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88 Cards in this Set
- Front
- Back
achalasia
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loss of myenteric (Auerbach's) plexus -> failure of relaxation of lower esophageal sphincter -> progressive dysphagia
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What is seen on barium swallow with achalasia?
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dilated esophagus w/ area of distal stenosis (bird beak)
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What is achalasia associated with?
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increased risk of esophageal carcinoma
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Barrett's esophagus
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replacement of nonkeratinized squamous epithelium w/ gastric (columnar) epituelium in distal esophagus
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What are the risk factors for esophageal cancer?
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(ABCDEF)
Alcohol Barrett's esophagus Cigarettes Diverticuli (e.g., Zenker's diverticulum) Esophageal web (e.g., Plummer-Vinson) Familial |
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Barrett's esophagus increases the risk of what type of cancer?
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esophageal adenocarcinoma
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congenital pyloric stenosis
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hypertrophy of the pylorus -> obstruction
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What is seen clinically w/ congenital pyloric stenosis?
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palpable mass in epigastric region
and projectile vomitting at ~2 weeks of age |
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celiac disease
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autoantibodies to gluten (gliadin)
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What are the morphologic features of celiac disease?
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villus flattening, increased lymphocytes and plasma cells in lamina propria
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tropical sprue
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tropical disease
infectious? |
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Whipple's disease
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infecion w/ Tropheryma Whippelii
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What are the morphologic features of Whipple's disease?
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PAS positive macrophages in intestinal mucosa
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disaccharidase deficiency
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most common is lactase deficiency -> milk intolerance
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pancreatic insufficiency
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due to CF, chronic pancreatitis
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What does pancreatic insufficiency cause?
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malabsorption of protein, fat, vit. A, D, E, K
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chronic gastritis, type A (fundal)
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autoimmune disorder: characterized by autoantibodies to parietal cells, pernicious anemia, achlorhydria
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chronic gastritis, type B (antral)
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caused by H. pylori infection
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What does chronic gastritis increase the risk of?
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gastric carcinoma (both types A and B)
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Does pain increase of decrease w/ gastric ulcers?
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pain increases w/ meals -> wt. loss
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What is the major cause of gastric ulcers?
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H. pylori (70%)
NSAID use? |
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Does pain increase of decrease w/ duodenal ulcers?
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pain decreases w/ meals -> wt. gain
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Does weight loss of weight gain occur w/ gastric ulcers?
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wt. loss
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Does weight loss of weight gain occur w/ duodenal ulcers?
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wt. gain
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What is the major cause of duodenal ulcers?
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H. pylori infection (almost 100%)
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Hypertrophy of Brunner's glands is seen in which disease?
Gastric ulcers or Duodenal ulcers? |
duodenal ulcers
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Which disease is probably of an infectious etiology?
Crohn's disease or Ulcerative colitis? |
Crohn's disease
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Which disease is probably of an autoimmune etiology?
Crohn's disease or Ulcerative colitis? |
ulcerative colitis
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Which disease is associated w/ "skip lesions?"
Crohn's disease or Ulcerative colitis? |
Crohn's disease
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Which disease is associate w/ continuous lesions?
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ulcerative colitis
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What part of the GI is Crohn's disease seen?
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any portion of the GI tract, usually terminal ileum, small intestines, and colon
skip lesions, rectal sparing |
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What part of the GI is ulcerative colitis seen?
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colon (colitis = colon inflammation)
continuous lesions, rectal involvement |
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Which disease involves the rectum?
Crohn's diesase or Ulcerative colitis? |
ulcerative colitis
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Which disease has transmural inflammations?
Crohn's diesase or Ulcerative colitis? |
Crohn's disease
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Which diease has pseudopolyps?
Crohn's diesase or Ulcerative colitis? |
ulcerative colitis
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What is the gross morphology of Crohn's disease?
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transmural inflammation, "cobblestone" mucosa, creeping fat, bowel wall thickening ("string sign" on x-ray), linear ulcers, fissures
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What is the gross morphology of ulcerative colitis?
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mucosal inflammation, friable mucosal pseudopolyps w/ freely hanging mesentery
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What is the microscopic morphology of Crohn's disease?
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noncaseating granulomas
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What is the microscopic morphology of ulcerative colitis?
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crypt abscesses and ulcers
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Which disease is associated with colorectal carcinoma?
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ulcerative colitis
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What are the complications of Crohn's disease?
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strictures, fistulas, perianal diease, malabsorption (nutritional depletion)
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What are the complications of ulcerative colitis?
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severe stenosis, toxic megacolon, colorectal carcinoma
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Which disease is associated w/ toxic megacolon?
Crohn's diesase or Ulcerative colitis? |
ulcerative colitis
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What are the extraintestinal manifestations of Crohn's disease?
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migratory polyarthritis, erythema nodosum
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What are the extraintestinal manifestations of ulcerative colitis?
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pyoderma gangrenosum, sclerosing cholangitis
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What is the clinical presentation of appendicitis?
