Emma Holliday COPY Flashcards
(160 cards)
1
Q
What are possible causes of an anion gap metabolic acidosis?
A
MUDPILES
- methanol
- uremia
- DKA
- paraldehyde
- iron, isoniazid
- lactic acidosis
- ethylene glycol
- salicylates
2
Q
What are possible causes of a non-gap metabolic acidosis?
A
- diarrhea
- diuretics
- RTAs
3
Q
How are metabolic alkaloses differentiated?
A
based on urine chloride
- less than 20: vomiting/NG tube, antacids, diuretics
- more than 20: Conn’s, Bartter’s, Gittleman’s
4
Q
What are the first two things to check in a patient with hyponatremia?
A
- check the plasma osmolality
- then check the patient’s volume status
5
Q
What are potential causes of the following types of hyponatremia:
- hypervolemic
- normovolemic
- hypovolemic
A
- hypervolemic: CHF, nephrotic syndrome, cirrhosis
- normovolemic: SIADH, Addison’s, hypothyroidism
- hypovolemic: diuretics, vomiting
6
Q
How is hyponatremia treated?
A
- normally, fluid restriction plus diuretics
- use normal saline if hypovolemic
- use 3% saline if symptomatic (namely seizures) or have a sodium less than 110
7
Q
What is an appropriate rate for correcting hyponatremia? What is the risk associated with correcting hyponatremia too quickly?
A
- 0.5-1.0 mEq per hour
- central pontine myelinolysis
8
Q
How is hypernatremia treated?
A
replace lost fluid with D5W or another hypotonic fluid
9
Q
What is the risk associated with correcting hypernatremia too quickly?
A
cerebral edema
10
Q
What are the symptoms of hypocalcemia and hypercalcemia?
A
- hypocalcemia: numbness, chvostek sign, Troussaeu sign, prolonged QT interval
- hypercalcemia: bones, stones, groans, psych overtones, and shortened QT syndrome
11
Q
What are the symptoms of hypokalemia and hyperkalemia?
A
- hypokalemia: paralysis, ileum, ST depression, U waves
- hyperkalemia: peaked T waves, prolonged PR and QRS, sine waves
12
Q
What are the clinical features of hyperkalemia and how is it treated?
A
- presents with ECG changes including peaked T waves, prolonged PR and QRS, and sine waves
- treat with calcium gluconate first, then insulin and glucose
- can use kayexalate, albuterol, and sodium bicarb as well
- dialysis is a last resort
13
Q
What is the preferred maintenance fluid?
A
D5 in half NS with 20 KCl (if peeing)
14
Q
What are three risks associated with the use of TPN?
A
- calculus cholecystitis
- liver dysfunction
- hyperglycemia, zinc deficiency, and other lyte problems
15
Q
What is the appropriate treatment for a circumferential burn? Why?
A
an escharotomy because we are worried about compartment syndrome
16
Q
What is the feared complication of smoke inhalation?
A
laryngeal edema compromising the airway
17
Q
Describe the presentation of carbon monoxide poisoning?
A
- altered mental status
- headache
- cherry read skin
- history of exposure
18
Q
Describe the presentation, diagnosis, and treatment of carbon monoxide poisoning.
A
- presents with a history of exposure, altered mental status, headache, and cherry red skin
- diagnose with a carboxyhemoglobin test (remember that pulse ox is worthless)
- 100% oxygen or hyperbaric oxygen if carboxyhemoglobin is severely elevated
19
Q
Why is SaO2 a poor test of someone suspected of having carbon monoxide poisoning?
A
because CO actually causes a leftward shift of the oxygen dissociation curve
20
Q
What would a the most likely cause of a clotting disorder in the following populations:
- the elderly
- those with edema, hypertension, and foamy urine
- a young person with family history
- unresponsive to heparin
- young woman with history of multiple spontaneous abortions
- post operatively with thrombocytopenia
A
- elderly: think malignancy
- edema, HTN, foamy urine: nephrotic syndrome
- young with FH: factor V leiden mutation
- unresponsive to heparin: antithrombin III deficiency
- young with multiple spontaneous abortions: lupus anticoagulant
- post-op with thrombocytopenia: HIT
21
Q
What is unique about the presentation and treatment of antithrombin III deficiency?
A
these patients are unresponsive to heparin
22
Q
Describe the lab findings suggestive of vWD.
A
- normal platelet count
- prolonged bleeding time and PTT
23
Q
What is the rule for fluid resuscitation of burn victims?
