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Flashcards in NMS Deck (172):
1

Total body water

65% Intracellular
35% Extracellular- 25% Interstitial, 10% Intravascular

2

2/3 rule

Total body water comprises approximately 2/3 of body weight; of this, 2/3 is intracellular, and one third extracellular. Of the extracellular, 2/3 is interstitial, and 1/3 is intravascular.

3

Blood volume

Approx. 7% of body weight

4

Body water excreted

1. urine- minimum = 0.5 mL/kg/hr
2. insensible loss (sweat, respiration, stool) = 600-900 mL/24 hr

5

Fluid requirement

First 10 kg = 4 cc/kg/hr
Second 10 kg = 2 cc/kg/hr
1 cc/kg/hr for every kg above

6

1/2 normal Saline (0.5% NaCl)

77 mEq/L Na+
77 mEq/L Cl-

Osmolarity = 154 mOsm/L

7

Normal Saline (0.9% NaCl)

154 mEq/L Na+
154 mEq/L Cl-

Osmolarity = 308 mOsm/L

8

Hypertonic Saline (3.0% NaCl)

513 mEq/L Na+
513 mEq/L Cl-

Osmolarity = 1027 mOsm/L

9

Lactated Ringer's

130 mEq/L Na+
4 mEq/L K+
2.7 mEq/L Ca++
98 mEq/L Cl-
28 mEq/L Lactate

Osmolarity = 525 mOsm/L

10

Plasmalyte

140 mEq/L Na+
5 mEq/L K+
3 mEq/L Mg++
98 mEq/L Cl-
27 mEq/L Acetate
23 mEq/L Gluconate

Osmolarity = 294 mOsm/L

11

Signs of acute volume loss

tachycardia
hypotension
decreased urine output

12

Signs of gradual volume loss

loss of skin turgor
thirst
alterations in body temperature
changes in mental status

13

Signs of acute hypervolemia

acute shortness of breath
tachycardia

complications- acute CHF

14

Signs of chronic hypervolemia

peripheral edema
pulmonary edema

15

hyponatremia

serum Na+ < 130 mEq/L

16

Hyperosmolar hyponatremia

Dilutional

Causes: hyperglycemia, mannitol infusion, other osmotic particles present

Tx: correct hyperglycemia or other source

17

Normo-osmolar hyponatremia

Pseudohyponatremia

Causes: hyperglycemia, hyperlipidemia, hyperproteinemia

Tx: none required

18

Hypo-osmolar hyponatremia

True hyponatremia

Hypovolemic
Hypervolemic
Euvolemic

19

Hypovolemic hypo-osmolar hyponatremia

most common
total body sodium low
hypovolemia = ADH secretion, decreased free water excretion
Increased intake of free water from thirst or infusion of hypotonic solution

Dx: Urine osmolarity HIGH, Na LOW
Tx: isotonic fluid infusion, Na+ replacement if deficit is severe

20

Hypervolemic hypo-osmolar hyponatremia

total body sodium high
low cardiac output (less blood to kidneys, free water not excreted)
hypoalbuminemic (ex: cirrhosis) or other edematous state salt (Renin-angiotensin) and free water (ADH) cannot be excreted

Dx: Urine osmolarity HIGH, Na LOW
Tx: treat underlying medical condition, NaCl and free water restriction

21

Euvolemic hypo-osmolar hyponatremia

syndrome of inappropriate antidiuretic hormone (SIADH)

can be stimulated by stress response to trauma and surgery.
free water retained

Dx: Urine osmolarity HIGH, urine Na HIGH
Tx: free water restriction

22

Acute hyponatremia symptoms

acute cerebral edema
seizures
coma

23

Chronic hyponatremia symptoms

usually well tolerated
confusion/decreased mental status
irritability
decreased deep tendon reflexes

24

Hypernatremia

serum Na+ > 150 mEq/L

Sxs: volume depletion (tachy, hypotension)
dehydration (dry mucous membranes, decreased skin turgor)
lethargy
confusion
coma (water shift into intracellular in CNS)

25

Hypovolemia hypernatremia

volume deficit, more free water lost than Na+

Tx: calculate free water deficit
replace half within 8 hrs
second half over 16 hrs

