S2: Ch 3 Gi 2-3

Front 1

343. Complications of Bile Duct Stricture?

Back 1

a. Can be life-threatening;
1. Secondary biliary cirrhosis
2. Liver abscess
3. Ascending cholangitis.

Front 2

344. Tx of Bile Duct Stricture?

Back 2

a. Endoscopic stenting (preferred)
b. Surgical bypass if obstruction complete or if endoscopic therapy fails.

Front 3

345. Where is the dysfunction in Biliary Dyskinesia?

Back 3

a. Motor dysfunction in the Sphincter of Oddi, which leads to recurrent episodes of biliary colic w/o any evidence of gallstones on diagnostic studies such as U/S, CT, or ERCP.

Front 4

346. How is Dx of Biliary Dyskinesia made?

Back 4

a. By HIDA scan.
b. Once the GB is filled w/labeled radionuclide, give CCK IV, then determine the ejection fraction of the GB. If the Ejection Fraction is low, then dyskinesia is likely.

Front 5

347. Tx options for Biliary Dyskinesia?

Back 5

a. Laparoscopic cholecystectomy and endoscopic sphincterotomy.

Front 6

348. CCK MOA?

Back 6

a. CCK relaxes the sphincter of Oddi and contracts the gallbladder.

Front 7

349. Pathogenesis of appendicitis?

Back 7

a. The lumen of the appendix is obstructed by hyperplasia or lymphoid tissue (60% of cases), a fecalith (35% of cases) or a foreign body, or other rare causes (parasite or carcinoid tumour)
b. Obstruction leads to stasis (of fluid and mucous), which promotes bacterial growth , leading to inflammation.
c. Distention of the appendix can compromise blood supply. The resulting ischaemia can lead to infarction or necrosis if untreated. Necrosis can result in appendiceal perforation, and ultimately peritonitis.

Front 8

350. When is the peak incidence of Appendicitis?

Back 8

a. In teens to mid-20s.
b. Prognosis is far worse in infants and elderly pts (higher rate of perforation).

Front 9

351. Symptoms of Acute appendicitis?

Back 9

a. Abdominal pain- classically starts in the epigastrium, moves toward umbilicus, and then to RLW.
b. With distention of the appendix, the parietal peritoneum may become irritated, leading to sharp pain.
c. Anorexia is always present. Appendicitis is unlikely if pt is hungry.
d. N/V (typically follow pain).

Front 10

352. Signs of Acute appendicitis?

Back 10

a. Tenderness in RLQ (maximal tenderness at McBurney’s point: 2/3 of distance from umbilicus to ASIS.
b. Rebound tenderness, guarding, diminished bowel sounds.
c. Low-grade fever (may spike if perforation occurs).
d. Rovsing’s sign: Deep palpation of LLQ causes referred pain in RLQ.
e. Psoas sign: RLQ pain when right thigh is extended as pt lies on L. side.
f. Obturator sign: Pain in RLQ when flexed right thigh is internally rotated when pt is supine.

Front 11

353. Diagnosis of Acute appendicitis?

Back 11

a. Clinical diagnosis.
b. Lab findings: (mild leukocytosis) are only supportive.
c. Imaging studies may be helpful if diagnosis uncertain or in atypical presentations.
i. CT scan (sensitivity 98-100%)- lowers the false-positive rate significantly.
ii. U/S (sensitivity of 90%).

Front 12

354. Tx of acute appendicitis?

Back 12

a. Appendectomy (usually laparoscopic).
b. Up to 20% of pts who are diagnosed w/acute appendicitis are found to have a normal appendix during surgery.
c. Bc the illness is potentially life-threatening, this is an acceptable risk even during pregnancy.

Front 13

355. From what cell type do carcinoid tumours arise?

Back 13

a. Neuroendocrine cells and secrete serotonin.

Front 14

356. Most common site for carcinoid tumours?

Back 14

a. Appendix.

