Gallbladder,Exocrine pancreas

Question 1

What is Courvoisiers law?

Answer 1

Gallbladder enlargers when CBD is obstructed by pancreatic ca, but not enlarged when CBD is obstructed by stone

Question 2

What is ransons criteria

0-2 minimal mortality
3-5 10-20% mortality
>5 is >50% mortality

Answer 2

Determines risk of death from pancreatitis
On admission
Age>55
Wbc>16000
Aspartate aminotransferase >250
LDH>350
Blood glucose>200
Base deficit >4

Within 24h-36h
Drop in hematocrit >10%
BUN rise >5mg
Serum Ca 6L

Question 3

What is trousseaus syndrome?

Answer 3

Migratory thrombophlebitis -10% pts with pancreatic ca

Question 4

Stepladder pattern air fluid level

Answer 4

SBO

Question 5

Mc small bowel benign tumor

Answer 5

Leiomyoma

Question 6

What are causes of ascending cholangitis

Answer 6

Strictures,foreign bodies, and parasites

Question 7

What is the drug of choice to treat disorders of the biliary tract?

Answer 7

Meperidine (Demerol)

Bc it does not cause spasm of sphincter of Oddi unlike Morphine. Morph one also decreases normal peristaltic movement of biliary tract increasing biliary pressures

Question 8

What are causes of an elevated serum amylase?

Answer 8

Sensitive for pancreatitis but not specific. (3x normal level= actua pancreatitis)

Other causes: perforated ulcers, intestinal infarction, intestinal obstruction and ruptured ectopic pregnancy and salivary gland diseases

Question 9

Pt with recurrent pancreatitis-like sx. What findings help make dx of chronic pancreatitis

Answer 9

Leukocytosis, pancreatic calcifications
Enlargement
Surrounding fluid collection

Question 10

How do you tell apart complete vs partial SBO?

Answer 10

Gas in rectum = partial which can be managed w conservative tx but complete needs laporotomy and prophylactic antibiotics

Question 11

Pts w celiac are at risk of developing what kind of cancer?

Answer 11

MALT lymphoma