26

Hypervolemia hypernatremia

iatrogenic infusion of too much sodium
rare

Tx: decrease Na+ infusion
free water infusion
diuretics

27

Free water deficit

= 0.6 x BW in kg x (pNA/140 - 1)

28

Hypokalemia

serum K+ < 3.5 mEq/L
Severe < 3.0 mEq/L or less

Sxs: ileus, weakness, respiratory failure, cardiac dysrhythmias

29

ECG changes in hypokalemia

seen when K+ < 3.0 mEq/L

T-wave flattening
T-wave inversion
depressed ST segments
U wave development
prolonged QT interval
ventricular tachycardia

30

Causes of hypokalemia

renal- diuretics, vomiting, renal tubular acidosis
extrarenal- diarrhea, burns
intracellular shift- insulin, alkalotic state
medical disease- hyperaldosteronism, cushing syndrome

31

Treatment of hypokalemia

every 10 mEq of K+ should increase serum concentration by 0.1 mEq/L

32

Hyperkalemia

serum K+ > 6 mEq/L

Sxs: diarrhea, cramping, nervousness, weakness, flaccid paralysis, cardiac dysrhythmias

33

ECG changes in hyperkalemia

peaked T waves
widened QRS
ventricular fibrillation

34

Causes of hyperkalemia

Renal failure with inappropriate consumption/admin of K+
Extracellular shift- rhabdomyolysis, massive tissue necrosis, metabolic acidosis, hyperglycemia
Medical disease-Addison's disease

35

Treatment of hyperkalemia

Acutely- IV Ca++, stablizes cardiac myocyte membrane to prevent dysrhythmias; glucose/insulin to shift K+ intracellularly; Bicarbonate to shift K+ intracellulary

Removal- ion-exchange resin (K-exylate) binds K+ in colon; Lasix only if kidneys can excrete; Dialysis

36

Respiratory acidosis

decreased ventilation relative to CO2 production, increased CO2 concentration

Causes: most common- decreased alveolar ventilation (respiratory depression, CNS disorder, physical), increased CO2 production (excess enteral carbs)

Tx: increase alveolar ventilation

37

Metabolic acidosis

loss of HCO3-, accumulation of strong anions, accumulation of weak acids

Causes: weak acid (anion gap; renal failure, lactic acidosis, DKA, toxins), strong anion (no gap; hyperchloremic acidosis), loss of bicarb (no gap; excess renal excretion, diarrhea)

Tx: underlying metabolic condition
bicarb only if pH < 7.2

38

Respiratory alkalosis

increase in alveolar ventilation with decrease in CO2 levels

Causes: anxiety, pain, shock, sepsis, toxins, CNS dysfunction, over ventilation

Tx: decrease ventilation, most self-limited

39

Metabolic alkalosis

pH over 7.45 and HCO3- > 26 mEq/L

causes: vomiting, diarrhea (loss of gastric contents), drugs that limit renal excretion of HCO3- (steroids, diuretics)

40

Primary hemostasis

Platelet adherence- glycoprotein Ib and vWF

Platelet activation- produce thromboxane A2 (vasoconstrict); Glycoprotein IIb/IIIa expressed for platelet-platelet adhesion (fibrinogen needed)

41

Extrinsic pathway

Tissue Factor (TF) binds Factor VII -> VIIa acivates Factor X -> Xa converts prothrombin -> thrombin (Va cofactor) -> fibrinogen -> fibrin

XIIIa mediates cross linking of fibrin

42

Intrinsic pathway

Factor XIIa activates XI -> XIa activates IX -> IXa activates X -> Xa converts prothrombin -> thrombin (Va cofactor) ->fibrinogen -> fibrin

XIIIa mediates cross linking of fibrin

43

Protein C and S

degrade factors V and VIII

44

Antithrombin III

inhibits thrombin-Xa complexes

45

Fibrinolysis

t-PA and urokinase-type plasminogen activator (uPA) convert plasminogen -> plasmin which cleaves fibrin