A
- for adults, give kg x %BSA x 3-4 of LR or NS
- for kids give kg x %BSA x 2-4 of LR or NS
- give half over the first eight hours and the rest over the subsequent sixteen hours
24
Q
What is unique about the antibiotics given to burn victims?
A
we avoid PO and IV antibiotics because it breeds resistance and instead we use topical antibiotics (silver sulfadiazine, mafenide, silver nitrate)
25
What are and what is unique about the three major topical antibiotics given to burn victims?
- silver sulfadiazine: doesn't penetrate eschars well and can cause leukopenia
- mafenide: will penetrate eschars but is severely painful
- silver nitrate: doesn't penetrate eschars and causes hypokalemia and hyponatremia
26
If you suffer a chemical burn, what is the best next step?
irrigate for at least thirty minutes
27
If you suffer an electrical burn, what is the best next step? What about after that?
get an ECG, if abnormal these patients need at least 48 hours of telemetry
28
If you suffer an electrical burn and have an abnormal ECG, what is the best next step?
48 hours of telemetry
29
If a patient's urine dipstick is positive for blood but is negative RBCs, this is indicative of what disease? What are the feared complications of this?
rhabdomyolysis, which is likely to cause ATN and hyperkalemia
30
What are two important complications of rhabdomyolysis?
- ATN
| - hyperkalemia
31
What are the criteria for compartment syndrome?
- the five P's: pain, pallor, paresthesia, pulselessness, paralysis
- or a compartment pressure greater than 30 mmHg
32
What level of consciousness warrants intubation in a trauma patient?
if they come in unconscious or have a GCS less than 8
33
If a patient sustains trauma to the neck and you hear subcutaneous emphysema when palpating the neck, what should be your first step?
intubate using a fiberoptic bronchoscope because you may have a laryngeal injury
34
What should be the first step if a trauma patient comes in with a GCS of 7 after sustaining a severe facial injury?
perform a cricothyroidotomy in any circumstance where ET tube placement may be difficult
35
A widened mediastinum in a trauma patient is likely indicative of what?
a great vessel injury
36
Which patients with a hemothorax warrant thoracotomy?
- greater than 1500cc upon placement of a chest tube
| - greater than 200cc/hr over the first 4 hours
37
What are the criteria that define a flail chest?
two or more fractures on three or more consecutive ribs
38
How is flail chest treated?
supplemental oxygen and pain control with a nerve block (don't use opioids which may decrease respiratory drive)
39
If a trauma patient presents with confusion, petechial rash on chest, and acute SOB, what are we worried about?
fat embolism
40
What are risk factors for an air embolism?
- removal of a central line
- lung trauma
- vent use
- post-op for heart vessel surgery
41
What is the best next step for a patient suffering from hypovolemic/hemorrhagic shock?
- place 2 large bore PIV
| - run 2L NS or LR over 20 min followed by blood if there isn't an appropriate response
42
Electrical alternans is indicative of what disease process?
cardiac tamponade
43
What is pulsus paradoxus?
a fall in systolic blood pressure greater than 10mmHg with inspiration indicative of pericardial tamponade
44
What is the confirmatory test for pulsus paradoxes?
FAST scan or needle decompression if suspicion is high
45
What is the next best step for someone with a tension pneumothorax?
needle decompression followed by chest tube placement (you don't have time for a CXR)
46
Describe the swan-ganz catheter findings in each of the following types of shock:
- hypovolemic
- vasogenic
- neurogenic
- cardiogenic
- hypovolemic: low RAP/PCWP, high SVR, low CO
- vasogenic: low RAP/PCWP, low SVR, high CO
- neurogenic: low RAP/PCWP, low SVR, high CO
- cardiogenic: high RAP/PCWP, high SVR, low CO
47
What is neurogenic shock?
a form of vasogenic shock in which spinal cord injury, spinal anesthesia, or adrenal insufficiency causes an acute loss of sympathetic vascular tone
48
Describe the treatment for each of the following types of shock:
- hypovolemic
- vasogenic
- neurogenic
- cardiogenic
- hypovolemic: crystalloid resuscitation
- vasogenic: fluid resuscitation and treatment of the offending agent (antibiotics or anti-histamines)
- neurogenic: dexamethasone if due to adrenal insufficiency
- cardiogenic: give diuretics, treat the HR to 60-100, then address the rhythm, and finally give vasopressor support if necessary
49
How is GCS calculated?
