High-Yield Concepts in Pancreatic Disorders (Gastrointestinal Diseases)

Question 1

Most common cause of Acute Pancreatitis

Answer 1

Gallstones, followed by alcohol

Question 2

Currently accepted pathogenic theory for Pancreatitis

Answer 2

Autodigestion

Question 3

Major symptom of Acute Pancreatitis

Answer 3

Abdominal pain (more intense when supine, relieved by sitting up)

Question 4

Cullen’s Sign

Answer 4

Blue discoloration around the umbilicus from hemoperitoneum

Question 5

Turner’s Sign

Answer 5

Blue-red-purple or green brown discoloration of the flanks from tissue catabolism of hemoglobin

Question 6

Laterality of pleural effusion in Pancreatitis

Answer 6

Most frequent on the left

Question 7

Recommended screening tests

Answer 7

Serum lipase and amylase levels

Question 8

Single best enzyme to measure for the diagnosis

Answer 8

Lipase (more specific)

Question 9

Pancreatitis from Hypertriglyceridemia

Answer 9

Serum triglyceride levels usually >11.3 mmol/L (>1000 mg/dL)

Question 10

Risk factors for severe disease and mortality in Acute Pancreatitis

Answer 10

Hematocrit > 44%

Azotemia with BUN >22 mg/dL

Question 11

Best imaging study for initial evaluation of suspected pancreatic disorder and for complications of Pancreatitis

Answer 11

Abdominal CT Scan

Question 12

Imaging study if gallstone disease is suspected in Acute Pancreatitis

Answer 12

Ultrasonography

Question 13

Diagnostic tests of choice to evaluate the pancreatic duct

Answer 13

EUS and MRCP (but ERCP still needed for treatment of biliary and pancreatic duct lesions)

Question 14

Best way to prevent ERCP-induced Pancreatitis

Answer 14

Avoidance of ERCP for diagnostic purposes in high-risk patients

Question 15

Hallmark of treatment in Acute Pancreatitis

Answer 15

Bowel rest, intravenous hydration with crystalloid, analgesia

Question 16

Preferred method of nutritional support in Acute Pancreatitis

Answer 16

Enyteral-feeding with a nasojejunal tube (vs. TPN)

Question 17

Diagnosis of Pancreatic Infection

Answer 17

CT-guided needle aspiration with Gram stain and culture

Question 18

Most common organisms in Pancreatic Infection

Answer 18

Gram-negative bacteria of intestinal origin

Question 19

Most common location of Pancreatic Pseudocyst

Answer 19

Pancreatic body or tail (only 15% in the head)

Question 20

Usual presenting complaint of Pseudocyst

Answer 20

Abdominal pain

Question 21

Usual cause of death from Pancreatic Pseudocyst

Answer 21

Rupture and hemorrhage of the pseudocyst

Question 22

Most frequently involved artery in Pseudoaneurysms

Answer 22

Splenic artery, followed by inferior and superior pancreatic duodenal arteries

Question 23

Most common cause of Chronic Pancreatitis in US adults

Answer 23

Alcoholism

Question 24

Most common cause of Chronic Pancreatitis in US children

Answer 24

Cystic fibrosis

Question 25

Predominant symptoms of Chronic Pancreatitis

Answer 25

Abdominal pain or maldigestion and weight loss

Question 26

Diagnostic test with best sensitivity/specificity for Chronic Pancreatitis

Answer 26

Secretin stimulation test (abnormal once >60% of pancreatic exocrine function has been lost)

Question 27

Most reproducible measurement in the Secretin Test

Answer 27

Maximal HCO3 concentration

Question 28

Most common cause of pancreatic calcification

Answer 28

Alcohol

Question 29

Cornerstone of pancreatic therapy

Answer 29

Pancreatic enzymes

Question 30

Most common congenital anatomic variant of the pancreas

Answer 30

Pancreas divisum