46

Prothrombin time (PT)

measures extrinsic cascade

measurement of vitamin K-dependent coag factors (II, VII, X)

used to monitor warfarin therapy

47

Activated partial thromboplastin time (aPTT)

measures intrinsic cascade

used to monitor pts on IV unfractionated heparin

48

Hemophilia A

Factor VIII deficiency

49

Hemophilia B

Factor IX deficiency

50

von Willibrand disease

most common congenital coagulopathy (1-2%)

vWF deficiency, treated with intranasal/IV DDVAVP

51

Clean wound

incision made under sterile conditions, nontraumatic procedure, does not enter bowel, tracheobronchial tree, genitourinary system, or oropharynx

should be closed primarily, infection rate less than 2%

52

Clean-contaminated wound

bowel, tracheobronchial tree, genitourinary system, or oropharynx was entered under sterile conditions. No evidence of active infection

should be closed primarily, infx rate 3-4%

53

Contaminated wound

major contamination of wound during procedure (ex: stool from colon), fresh traumatic wounds

should be left open, infx rate 7-10%

54

Dirty and infected wounds

established infection present before procedure (ex: appendiceal abscess)

should be left open, infx rate 30-40%

55

Normal wound healing phases

1. Coagulation phase
2. Inflammatory phase ~ 1 wk
a. cellular- PMN (24-48 hr) and macrophages remove necrotic tissue and debris; epithelial bridging
b. vascular- angiogenesis
c. mediators
3. Proliferative phase- fibroblasts form collagen, wound strength increases, wound contraction, 3 wks
4. Wound remodeling- scar formation

56

Primary closure

skin edges approximated shortly after wound incurred

57

Secondary intention

wounds with risk or current infection left open, heal by epitheliazation and wound contraction

58

Delayed primary closure

heavily contaminated wounds, left open 3-5 days, then primarily closed

59

Skin grafts

graft contains epidermis and portion of dermis, provide epithelial coverage for healing

60

Flaps

Rotation flap- retains normal blood supply, rotated to fill in a defect
Free flap- removed from normal blood supply, moved to another area, vasuclature reanastomosed (ex: toe to hand to form thumb)

61

Fick equation

to determine caloric requirements

cardiac output x arterial-venous oxygen content difference = oxygen consumption

62

Systemic vascular resistance (SVR)

SVR = [(MAP - CVP)/CO] x 80
normal: 800-1200 dynes.sec/cm5

63

Pulmonary vascular resistance (PVR)

PVR = [(MPAP - PCWP)/CO} x 80
normal: 20-120 dynes.sec/cm5

64

Dopamine

low dose (1-3 ug/kg/min)- receptors in kidney and intestine, increases blood flow

med dose (3-10 ug/kg/min)- beta receptor agonist, increase in cardiac contractility, incr CO

high dose (>10 ug/kg/min)- alpha agonist and vasoconstrictor

65

Dobutamine

affects both beta-1 and -2 receptors, increase in cardiac output, vasodilation

66

Norepinephrine

alpha agonist, vasoconstriction, mild beta activity, some increase in cardiac contractility

67

Epinephrine

alpha agonist, some beta agonist effect. vasoconstriction and increased cardiac output

68

Phenylephrine

alpha agonist, pure arterial constriction

69

Nitroprusside

primarily arterial vasodilator

reflex tachy, metabolite is cyanide

70

Nitroglycerin

primarily venodilator, coronary artery dilator

71

Shock

inadequate tisse perfusion to maintain normal cellular metabolism

72

Hypovolemic shock

most common type of shock, hemorrhage most common cause. perfusion defect due to blood loss (decreased preload) -> decreased CO

loss of RBC volume reduces O2 carrying capacity (Hgb)

Tx: volume replacement (2 x IV), stop blood loss

73

Cardiogenic shock

inadequate cardiac performance -> decreased CO

most commonly related to MI, also CHF, valvular disease

central venous pressures are elevated

Tx: inotropic support (dopa or dobutamine), nitro to reverse cardiac ischemia

74

Neurogenic shock

loss of sympathetic tone -> peripheral vasodilation -> relative hypovolemia, decreased cardiac performance

can be result of vasovagal response, cervicothoracic spinal cord injury, spinal anesthesia

Tx: volume resuscitation, consider phenylephrine or NEpi if unresponsive to volume replacement

75

Septic shock

toxins released by microbes -> hyperinflammatory derangements, hypovolemia, cardiac dysfunction, vasodilation

Tx: volume resuscitation, central venous access, consider dobutamine if SvO2 < 70%, consider NEpi or dopa if MAP < 65 mmHg

76

Obstructive shock

physical obstruction that decreases cardiac output (ex: tension pneumo, cardiac tamponade, massive PE, venous air embolism)

Tx: volume resuscitation, correct underlying condition.