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initial diffuse periumbilical pain -> localized pain at McBurrney's point
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diverticulum
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blind pouch leading off the alimentary tract, lined by mucosa, muscularis, and serosa, that communicates w/ the lumen of the gut
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What is the cause of diverticulosis?
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increased intraluminal pressure and focal weakness in the colonic wall
associated w/ low-fiber diets |
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What part of the colon is diverticulosis most frequently involved?
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sigmoid colon
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diverticulitis
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inflammation of diverticula classicaly causing LLQ pain
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intussusception
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invagination of a proximal segment of bowel into a more distal segment -> bowel obstruction
can compromise blood supply |
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volvulus
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twisting of portion of bowel around it's mesentery
can lead to bowel obstruction |
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Hirschsprung's disease
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failure of neural crest cell migration -> lack of enteric nevous plexus in segment -> congenital megacolon
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AST:ALT > 1.5
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alcoholic hepatitis
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Budd-Chiari syndrome
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occlusion of IVC or hepatic veins w/ centrilobular congestion and necrosis -> congestive liver disease
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Wilson's disease
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failure of copper to enter circulation in the form of ceruloplasmin -> copper accumulation (esp. in liver, brain, cornea)
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What are the characteristics of Wilson's disease?
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(ABCD)
Asterixis Basal ganglia degeneration (parkinsonian symptoms) Ceruloplasmin low, Cirrhosis, Corneal deposits (Kayser-Fleisher rings), Copper accumulation, Carcinoma (hepatocellular), Choreiform movements Dementia |
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What is used to treat Wilson's disease?
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penicillamine
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hemochromatosis
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disease caused by deposition of hemosidern (iron)
"bronze" diabetes |
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hepatocellular jaundice
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increased conjugated & unconjugated bilirubin
increased urine bilirubin normal/decreased urine urobilinogen |
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obstructive jaundice
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increased conjugated bilirubin
increased urine bilirubin decreased urine urobilinogen |
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hemolytic jaundice
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increased unconjugated bilirubin
absent urine bilirubin increased urine urobilinogen |
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Gilbert's syndrome
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mildly decreased UDP-glucuronyl transferase
asymptomatic elevated unconjugated bilirubin w/o overt hemolysis associated w/ stress |
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Crigler-Najjar syndrome, type I
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absent UDP-glucuronyl transferase
increased unconjugated bilirubinn |
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Crigler-Najjar syndrome, type II
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less severe than type I
responds to phenobarbital |
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What are the treatments for Crigler-Najjar syndrome, type I?
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plasmaphresis, phototherapy
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Dubin-Johnson syndrome
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defective liver excretion
increased conjugated bilirubin grossly black liver |
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Rotor's syndrome
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similar to Dubin-Johnson syndrome
(defective liver excretion, increased conjugated bilirubin, grossly black liver) except milder and does not cause black liver |
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primary sclerosing cholangitis
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inflammation and fibrosis of bile ducts -> alternating strictures and dilation w/ "beading" on ERCP
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Primary sclerosing cholangitis is associated w/ what disease?
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ulcerative colitis
can lead to biliary cirrhosis |
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Reye's syndrome
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rare, often fatal childhood hepatoencephalopathy (fatty liver, hypoglycemia, coma)
associated w/ viral infection and salicylates |
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gallstones
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formed when solubilizing bile acids and lecithin are overwhelmed by increased cholesterol and/or bilirubin
3 types: cholesterol, mixed, pigment |
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What are the risk factors for developing gallstones?
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(4 F's)
Female Fat Fertile Forty |
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cholesterol stones
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radiolucent w/ 10-20% opaque due to calcifications
associated w/ obesity, Crohn's disease, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, Native American origin |
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mixed stones
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radiolucent
both cholesterol and pigment components most common type |
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pigment stones
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radiopaque
seen in pts. w/ chronic RBC hemolysis, alcoholic cirrhosis, advanced age, biliary infection |
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Charcot's triad
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epigastric, RUQ pain
fever jaundice |
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What types of gallstones are radiolucent
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cholesterol (10-20% opacity), mixed
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What types of gallstones are radiopaque?
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pigment
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What types of gallstones are seen w/ chronic RBC hemolysis?
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pigment
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What type of gallstones are seen in pts. w/ alcoholic cirrhosis?
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pigment
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What type of gallstones are associated w/ Crohn's disease?
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cholesterol
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What type of gallstones are associated w/ Native American origin?
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cholesterol
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acute pancreatitis
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caused by activation of pancreatic enzymes -> autodigestion
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What are causes of acute pancreatitis?
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(GET SMASHeD)
Gallstones Ethanol Trauma Steroids Mumps Autoimmune disease Scorpion sting Hyperlipidemia Drugs |
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What is the clinical presentation of acute pancreatitis?
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epigastric abdominal pain radiating to back, anorexia, nausea
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What is acute pancreatitis strongly associated with?
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alcoholism
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What is the clinical presentation of pancreatic adenocarcinoma?
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abdominal pain radiating to back
wt. loss (due to malabsorption and anorexia) migratory thrombophlebitis (Trousseau's syndrome) obstructive jaundice w/ palpable gallbladder (Courvoisier's sign) |