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236 Cards in this Set
- Front
- Back
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Where does colon cancer most commonly occur
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Rectosigmoid colobn
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What is winters formula? (To determine aprop resp compensation in response to metabolic acidosis
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Pco2=1.5(HCO3) + 8 +/- 2
Or .7 inc for |
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What are the retroperitoneal structures?
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SAD PUCKER
Supra renal gland Aorta Duodenum (2-4) Pancrease (except tail) Ureteres Colon (asc and desc) Kidneys Esophagus (lower 2/3) Rectum ++IVC |
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Where does the falciform ligament connect and what is in it
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Liver to ant abd wall, has the ligmentum teres (umbilical vein)
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Where does the hepatoduodenal ligament connect and what is in it
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Liver to duodenum, Portal triad (portal vein, hepatic artery, common bile duct) Can compresse this between thumb and finger through the foramen of winslow to control bleeding (connects lesser and greater sacs)
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Where does the gastrohepatic ligament connect and what is in it
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Liver to lesser curve, gastric arteries, separates R lesser and greater sacs, part of the lesser omentum, may be cut during sugery to access lesser sac
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Where does the gastrocolic ligament connect and what is in it
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Greater curve to duodenum, part of greater omentum, has gastroepiploic vessels
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Where does the gastrosplenic ligament connect and what is in it
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Greater curve and splee, seperates left greater and lesser sacs, contains short gastrics
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Where does the splenorenal ligament connect and what is in it
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Spleen to pos abd wall, splenic artery and vein
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where are meissners and auerbachs plexi
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Meissners - submucosa
Auerbachs - muscularis externa |
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What are the BER of the stomach duod and ileum
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Stom - 3wave/min
Duode - 12 w/min Ileum 8-9w/min |
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What is the epithelium of the esophagus -
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Nonkeratinized stratified squamous epi (resp is pseudostratified columnia with cilia)
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At what level does the L renal artery come off
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L1
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What level do the gonadal arteries come off
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L2
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What level does the IMA come off
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L4
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What level does the SMA come off
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L1
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What level does the celiac dome off
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T12
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Where is the bifrucation of the aorta
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L4
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What is in the foregut
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Stomach to prox duodenum, liver, gallbladder, panc, spleen (mesoderm)
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What is the artery and innerv of the foregut
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Celiac, vagus
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What is in the midgut
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Distal duodentum to prox 2/3 of the transversecolon
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What is the artery and innerve of the midgut
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SMA, vagus
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What is in the hindgut?
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Distal 1/3 of transverse colon to the upper portion of the rectum, splenic flexure is a watershed region --> succeptible to ischemic damage during hypotension
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What is the art and innerv of the hindgut
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IMA, pelvic plexus
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where does the R gastric come from and does it supply the distal or prox lesser curve?
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hepatic artery proper, it supplies the distal lesser curve (the Stomach LEFTS always supply proximal)
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which of the gastric arteries have poor anastasmoes
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Short gastrics
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what is behind the duodenal bulb?
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Gastrodoudenal art, common biliar duct, and portal vein
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What is the anas connection to the internal thoracic/mamarry (subclavian)
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Superior epigastric (internal thoracic) <->inferior epigastric (ext iliac)
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What is the anas connection to the superior pancreaticoduodenal (celiac goes to prox duod branch off of gastroduodenal)
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Inferior panc duodenal (SMA)
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Middle colic (SMA)
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Left colic (IMA)
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Superior Rectal (IMA)
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Middle rectal (internal iliac)
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What is the portal systemic connection responsible for Esophageal varices
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Left gastric <-> esophageal(sys)
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What is the portal systemic connection responsible for caput medusa
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Paraumbilical <-> superficial and inferior epigastric
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What is the portal systemic connection responsible for internal hemorrhoids
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Superior rectal <-> middle and inferior rectal (sys)
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What is a way to relieve Portal HTN
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TIPS transjugular intraepatic portosystemic shunt bn portal and hepatic vein to relieve Portal HTN by shunting blood into systemic circulation
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What liver lobule zone does most of the o2 dependent things (B ox gluconeo)
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Zone 1
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What liver lobule zone is P450 in?