77

Miscellaneous shock

cyanide toxicity, severe hypoxia, normovolemic severe anemia, profound hypoglycemia, anaphylaxis

78

Carcinoma

malignancy from epithelium

79

Adenocarcinoma

malignancy from epithelium with glandular component

80

Sarcoma

malignancy from mesodermal tissues

81

Steps necessary for malignancy

1. expression of cell adhesion molecules
2. produce extracellular matrix molecules
3. produce cytoskeletal proteins for motility
4. produce angiogenic factors for neovascularization

82

Classic symptoms of cancer

CAUTION
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness

83

Postop fever

1. Wind - post op days 1-3
2. Water - UTI, post op days 3-5
3. Wound infections - post op days 5-8
4. Walk - venous complications
5. Wonder drugs

84

Indications for operative repair of fistula

FRIEND
Foreign body at fistula
Radiation injury
Injured bowel or inflammatory bowel disease
Epithelialization of fistula tract
Neoplasia or cancer
Distal obstruction beyond fistula

85

symptomatic anemia

tachycardia
oliguria
hypotension
fatigue
syncope
tachypnea
dyspnea
transient ischemic attack

86

preoperative risk factors for mortality in noncardiac surgery

Admission serum albumin
ASA class
Disseminated cancer
Emergency operation
Age
Blood urea nitrogen (BUN) > 40 mg/dL
DNR orders
Operation complexity score
SGOT > 40 IU/mL
Weight loss > 10% in 6 months
Functional status
WBC > 11,000/mm3

87

Perioperative pulmonary edema

Causes: Volume overload
Cessation of positive pressure ventilation (increase in preload)
Anesthetic induced myocardial depression
Postop HTN

70% develop within first hour after surgery

88

Indications for emergent dialysis

AEIOU
metabolic Acidosis, can't give bicarb
Electrolyte - hyperkalemia
Intoxication of medication
volume Overload, severe
Uremia - pericarditis, mental status changes, asterixis

89

Anterior mediastinum

from sternum to pericardium
contains thymus, lymph nodes, ascending and transverse aorta, great veins

90

Visceral mediastinum

from pericardium to anterior longitudinal spinal ligament
contains pericardium, heart, trachea, hilar structures of lung, esophagus, phrenic nerves, lymph nodes

91

Paravertebral sulci

potential spaces
contain sympathetic chains, intercostal nerves, descending thoracic aorta

92

Immediate life-threatening thoracic injuries

1. Airway obstruction
2. Tension pneumothorax
3. Open pneumothorax
4. Massive hemothorax
5. Cardiac tamponade
6. Flail chest

93

Potentially life-threatening thoracic injuries

1. Tracheobronchial disruption
2. Aortic disruption
3. Diaphragmatic disruption
4. Esophageal disruption
5. Cardiac contusion
6. Pulmonary contusion

94

Most common chest wall deformity

Pectus excavatum (funnel chest)

95

Poland's syndrome

unilateral absence of costal cartilages, pectoralis muscle, and breast

96

Thoracic outlet syndrome (TOS)

compression of neurovascular bundle at thoracic outlet. Brachial plexus compression occurs most offen, vascular compression less frequently

97

Common metastatic pulmonary tumors

Colorectal
Breast
Melanoma
Renal

98

Anterior mediastinum mass

4 T's
Thymoma
Teratoma - from branchial cleft pouch
Terrible Lymphoma
Tumor- Germ cell (seminoma, embryonal cell carcinoma, teratocarcinoma, choriocarcinoma, endodermal sinus)

99

Classic triad of mitral stenosis

apical diastolic rumble
opening snap
loud first heart sound

100

Coronary artery disease risk factors

HTN
Smoking
Hypercholesterolemia
Family history of heart disease
DM
Obesity

101

Stable angina

Unchanged for a prolonged period

102

Unstable angina

recent change from previously stable pattern, includes new-onset angina

103

Angina at rest

unprovoked by activity

104

Graft of choice for CABG

Internal mammary artery (IMA) - 90% 10 year patency

105

Tumors with mets to heart

Melanoma
Lymphoma
Leukemia

106

Acute pericarditis

Bacterial infection
Viral infection
Uremia
Traumatic hemopericardium
Malignant disease
Connective tissue disorders