Front 15

357. Pathophys of acute pancreatitis?

Back 15

a. Inflammation of the pancreas resulting from prematurely activated pancreatic digestive enzymes that invoke pancreatic tissue autodigestion.
b. Most pts w/acute pancreatitis have mild to moderate disease, but up to 25% have severe disease.

Front 16

358. 2 most common causes of acute pancreatitis?

Back 16

a. Alcohol abuse (40%)
b. Gallstones (40%)

Front 17

359. Risk factors for Perforation of appendix (20% of cases)?

Back 17

a. Delay in tx (>24 hrs) and extremes of age.

Front 18

360. Signs of appendiceal rupture?

Back 18

a. High fever
b. Tachycardia
c. Marked leukocytosis
d. Peritoneal signs
e. Toxic appearance

Front 19

361. In what % of pts w/carcinoid tumour does carcinoid syndrome develop?

Back 19

a. 10%.

Front 20

362. Presentation of carcinoid syndrome?

Back 20

a. Cutaneous flushing, diarrhea, sweating, wheezing, abdominal pain, and heart valve dysfunction.

Front 21

363. What ↑’s the risk of mets from carcinoid?

Back 21

a. Risk ↑’s w/size of tumour.
b. Mets are rare w/appendiceal tumours.
c. Ileal tumours have the greatest likelihood of malignancy.

Front 22

364. Tx of choice for carcinoid?

Back 22

a. Surgical resection.

Front 23

365. 10 Causes of acute pancreatitis other than alcohol and gallstones?1-5

Back 23

1. Post-ERCP-pancreatitis occurs in up to 10% of pts undergoing ERCP.
2. Viral infections (e.g., mumps, coxsackie virus B)
3. Drugs: sulfonamides, Thiazide diuretics, furosemide, estrogen, HIV meds, and many other drugs have been implicated.
4. Postoperative complications (high mortality rate)

Front 24

365. 10 Causes of acute pancreatitis other than alcohol and gallstones?6-10

Back 24

5. Scorpion bites
6. Pancreas divisum (controversial)
7. Pancreatic cancer
8. Hypertriglyceridemia, hypercalcemia
9. Uraemia
10. Blunt abdominal trauma (most common cause of pancreatitis in children).

Front 25

366. Symptoms of acute pancreatitis?

Back 25

a. Abdominal pain, usually in epigastric region
i. May radiate to back (50% of pts)
ii. Often steady, dull, and severe; worse when supine and after meals.
b. N/V, anorexia.

Front 26

367. Signs of Acute pancreatitis?

Back 26

a. Low-grade fever, tachycardia, hypotension, leukocytosis
b. Epigastric tenderness, abdominal distention
c. ↓’d or absent bowel sounds indicate partial ileus.

Front 27

368. What signs are seen w/haemorrhagic pancreatitis?

Back 27

a. Grey Turner’s sign (flank ecchymoses)
b. Cullen’s sign (Periumbilical Ecchymoses)
c. Fox’s sign (ecchymoses of inguinal ligament).

Front 28

369. Lab studies for acute pancreatitis?

Back 28

a. Serum amylase- most common test.
b. Serum lipase- more specific test for acute pancreatitis than amylase
c. LFTs- The ID cause (gallstone pancreatitis).
d. Hyperglycemia, hypoxemia, and leukocytosis may also be present.

Front 29

370. What can be ordered for assessment of prognosis w/acute pancreatitis?

Back 29

a. Ranson’s criteria:
1. Glucose
2. Calcium
3. Hematocrit
4. BUN
5. Arterial blood gas (Pao2, base deficit)
6. LDH
7. AST
8. WBC count

Front 30

371. +/- of Serum amylase for acute pancreatitis?

Back 30

a. Most common test, but many conditions cause hyperamylasemia (Nonspecific) and its absence does not R/O acute pancreatitis.
b. However, if levels are >5x the upper limit of normal, there is high specificity for acute pancreatitis.