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centrilobular necrosis
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What 2 things meet at the pectinate line
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Hindgut meets ectoderm
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What occurs above the pectinate line
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Internal hemorrhoids (NOT painful) adenocarcinoma, IMA branch superior rectal art supplies it, drains into portal system
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What occurs below the pectinate line
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External hemorrhoids and SCC, art supply from inferior rectal arter (branch of pudendal) Drains into IVC
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Where do most fissures occur
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Posterior midline or the anal verge
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What two things meet at the ampulla of vater
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Panc duct and the CBD
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what does the femoral sheath NOT contain
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the nerve, sheath is 3-4 cm below the ing ligament
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what borders the fem triangle
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Lateral: sartorius, Medial Femoral nerve/sheath, superior inguinal ligament
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What salivary gland produces serious saliva
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parotid
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What salivary gland produces mucionous
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sublingual
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Diaphragmatic hernia causes what is the most common?
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Can occur in infants due to defect in pleuroperitoneal membrane, commonly a hiatal hernia in which stomach herniates upward throug hthe esophageal hiatus of the diaphragm (often asympt)
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What is a sliding hiatal hernia
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Mos common GE junction is displaced see and hourglass stomach
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What is a paraesophageal hernia
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GE junction is normal, caria moves into thorax to the side
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What two rings does an inderect go through
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Superficial and deep inguingal
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What borders Hesselbachs triangle
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This is for a direct hernia
1-lateral - inferior epigastric 2- medial - rectus abdominus 3- inferior - inguinal ligament |
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Is a direct hernia medial or lateral to the inferior epigastrics
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Medial
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What rings does a direct hernia go through
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ONLY THROUG HTHE EXTERNAL (superficial). It will be covered by external spermatic fascia. Tends to be more midline than a femoral Bulges into the abdomina wal
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Femoral hernia where does it protrude
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Below inguinal ligament through femal cnal below and lateral to pubic tubercal. Tend to occur in women...and on the RIGH ** it is the leading cause of bowel incarceration
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What are two potent stimulators of gastrin
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Phenylalanine and Tryptophan (also vagally innervated)
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What secretes CCK
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Icell in the duodenum,
** CCK can act on neural muscarin pathways to cause panc secretion (it inc panc sec) |
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What increases bilsecretion and Panc HCO3 sec
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Secretin
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What 2 things meet at the pectinate line
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Hindgut meets ectoderm
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What occurs above the pectinate line
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Internal hemorrhoids (NOT painful) adenocarcinoma, IMA branch superior rectal art supplies it, drains into portal system
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What occurs below the pectinate line
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External hemorrhoids and SCC, art supply from inferior rectal arter (branch of pudendal) Drains into IVC
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Where do most fissures occur
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Posterior midline or the anal verge
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What two things meet at the ampulla of vater
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Panc duct and the CBD
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what does the femoral sheath NOT contain
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the nerve, sheath is 3-4 cm below the ing ligament
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what borders the fem triangle
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Lateral: sartorius, Medial Femoral nerve/sheath, superior inguinal ligament
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What salivary gland produces serious saliva
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parotid
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What salivary gland produces mucionous
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sublingual
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Diaphragmatic hernia causes what is the most common?
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Can occur in infants due to defect in pleuroperitoneal membrane, commonly a hiatal hernia in which stomach herniates upward throug hthe esophageal hiatus of the diaphragm (often asympt)
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Where are the cells that secrete somatostatin found
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D cells in the panc islets and GI mucosa stim by acid and the vagus
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What secretes GIP and what does it do
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K cells in the duodenum and jej - cause dec gastic H and inc insulin this is why a oral glucose load more rapidly responds with insulin than by IV
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What releases VIP
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PS ganglia in sphincters, the GB and SI
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What does VIP do
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Inc intestinal water, and electrolyte sec, causes relax of sphincters...stim by distension and vagal stim, dec by adrenergic input
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Where are VIP omas found
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pancreas see lots of diarrhea
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Where does b12 bind IF
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duodenum (proteases break it free from R binders)
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What dec gastric acid
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Somatostatin, GIP, PG, secretin
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What causes pepsin release
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Vagal stim and local acid
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What 2 secretions contain Hco3
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Panc and biliary
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What CN moves through the parotid gland
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CN VII
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IF saliva is made at a low flow rate what is the tonicity
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Hypotonic
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What is saliva tonicity at high flow rates
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Isotonic
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What two cell types are in the antrum
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G cells and mucous cells
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What molecule blocks vagal stimulation of parietal cells, and why are G cells unaffected
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Atropine, G cells are unaffected as a different transmitter (GRP) is used
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What gastric cell releases Histamine
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ECL stim by gastrin
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What is the muscarinic receptor that inc acid secretion
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M3
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What is the H receptor
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H2
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What type of G protein do the M3 and Gastrin use
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Gq --> inc IP3
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In what condition do you see hypertrophy of brunners glands
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PUD glands are in the submucosa)
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Where are the oligosaccraride hydrolases? What do they do?