107

Most common congenital heart defect

Ventricular septal defects (conoventricular most common)

108

Eisenmenger's syndrome

Development of higher pulmonary vascular resistance that leads to reversal of flow across ventricular septal defect

109

Tetralogy of Fallot

1. Obstruction of right ventricular outflow
2. Ventricular septal defect (VSD)
3. Hypertrophy of right ventricle
4. Overriding aorta

110

wet gangrene

infection within nonviable tissue

111

Pentoxifylline

for intermittent claudication
reduces blood viscosity by decreasing plasma fibrinogen and platelet aggregation
GI upset

112

Leriche syndrome

buttock and thigh claudication
absent femoral pulses
impotence (males)

113

Acute lower extremity ischemia

"5 P's"
1. Pain
2. Pallor
3. Paralysis
4. Paresthesias
5. Pulselessness

114

Thrombolytic contraindications

sensory and motor changes on presentation
recent surgery (< 2 wks)
known intracranial pathology

115

Acute mesenteric ischemia

surgical emergency, 80% mortality
severe abd pain, out of proportion to PE findings

caused by: embolization, thrombosis, nonocclusive ischemia (ex: cardiogenic shock)

116

Riolan's arch

collateral blood supply between SMA and IMA

117

most common causes of renal artery stenosis

atherosclerosis
fibromuscular dysplasia

118

risk factors for AAA

Age
Smoking
HTN
Family history

Men > Women 4:1

119

Ruptured AAA Dx

1 Severe pain
2 Pulsatile, tender abdominal mass
3 Shock (elevated HR, unstable BP, or syncope)

120

Ischemic cholitis

suspect with post-op diarrhea, stool is heme +

Tx: Hartmann's procedure: resect necrotic colon, proximal colostomy, distal closure

121

Artery supply to spinal cord

artery of Adamkiewicz, arises between T8-T12

122

classic anterior spinal artery syndrome

Paraplegia
Rectal and urinary incontinence
Loss of pain and temp sensation
Preservation of vibratory and proprioceptive sensation

123

Raynaud's phenomemnon

associated with scleroderma and collagen vascular diseases.

124

Milroy's disease

Lymphedema that is both congenital and hereditary

125

Chief cells

found in fundus of stomach
secrete pepsinogen -> pepsin
stimulated by cholinergic impulses, gastrin, secretin

126

Oxyntic/Parietal cells

found in body/fundus of stomach
produce hydrochloric acid and intrinsic factor
stimulated by gastrin

127

G cells

found in antrum of stomach
secrete gastrin

128

Carcinoid syndrome

flushing
diarrhea
bronchoconstriction
tricuspid and pulmonary valve disease

only in pts with liver mets or primary extraintestinal carcinoid

129

Crohn's disease surgery indications

intestinal obstruction- most common
abscesses and fistulas
perforation, hemorrhage, intractible sxs- less common

130

most common diverticulum of GI tract

Meckel's diverticulum

2 ft from ileocecal valve

131

Familial Adenomatous Polyposus

autosomal dominant
mutation of APC gene on chrom 5

132

Amsterdam criteria for HNPCC

Three+ relatives with colon cancer (1 first deg)
Colorectal carcinoma in 2+ generations
1+ diagnosed before age 50

133

Colon cancer risk factors

Family history
Ashkenazi Jews
Personal history of colorectal cancer
Personal history of colorectal polyps
Chronic inflammatory bowel disease (UC>Chr)
Age > 50
Diet (high fat, low fruit/veg, high calcium)
low activity level
Obesity
DM
Smoking
EtOH

134

most sensitive indicator of recurrent colorectal cancer

CEA- glycoprotein secreted by colorectal tumors
if rising- CXR and abd CT

(nonspecific, also high in cirrhosis, pancreatitis, renal failure, UC, other cancer, smoking)

135

fulminant colitis with toxic megacolon

Dilation of transverse colon
Abdominal pain, tenderness, distention
Fever, leukocytosis, hypoalbuminemia
Risk of colonic perforation

136

serologic markers for IBD

pANCA (UC)
ASCA (CD)