- 4 eyes: spontaneous, to speech, to pain, no response
- 6 motor: obeys, localizes, withdraws from pain, abnormal flexion, abnormal extension, no response
- 5 verbal: oriented, confused, inappropriate words, incomprehensible sounds, no response
50
What is the best first test in someone who has sustained head trauma?
CT
51
How can an acute subdural be differentiated from a chronic subdural?
- acute subdural are hyperdense
| - chronic subdural are hypodense
52
What signs and symptoms are indicative of increased intracranial pressure?
- papilledema
- headache
- vomiting
- altered mental status
53
How is increased intracranial pressure treated?
- elevate the head of the bed
- give mannitol
- hyperventilate to pCO2 of 28-32
54
Where are the three zones of penetrating trauma to the neck and what is important about each?
- zone 1 is low, below the cricoid; need to do an aortography
- zone 2 is in the middle; need to do a 2D doppler to explore the potency of the vessels and you may want to do an exploratory surgery
- zone 3 is high, above the angle of the mandible; need to perform an aortography and triple endoscopy
55
If a patient comes in with free air under the diaphragm, what is the best next step?
exploratory laparotomy
56
What is the best next step for a patient who suffers a GSW to the abdomen?
exploratory laparotomy plus tetanus prophylaxis
57
What is the best next step in a patient who suffers a stab wound to the abdomen?
- if stable, perform a FAST exam; use diagnostic peritoneal lavage if FAST is equivocal; ex lap if either is positive
- if unstable, perform an ex lap
58
What is the best next step in a patient who suffers blunt trauma to the abdomen?
- if stable, perform an abdominal CT
| - if unstable, perform an ex lap
59
What should you suspect in a patient who suffers blunt abdominal trauma has the following:
- lower rib fracture plus blood in the abdomen
- lower rib fracture plus hematuria
- kehr sign and viscera in thorax on CXR
- handlebar sign
- spleen or liver laceration
- kidney injury
- diaphragm rupture (kehr sign is referred pain to the shoulder)
- pancreatic rupture (handlebar sign is the circular imprint on the abdomen)
60
Retroperitoneal fluid found on CT in a trauma patient is likely indicative of what?
duodenal rupture
61
How should a pelvic fracture be fixed?
internally if the patient is stable and externally if the patient is unstable
62
If a patient suffers pelvic trauma and is now hypotensive or tachycardia, what is the best next step and why?
concern is that they're bleeding into their abdomen/pelvis, so do a FAST or diagnostic peritoneal lavage
63
What are two signs of urethral injury?
- high riding prostate
| - blood at the urethral meatus
64
What is the next best step in a patient with a suspected urethral injury?
- do a retrograde urethrogram
| - never place a foley
65
If a patient has blood at the urethral meatus but a normal retrograde urethrogram, what is the next best step?
do a retrograde cystogram to evaluate the bladder, looking for extravasation of the dye (need two views to identify a trigone injury)
66
If a retrograde cystogram demonstrates extraperitoneal or intraperitoneal extravasation, what is the best next step?
- extraperitoneal: bed rest with a foley for comfort
| - intraperitoneal: exploratory laparotomy
67
Name four types of fractures that go to the OR.
- depressed skull fractures
- a femoral neck or intertrochanteric fracutre
- any open fracture
- any severely displaced or angulated fracture
68
What type of fracture should be suspected in the following circumstances:
- shoulder pain s/p seizure or electrical shock
- shoulder pain with an outwardly rotated arm and numbness over the deltoid
- older woman who fell on outstretched hand now with a displaced radius
- young person who fell on outstretched hand now with anatomic snuff box tenderness
- punched a wall
- posterior shoulder dislocation
- anterior shoulder dislocation
- colle's fracture
- scaphoid fracture
- boxer's fracture
69
Where along the clavicle is it most often fractured?
between the middle and distal thirds
70
What is the treatment for atelectasis?
mobilization and IS
71
What is the most common cause of a low or a high fever on POD 1?
- atelectasis if low
| - necrotizing fasciitis if high
72
What is the pattern of spread for necrotizing fasciitis?
subcutaneously along Scarpa's fascia
73
What are the two most common etiologic agents responsible for necrotizing fasciitis?
- C. perfringens
| - GABHS
74
What is the treatment for necrotizing fasciitis?
use IV penicillin and debride in the OR until the skin bleeds
75
Describe the cause, triggers, and treatment of malignant hyperthermia.