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Brush border, rate limiting step of carb digestion produce monosaccs from oligo and disacchs
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What 3 monosaccs are absorbed by entero
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Glucose galactose and fructose
G and G takne up by SGLT1 (na dep) Fruc - GLUT 5 All go into blood via GLUT 2 |
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Where is folate absorbed
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jejunum
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In what mucosal layer and peyers
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Lam prop and Submucosa
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What does bile contain
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Bile salts (bile acid conjugates to glycine or taurine to make them water soluble) ppls, cholesterol, bilirubin, water, and ions.Only significant method for cholesterol excretion
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After being broken down by macros what does unconj bilirubin use to get to the liver
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Albumin in the blood
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What happens to urobiliinogen (made by bacteria in gut from bili)
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80% goes to feces
20% reabs --> 10% kidney exc, 90% back to liver |
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Where do salivary tumors usually occur ?
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Parotid, usually benign
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What is a pleomorphic adenoma of the partoid
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most common, painless movable high rate of recurrence, benign
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What is the most common malig salv tumor
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Mucoepidermoid carcinoma
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What is a warthins tumor
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benign; heterotopic salivary glad trapped in a lymph node surrounded by lymphatic tissue
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what is CFTR upregulated by (think cholera toxin)
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cAMP
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What plexus do you lose in achalasia
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loss of myenteric plexus, high LES pressure, uncoor peristalsis
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What is the dysphagia profile of acha
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Solids then liquids, (UNLIKE OBSTRUCTION WHICH IS ONLY SOLIDS) assoc w/ inc risk of eso carcinoma
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What causes esophageal dysmotility with Low pressure prox to LES
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CREST
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What diseases can affect the UES
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NMJ dz myasthenia gravis,
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How does diffuse esophageal spasm resent
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Noncoordinated, painful, can prevent movement of a food bolus, looks like a corkscrew on eso barium swallow
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Where do eso varcies occur
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Lower 1/3 of the esophagu
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What are eso strictures assoc with
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Lye ingestion and acid reflux
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What are the causes of esophagitis
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Reflux, infecton (CMV, HSV1,candida) or chemical ingestion
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What are causses of Intussusception in kids v adults, what iare some conplications
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-kids = idiopathic coud be viral (adeno)
- adults -intraluminal mass of tumor Can compromise bowel blood supply. Abd emergency in kids |
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What is a volvulus
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Twisting of a portion of bowel around its mesentery, can lead to obstruction and infarction. May occur at cecum and sigmoid coln where there is redundant mesentary (floppy colon) Usually in the ELDERLY
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How can Gi infection cause intusseception
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Hyperplastic peyers patches that can cause a bowel obstruction
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What are the s/sx of a bowel obstruction
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Pain, nausea, vomiting, perforation, adhesion and hernia
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Why does intuss cause ischemia
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It can impair venous return from the invaginated segement
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What is hirschsprungs disease
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Congen megacolon char by lack of ganglion cells/enteric nervous plexuses (aurerbachs and meissners (submuc). This is due to FAILURE OF NEURAL CREST CELL MIGRATION. Presents as chronic constipation early in life. Usually have a failure to pass meconium. 75% involve the rectum. Risk Inc with Downs.
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What is an acute coloic pseudoobstruction what causes it
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Nonobstructive gross dilation of cecum or R hemicolon,. Assoc with chronic narcotis ,spinal anesthesia, trauma and sepsis.
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What disease are associated with toxic megacolon
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C diff, UC, T. cruzi
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What are the s/sx and associations of duodenal atresia
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Bilious vomiting, poximal stomach distension - see the DOUBLE BUBBLE sign in the stomach. Assoc with downs Due to failure of RECANAL of the duodenum
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What is usually involved in nec enterocolitis.