137

Sulfasalazine

main medical treatment for UC

138

Sclerosing cholangitis

UC > CD

139

Immunosuppressives for IBD

6-Mercaptopurine
Azathioprine
Methotrexate
IV cyclosporine

140

most common benign hepatic tumor

Hemangioma

141

benign hepatic tumor strongly associated with oral contraceptives and androgenic steroid use

Hepatocellular adenoma

142

sulfer-colloid scan

distinguish between Focal Nodular Hyperplasia and a hepatocellular adenoma: FNH takes up sulfer-colloid, adenoma does not

143

benign hepatic tumor of children

Infantile Hemangioendothelioma
has malignant potential

144

Most common primary malignant tumor of liver

Hepatocellular carcinoma

145

risk factors for hepatocellular carcinoma

Chronic hep B
Cirrhosis
Hemochromatosis
Schistosomiasis and other parasitic infection
Carcinogens- polycholirnated bipheyls, chlorinated hydrocarbos, vinyl chloride, nitrosamines

146

most common primary malignant liver tumor in children

Hepatoblastoma

147

tumor from bile duct epithelium

Cholangiocarcinoma

148

Pringle maneuver

control and compression of porta hepatis
used for hemostasis after liver trauma

149

Vasopressin

potent vasoconstrictor, lowers portal pressure

150

Somatostatin

causes splanchnic vasoconstriction, fewer side effects than vasopressin

151

TIPS

Transjugular intrahepatic portosystemic shunt
between a hepatic vein and a branch of the portal vein

152

Salt and water retention in liver failure

Due to hyperaldosteronism -> decreased aldosterone breakdown by liver

Tx: diuretics, especially aldosterone antagonists

153

Increase bile flow

Vagal and splanchnic stimulation
Secretin
Theophylline
Phenobarbital
Steroids

154

Release of bile

Colecystokinin (CCK)- humoral control
vagal and splanchnic nerves also contribute

155

Acalculous cholecystitis

acute or chronic cholecystitis in the absence of stones
acute from burns, sepsis, trauma, or collagen vascular disease
chronic also called biliary dyskinesia

156

Turner's sign

flank eccchymoses from blood dissection of flank tissues
sign of retroperitoneal hemorrhage from sever pancreatic inflammation and necrosis

157

Cullen's sign

periumbilical ecchymosis from blood dissection up falciform ligament

158

Adrenal cortex

zona glomerulosa- mineralocorticoids (aldosterone)
zona fasciculata- glucocorticoids (cortisol)
zona reticularis- androgens and estrogens

159

Superior parathyroid origin

fourth branchial pouch
close to origin of thyroid

abnormal location- within thyroid, or posterior mediastinum

160

Inferior parathyroid origin

third branchial pouch
close to thymic anlage, cross superior in descent

161

Tx for symptomatic hypocalcemia

IV Ca2+ gluconate (severe)

162

Thymus embryology

Third branchial pouch
descends into anterosuperior mediastinum

163

Sxs of myasthenia gravis

ptosis
double vision
dysarthria
dysphagia
nasal speech
weakness of arms and legs

164

Path of myasthenia gravis

autoantibodies against ACh receptors

165

Tx of MG

Medically- neostigmine, pyridostigmine (drugs that stimulate NMJ)

Surgically- thymectomy
- post-op plasmapharesis

166

MEN I

Hyperparathyroidism
Pancreatic tumors (nonbeta islet cell- ZE synd)
Pituitary tumors

167

Sxs of MEN I

hypercalcemia
hypoglycemia
peptic ulcer (pancreatic gastrinoma)
pituitary mass complaints

168

MEN 2A

Medullary thyroid carcinoma (medullary hyperplasia of C cells- increased calcitonin)
Pheochromocytomas (B/L)
Parathyroid hyperplasia

169

MEN 2B

Medullary thyroid carcinoma
Pheochromocytomas
Marfanoid/multiple mucosal neuromas

170

APUD cells

Amine Precursor Uptake Decarboxylation cell system

171

APUDomas

Insulinomas
Gastrinomas (Z-E synd)
Glucagonomas
VIPomas (vasoactive intestinal peptide)
Somatostatinomas

172

Pancreatic cholera (WDHA syndrome)

Watery Diarrhea
Hypokalemia (high potassium in stool from hypersecretion)
Achlorhydria

severe diarrhea due to hypersecretion of a pancreatic nonbeta islet cell tumor