- a genetic defect involving the ryanodine receptor
- triggered by succinylcholine or halothane
- treated with dantrolene to block the RYR and reduce intracellular calcium
76
What is the empiric treatment of post-op pneumonia while awaiting cultures?
a fluoroquinolone to cover for strep pneumo
77
What is most likely to cause a fever:
- immediately post-op
- POD 1
- POD 3-5
- POD 7 or beyond
- immediate: malignant hyperthermia
- POD1: nec fas or atelectasis
- POD3-5: pneumonia or UTI
- POD7: central line infection, cellulitis, dehiscence, abdominal abscess
78
What is the preferred treatment for post-op UTI?
- get a UA and culture
| - change the foley and treat with a broad-spectrum antibiotic until cultures come back
79
What is suggested by pain and tenderness at an IV site? What is the proper treatment?
- suggests a central line infection
| - get blood cultures from the line, pull the line, and provide antibiotics to cover staph
80
What is suggested by pain at an incision site with edema, induration, and drainage? What about without drainage?
- with drainage is more suggestive of a simple wound infect
| - without drainage is more suggestive of cellulitis
81
What is the treatment for a simple post-op wound infection?
open the wound and repack; no antibiotics are necessary
82
What is the treatment for post-op cellulitis?
draw blood cultures and start antibiotics
83
What is the most likely diagnosis and the best next step if a patient has pain and salmon colored fluid draining from his incision?
- most likely dehiscence
| - treat with IV antibiotics and primary closure of the fascia
84
How is abdominal abscess diagnosed and treated?
- most likely to present with unexplained fever and a history of abdominal surgery
- diagnose with a CT or a diagnostic laparotomy if necessary
- treat with drainage, either percutaneous, IR-guided, or surgically
85
What is the treatment for thrombophlebitis?
antibiotics and heparin
86
What is the best prevention for pressure ulcers?
q2 turns
87
What is a Marjolin's ulcer?
it is a chronic ulcer that leads to increased cell turnover and ultimately to squamous cell carcinoma
88
Why tissue biopsy a pressure ulcer?
to rule out Marjolin's ulcer and squamous cell carcinoma
89
How are pressure ulcers staged and treated?
- stage 1: skin intact but erythematous and blanches
- stage 2: blisters or breaks in the dermis are present
- stage 3: subq destruction of the muscle is present
- stage 4: involvement of the joint or bone
- stages 1 and 2 require barrier protection, stages 3 and 4 require flap reconstruction
90
What are the indications for a diagnostic throacentesis?
more than 1 cm of fluid on a lateral decubitus view
91
What are the criteria for a transudative or exudative pleural effusion?
transudative if:
- LDH less than 200
- LDH effusion/serum less than 0.6
- protein effusion/serum less than 0.5
92
What are the likely causes of transudative and exudative pleural effusions?
```
transudative (LDH less than 200, LDH ratio less than 0.6, protein ratio less than 0.5)
- CHF, nephrotic syndrome, cirrhosis
- RA if low pleural glucose
- TB if high pleural lymphocyte count
- malignancy or PE if bloody effusion
exudative
- parapneumonic or cancer
```
93
What would cause a transudative pleural effusion with low glucose?
RA
94
What would cause a transudative pleural effusion with blood?
malignancy or PE
95
What would cause a transudative pleural effusion with a high lymphocyte count?
TB
96
What would suggest an exudative pleural effusion and what are potential causes?
- suggested by LDH greater than 200, LDH ratio of effusion/serum greater than 0.6, protein ratio of effusion/serum greater than 0.5
- caused by parapneumonic process or cancer
97
What is a complicated pleural effusion and how is it treated?
- complicated if there is a positive gram stain or culture, pH less than 7.2, or low glucose
- requires insertion of a chest tube
98
How is a spontaneous pneumothorax diagnosed and treated?
- diagnosed with CXR
- treat with a chest tube
- indications for surgery include an ipsilateral or contralateral recurrence, bilateral, incomplete lung expansion after thoracotomy, live in remote area
- surgery involves pleurodesis to make the pleura stick to the chest wall and prevent collapse
99
Lung Abcsess
- usually secondary to aspiration in alcoholics or the elderly
- most often seen in the posterior upper or superior lower lobes on the right
- seen as a mass with air fluid level on chest x-ray
- treat initially with antibiotics, usually IV penicillin or clindamycin
- surgery indicated by failure of the antibiotics, abscess greater than 6 cm, or the presence of an empyema
100
First step in a patient with a solitary lung nodule?
find an old CXR for comparison
101
What do popcorn calcifications in a solitary lung nodule suggest
a benign hamartoma
102
What do concentric calcifications in a lung nodule suggest?
an old granuloma
103
What features suggests that a lung nodule is benign? What is the next step?