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Colon, but can involve entire tract
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What is Ischemic colitis
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Reduction in intestinal blood flow causes ischemia, pain after eating --> weight loss, commonly occurs at splenic flexure and distal colon, typically affects the elderly
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What causes angiodysplasia
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Tortuous dilation of the vessles --> bleeding most often found in cecum, terminal ileum and asc colon. Most common in older ppl. Dx with endoscopy and treat with cautery
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What is assoc with gerd
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Esophagitis, eso ulcers, increased risk of adeno carcinoma
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What can cause a zenker diverticulum
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Cricopharyngeal dysfunction, muslces have dimished relaxation and during swallowing they have more intense contractions. Pressure can cause pharyngeal mucosal herniation
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What are the signs of eso cancer?
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Progressive dysphagia (solid --> liquid) odynophagia, weight loss
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What are the risk factors for eso cancer?
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Alcohol/acalasia, barretts, cigarettes, diverticuli(zenker), esophageal web, esophagitis, familial
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where does adenocarc occur? and scc?
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1. lower 1/3
2. mid 1/3 |
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What are s/sx of whipples
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Malabs, arthralgia, cardia and neuro symtpoms are common. Most often occurs in older bowell.
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What do you see histo in dermatitis herpatiformis
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PMNs and fibrin at the tips of the paillae forming microabscess. IF reveals IGa deposits in the tips. See symetrrically on extensor surface very purulent. See with celiac
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What kind of diarrhea do you see in disacc def?
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osmotic...self limited lactase def can occur following inury (eg viral diarrhea)
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What is the pathology of ABeta lipoproteinemia
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can't gen chylomicros = dec exc of cholesterol, and VLDL into bloodstream, fat accum in enterocytes malabs and neur manifestation see acanthocytes
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How do you test lactase def
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Give them lactose check their blood for lactose if lose (<20) + GI sx = ++ test
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Osmotic gap what is low what is high
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Low <50
High >100 lactase def, fictious diarr |
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What the Ab in celiac
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Tissue transglutaminase and gliadin - IgA
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What do you see in celiac
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Villi bluntin and lympos in the lamina propriamain affects the jejunum . Mod increase risk of malignancy
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What are the HLA associations in celiac sprue
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DQ2, DQ8
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What is the mechanism to acute gastritis
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Disruption of mucosal barrier --> inflmm
Causes: Stress Alcohol Uremia Burns (curlings) Brain injury (Cushings ulcer due to inc ICP stim vagal) |
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Where does Type A chronic gastritis occur, causes?
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Fundus, body
AI, pernicious anemia, achlorhydia |
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Where does Type B chronic gastritis occur, causes?
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Antrum most common type, caused by H. pylori infection, inc risk of MALT lymphoma
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What is Menetriers disease
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Gastric hypertrophy with protein loss, parietal cell atrophy, and inc mucosa cells, Precancerous Rugae of stomach are super hypertrophied. In kids this can be assoc w/ CMV
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What kind of cancer is gastric
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almost always adeno
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What is associated with Gastic cancer
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Nitrosamines, achlorhydia, chronic gastritis, type A blood, Signet ring cells, acanthosis nigricans
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When gastric cancer is diffusely infiltrative (thickened rigid appearance) Linitis plastic...what is it called?
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Linitis plastica...what is it called?
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What is a sister mary joesphy nodule and a virchows node
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sister - periumbilical sub cut met
Virchows nodule - left superaclavicular node by mets |
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What is a blumer shelf
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Extracolonic mass due to mets that settle in the pouch of douglass can feel on DRE
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What is the pathogenesis of pyloric stenosis
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Congeital pyloric hypertrophy --> obstruction --> nonbilious projectile vomiting --> demands to be refed soon --> 2 to 6 weeks
Can aquire it from chronic ulceration --> scar tissue |
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What are the s/sx of gastric cancer
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wt loss, abd pain, N/V, early satiety
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In which ulcer do almost 100% of people have H pylori
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doudenal ulcer
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If you have many ulcers and they are in more distal areas of the duodenum what should you consider
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Zollinger ellison
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Where are ulcers in the stomach most commonly found
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Lesser curvature
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Which ulcer is not cancerious
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doudenal
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What are complications of a duodenal ulcer
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Bleeding, penetration into pancreas, perforation, and obstruction, not cancerous
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What does an erosion not enetrate
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the muscularis mucosa
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What is the possible etiology of crohns and of UC?
