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29 Cards in this Set

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What is macroamylasemia?
Presence of macroamylase in the blood, which is abnormal. It consists of amylase attached to a protein.
Conditions associated with macroamylsemia?
1. Celiac disease
2. Lymphoma
3. HIV
4. Monoclonal gammopathy
5. RA
6. Ulcerative Collitis
In what way does lipase differ from other pancreatic enzymes?
Pancreatic lipase is secreted in its final form but only becomes effective in the presence of colipase in the duodenum.
Serum levels of lipase are raised in which conditions?
1. Pancreatitis (used to diagnose acute pancreatitis)
2. Pancreatic adenocarcinoma
Drugs that may increase lipase levels include
1. Codeine
2. Indomethacin
3. Morphine
Elastase 1 is a useful marker of
Pancreatic exocrine function
What is the fecal elastase test?
1. Used to assess pancreatic exocrine function
2. Preferred over secretin stimulation test. However, it may have problems detecting mild exocrine pancreatic insufficiency
Reason for a blood elastase test?
Differentiate between acute and chronic pancreatitis
Most common causes of pancreatic insufficiency?
1. Cystic Fibrosis
2. Shwachman-Diamond Syndrome (SDS)
3. Type 1 DM
Symptoms of pancreatic insufficiency?
1. Malabsorption and malnutrition
2. Vitamin deficiencies
3. Weight loss (failure to thrive)
4. Steatorrhea
Acute pancreatitis mnemonic
I GET SMASHED
I - Idiopathic
G - Gall stones
E - Ethanol
T - Traumas
S - Steroids
M - Mumps, Malignancy
A - Auto-immune
S - Scorpion sting
H - Hypercalcemia, Hyperlipidemia
E - ERCP
D - Drugs
Gold standard for diagnosing pancreatitis?
CT (and abdominal USG).

Note: XR is not recommended
Which scoring system is the most predictive of adverse outcomes in acute pancreatitis?
- CT Severity Index.
- A CT score >5 is associated with a 15x mortality rate
Which H.pylori strains are more dangerous?
Strains producing both VacA and CagA cause more intense tissue inflammation and induction of cytokine production. In addition, CagA strains may be associated with a higher frequency of precancerous lesions.
Non-invasive tests for H.pylori?
1. Urease Breath Test
2. Serological tests - IgG, IgA, IgM
3. PCR (salive or feces)
4. 13C-Bicarbonate in serum
5. 15-NH4 in urine
H.pylori test results may be influenced by
1. PPIs
2. H2-blockers
3. Antibiotics
Diagnostic tests for celiac disease includes
1. IgA-tTGA
2. EMA
3. HLA typing
4. Small bowel histology (most specific and sensitive)
Role of Peptide YY?
Suppress appetite
Hormones that may suppress appetite?
1. GLP-1
2. Oxyntomodulin
3. Pancreatic polypeptide
Role of CCK?
1. Stimulate the pancreas to produce the enzymes of pancreatic juice
2. Causes the gallbladder to empty. It also promotes normal cell growth of the pancreas.
Most common diagnostic tool for gastritis?
Endoscopy with biopsy
Other than [the most common diagnostic test for gastritis] the following tests may be ordered
1. Contrast XR
2. Hemofec
3. CBC (anemia)
4. H.pylori tests (RUT, Urea breath test)
Complications of chronic gastritis?
1. Peptid ulcer disease
2. Gastric polyps
3. Tumors (benign and malignant)
4. Atrophic gastritis
Most common causes of cirrhosis?
1. HepC
2. Alcohol abuse
3. Obesity
Test to assess severity of cirrhosis?
MELD. Predicts 90-day survival. Scores 6-40; lower is better.
MELD measures which three units?
1. INR
2. Bilirubin
3. Creatinine
What is Alagille syndrome?
AD inherited disease: reduced number of bile ducts-->hepatic insufficiency-->necessitates liver transplant
Unique symptoms of Alagille syndrome?
Other than liver failure:
1. Heart murmur
2. Deep set eyes, small and pointed chin
3. Opaque ring on the eyes
4. Kidney problems (various)
5. Splenomegaly
6. Abnormal carotid arteries
To make a diagnosis of Alagille syndrome, a positive liver biopsy and the presence of three of the following symptoms are usually required:
1. liver symptoms
2. heart abnormalities or murmurs
3. skeletal abnormalities
4. posterior embryotoxon
5. facial features typical of Alagille syndrome
(6. JAG1/2 mutation)