gallbladder contraction and pushes stone into cystic duct

Question 51

tell me about carcinoid tumors

Answer 51

they produce serotonin and substance P from enterochromaffin cells

Question 52

cutaneous flushing and R heart valve lesions are in the clinical presentation of

Answer 52

carcinoid tumors

Question 53

Urein 5-HIAA detects

Answer 53

serotonin metabolite for carcinoid tumors

Question 54

Carcinoid tumor treatment

Answer 54

remove tumor and give octerotide