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C - disorder response to intestinal bacteria
UC - Autoimmune |
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Which IBD shows skip lesions, rectal sparing and can hit any portion of the GI tract but usually hits the terminal ileum and colon
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Crohns
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What IBD always involves the returm, and causes mucosal and submucosal inflamm?
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UC
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What causes pseudopolyps
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UC
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What IBD is assoc wit holorectal cancer
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Both but I think more so UC
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What are the extraintesting manifestations of UC
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Pyoderma gangrenosum, primary sclerosing cholangitis, ank spondylitis, uveitis
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What are the extraintestinal manifestations of Crohns
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migratory polyarthritis, erythema nodosum, immunologic disorder.
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How do you treat crohns vs UC
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1. Corticosteroids, infliximab
2. ASA (sulfasalazine), 6-mp, infliximab, colectomy |
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Which IBD has non caseating granulomas and lymphoid aggregates
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Crohns -- TRANSMURAL INFLAMM
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What is the mico path of UC
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Crypt abscesses, ulcers, bleeding, NO GRANULOMAS
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What are the criteria for IBS
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>/= 2
Pain improves with defecation Change in freq Change in appearance No structural abns |
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ApWhat are the causes of appendicitis in adults and kids
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Kids - lymph hyperplasia after virus,
Adults - obstruction, fecalith |
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What are the sx of appedicitis
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Diffuse periumbilical pain --> localized at mcburneys. Nausea, fever, may perf --> peritonitis
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Whats the ddx for appedicitis
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Diverticulitis, ectopic pregnancy
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Where are diverticulum most often found
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Sigmoid
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Diverticulous s/sx
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Often asymptomatic, can cause painless rectal bleeding
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What is the classic triad of divertic
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Fever, LLQ pain, leukocytosis. Can perf. Give abs, can cause BRBPR, can also cause a colovesicular fistula --> pneumaturia
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Zenkers diverticulum - false or true?
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False
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What is the most common congenital anomly of the GI tract
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Meckels
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What can meckelscause
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itussusception. volvulus, obstruction.
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What are the 5 "2s" of meckels
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2% of the pop
2 inces long 2 feet from ileocecal valve may have 2 types of epi (panc,gastric) Presents in first 2 years of life |
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Where are polyps often found
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Rectosigmoid
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Wht type of polyp is precancerous and what is assoc with inc malignant risk
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Adenomatous polymps, inc size, villous histology, and epi dysplasia are precursors to CRC.
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What is the most common non neoplastic polyp in the colon
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Hyperplastic
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What are mostly sportadic lesions in kids <5, 80% in the rectum, if single - no malig potential
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Juvenile polyp
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What is Peutz jeghers syndrome.
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AD syndrome with multiple nonmalig hamartomas throughout the GI tract with hyperpigmentsed mouth, lips, hands, genitals
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What is Cowden
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AD PTEN mutation in the t supressor gene. Hamar polymps, skin tumors, hemangiomas and lipomas no GI risk
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What is cronkite-canada
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Non hereditary dev after 50 polps are throughout the GI tract
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What do you see in CRC on the L vs R
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L - obstruction, colicky pain can still bleed
R - bleeding/anemia, dullpain |
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Whats the gene mut in FAP
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APC gene on chromo 5q...2 hit hypothesis leads to 100% progression to CRC with thoughsands of polymps
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What is gardners syndrome
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FAP + osseous and soft tissue tumors (retinal hyperplasia too)
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HNPCC/Lynch
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AD mut in DNA mismatch repair 80% go to CRC also inc risk of endometiral stomach ovarian and brain cancer.
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Whats the tumor marker for CRC
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CEA
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What is the radiographic sign with CRC
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apple core lesion
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Where is the most common CRC met
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Liver via portal circ
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What are additional CRC RFs
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IBD, S. bovis, bacteremia, tobacco, large villous adenomas, juvenile polyposis syndrome, peutz jeghers syndrome.