- popcorn calcifications, concentric calcifications, patient less than 40, size less than 3 cm, or well-circumscribed suggest it is benign
- treat with CXR or CT scans every 2 months to look for growth
104
What is the next step if a lung nodule appears malignant?
remove the nodule with if central and open lung biopsy if peripheral
105
What are potential symptoms of lung cancer?
- weight loss
- cough
- dyspnea
- hemoptysis
- repeated pneumonia
- lung collapse
106
What is the most common form of lung cancer in non-smokers?
adenocarcinoma, which tends to occur in the scars of old pneumonia
107
Describe common features of adenocarcinoma.
- most common form in non-smokers
- tends to occur in the scars of old pneumonia
- found in the periphery
- often metastasizes to the liver, bone, brain, and adrenals
- has a characteristics exudative effusion with high hyaluronidase
108
What is the classic presentation for squamous cell carcinoma of the lung?
- paraneoplastic syndrome secondary to PTH-rP including kidney stones and constipation
- low PTH levels, low phosphate, high calcium
- central lung mass
109
What is superior sulcus syndrome?
a syndrome of shoulder pain, ptosis, constricted pupil, and facial edema associated with small cell carcinoma
110
What is the likely problem in someone with a lung nodule who has ptosis that improves after 1 minute of upward gaze?
they likely have small cell carcinoma with lambert-eaton syndrome
111
What is lambert-eaton syndrome?
a paraneoplastic syndrome involving antibodies against pre-synaptic calcium channels and associated with small cell carcinoma
112
Which lung cancer is associated with each of the following:
- non-smokers
- Lambert Eaton syndrome
- superior sulcus syndrome
- PTH-rP
- exudative effusion with high hyaluronidase
- adrenal mets
- SIADH
- hyponatremia
- peripheral cavitations
- non-smokers: adenocarcinoma
- Lambert Eaton syndrome: small cell carcinoma
- superior sulcus syndrome: small cell carcinoma
- PTH-rP: squamous cell carcinoma
- exudative effusion with high hyaluronidase: adenocarcinoma
- adrenal mets: adenocarcinoma
- SIADH: small cell carcinoma
- hyponatremia: small cell carcinoma
- peripheral cavitations: large cell carcinoma
113
What is the important distinction between small and non-small cell carcinoma of the lung?
small cell is more chemo and radio sensitive but non-small cell cancer is more amenable to surgery
114
What are potential causes of ARDS? What criteria are used for diagnosis? How is it treated?
- causes include sepsis, gastric aspiration, trauma, low perfusion, and pancreatitis
- diagnosed based on PaO2/FiO2 < 200, bilateral alveolar infiltrates on CXR, PCWP < 18
- treat with PEEP
115
What is described as a systolic ejection murmur that gets louder with valsalva? Softer with valsalva?
- louder: HOCM
| - softer: aortic stenosis
116
How can you differentiate HOCM from aortic stenosis on auscultation?
- aortic stenosis is a systolic cres-decres ejection murmur that gets softer with valsalva
- HOCM is a systolic cres-decres ejection murmur that gets louder with valsalva
117
What is described as a late systolic murmur with a click?
mitral valve prolapse
118
What is described as a holosystolic murmur that radiates to the axilla?
mitral regurgitation
119
What is described as a holosystolic murmur with a late diastolic rumble?
VSD
120
What is described as a continuous machine-like murmur?
PDA
121
What is described as a wide fixed and split S2?
ASD
122
What is described as a rumbling diastolic murmur with an opening snap?
mitral stenosis, potentially complicated by left atrial enlargement and a-fib, often have a history of rheumatic fever
123
What is described as a blowing diastolic murmur with widened pulse pressure?
aortic regurgitation
124
Which murmurs get louder with inspiration?
right sided murmurs
125
Left sided murmurs tend to get louder with what two things?
sitting up and expiring
126
Is Zenker's diverticulum a true or false diverticulum?
a false one as it only contains the mucosa
127
How is achalasia treated?
- conservatively with CCBs, nitrates, or boto
| - surgically with a myotomy
128
What presents as dysphagia worse for hot and cold liquids that is accompanied by chest pain similar to an MI and without regurgitation? How is it treated?
this describes diffuse esophageal spasm and should be treated medically with CCBs or nitrates
129
What is the most sensitive test for diagnosing GERD?
24-hour pH monitoring
130
What are the indications for endoscopy in a patient with GERD?
do an endoscopy if danger signs are present
131
How is GERD treated? When do we use surgical intervention?
- treat conservatively with behavior modification, antacids, H2 blockers, and PPIs
- do surgery for bleeding, stricture, Barrett's esophagus, an incompetent LES, symptoms with maximal medical treatment
132
What would usually cause a pleural effusion with increased amylase?
boerhaave's syndrome (esophageal rupture)
133
What is the best next step and the treatment if a patient presents with likely boerhaave's syndrome?
- next step: CXR and gastrograffin esophogram (no barium so no endoscopy)
- treatment is surgical repair
134
How are gastric varies treated?
- do ABCs
- perform a NG lavage
- treat medically with octreotide or somatostatin
- balloon tamponade only if you need to stabilize for transport
- remember, no prophylactic treatment, only treat symptomatic cases
135
What are the best next steps in someone with suspected esophageal cancer?
- barium swallow
- then endoscopy with biopsy
- then staging CT
136
What is the difference between a type 1 and a type 2 hiatal hernia?
- type 1 is a sliding hernia whereas type 2 is a paraesophageal hernia
- type 1 produces worse GERD and is usually medically managed
- type 2 is more likely to present with abdominal pain, obstruction, strangulation, and a need for surgical intervention
137
What is the typical presentation for gastric ulcers?
mid-epigastric pain worse with eating in those with a history of H. pylori, chronic NSAID use, or steroid use
138
What is the workup for gastric ulcers? What is the treatment?
- initially get a barium swallow to demonstrate punched out lesions with regular margins
- need an EGD with biopsy to tell if it's related to H. pylori and is benign or malignant
- treat medically for 12 weeks and perform surgery if it persists
139
Gastric lymphoma is associated with what other disease?
HIV
140
MALT-lymphoma is associated with what other disease?
H. pylori infection
141
What is Blummer's Shelf?
metastases felt on DRE from gastric cancer
142
What is Mentriers disease?
a protein losing enteropathy (foamy pee) with enlarged rugae seen on EGD
143
What are gastric varices most often caused by and associated with?
associated with splenic vein thrombosis following pancreatitis
144
What is Dieulafoy's disease associated with?
massive hematemesis resulting from a mucosal artery eroding into the stomach
145
What is the treatment for H. pylori?
PPI, clarithromycin, and amoxicillin for 2 weeks followed by a breath or stool test for cure
146
What is the preferred test for duodenal ulcer?
- blood, stool, or breath test for H. pylori will most likely be positive as 95% are associated with infection
- but an endoscopy with biopsy is best because it can also exclude cancer
147
What is the most likely diagnosis if a patient has recurrent, multiple, or refractory duodenal ulcers?
ZE syndrome
148
How is Zollinger-Ellison diagnosed and managed?
- test with a secretin stimulation test to find inappropriately high gastrin (should suppress it)
- treat with surgical resection of pancreatic/duodenal tumor and look for pituitary or parathyroid problems (MEN1)
149
What are the two most common causes of pancreatitis?
gallstones and alcohol consumption
150
What is the best imaging test for pancreatitis?
CT
151
How is pancreatitis treated?
NG suction, NPO, IV rehydration, and observation
152
What are the feared complications of pancreatitis?
pseudocysts, hemorrhage, abscess, and ARDS
153
What are four common manifestations of chronic pancreatitis?
- chronic mid-epigastric pain
- diabetes mellitus
- malabsorption and steatorrhea
- splenic vein thrombosis and gastric varices
154
How is pancreatic adenocarcinoma diagnosed?
endoscopic ultrasound and FNA
155
What is Courvoisier's sign?
palpable, non-tender gall bladder associated with pancreatic cancer
156
What is Trousseau's sign?
migratory thrombophlebitis associated with pancreatic cancer
157
What must be true for pancreatic cancer to be a candidate for surgery?
- no mets outside the abdomen, to the liver, or to the peritoneum
- no extension into the portal vein or SMA
158
Describe the findings consistent with an insulinoma.
- symptoms of sweating, tremors, hunger, and seizures
- blood glucose less than 45
- symptom resolution with glucose administration
- hyperinsulinemia, increased C-peptide, and increased pro-insulin
159
What are the symptoms of glucagonoma?
- hyperglycemia
- diarrhea
- weight loss
- necrolytic migratory erythema
160
What are the symptoms of VIPoma?
watery diarrhea, hypokalemia, dehyration, and flushing that respond to octreotide (similar to carcinoid syndrome)