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What is the apc/Bccatenin pathway
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Chromoxomal instability pathway (85%) loss of APC (dec intercell adhesion and inc prolife this is loss of B catenin) ---> KRAS mut (unreg intracell signal xduction --> adenoma --> loss of p53 (inc tumorigenesis) --> carcinoma
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What is the microsatellite instability pathway
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Dna mismatch repair gene mutations --> sporadic and HNPCC syndrome. Muts accumulate but no defined morph correlates...See R sided, sessile serrated ademonas
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what is the most common site of carcinoid syndrome
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Apppedix,ileum, and rectum, most commonly malignant in the SI
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What do you see in EM
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dense core bodies
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In histological section...What do you see in carc tumor
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uniform 'nests' of cells
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What causes Micronodular nodules
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< 3 mm Uniform in size due to metab insult - alco, hemochro, wilsons,
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What cause Macronodular nodules
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>3mmvaried size, usually due to significant liver injury like hepatic necrosis or drug induced. Inc risk of hepatocellular carcinoma
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when is the ALT>AST
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viral hepatitis
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GGT
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inc with variousl iver dz, inc with heavy alcohol consumption
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What enzyme can mumps inc
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Amylase
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What type of fat change happens in reyes, wahts the pathophys
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Microvesicular fatty change, hdue to mito abns, also see hypoglycemia and coma. asp metab dec B ox by reversible inhibition of mito enzymes
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What type of change do you see in hepatic steatosis
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Macrovesicular - its reversible with cessation
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What causes alc hepatitis
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Long term sustained consumption, See swollen necrotic hepatiwith neutrophilic infiltration, mallory bodies, intracytoplasmic eosinophilic inclusions
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Alco cirossis where do you see the sclerosis
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around the central vein (zone III) see jaundice, hypoalbuminemia, micronodular change
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What are the RF of HCC
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Hep B and C, wilsons, hemo, apha 1 antitryp, alc cirrhosis and carincogens, aflatoxins
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what are the finding in HCC
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jaundice, tenderhepatomeg, ascites, polycythemia, and hypoglycemia , INC AFP...you may get BUDD CHIARI
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What are 2 causes of nutmeg liver
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CHF, and Budd chiari..if congestion continues you can get centrilobular congestion and necrosis that results in cardiac cirrhosis
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What can HCC tumors secrete
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EPO, insulin like prot, PTH like
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Budd chiari patho
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Occ of IVC or hepatic veins with centrilobular congestion and necrosis leading to congestive liver disease can get varisces and have visbile abd and back veins. Signs of liver failure. Assoc with hypercoaguable states, polycthemia vera, preg, and HCC, tb, OCs
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Whats the protein problem in A1antitrypsin
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Misfolded CODOMINANT
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what things can cause liver angiosarcoma
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arsenic, thorotrast, polyvinyl chloride CD 31+ or PECAM
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What kind of bilirubinemia do you see withneonatal jaundice
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Unconjugated hyperbili
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Whats the def and s/sx of crigler najar I
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UDP glucuronyl transferase is ABSENT (autoR) presents early in life, patients die within a few years see jaundice kernicterus, and inc unconj bili. Tx =plasmapheresis and phototherapy
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How can you treat C-J type II
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AD phenobarbital
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What is the enzyme def in Dubin johnson
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CMOATdefective liver excretion. Black liver
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what is the patho of WIlsons
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Inadequate hepatic copper excretion and failure of copper to enter circ as ceruloplamsin
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What are the s/sx of wilsons
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Asterixis,
BG degeneration (parkinsons like) Ceruloplamin low (cirrhosis, corneal deposits, carcinoma, choreiform movements) Dementia Hemolytic anemia, RTA damage, |
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How do you treat wilsons
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Penicillamine
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What is the classic triad of hemochromo
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Micronodular cirrhosis, DM and skin pigrmenation
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whats the HLA assoc with hemochromo
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HLA a3
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What is a secondary cause of hemochromo
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Transfusions without chelation (B thal)
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What is the cause of primary biliary cirrhosis
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AUTOIMMUNE see lympho infiltrate and granulomas. Inc serum mitochondrial antibody (incl IgM), santhomas. INTRAHEPATIC
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What do you see in primary sclerosing cholangitis
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Onion skin bile duct fibrosis --> alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
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What is assoc with PSC
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Hypergammaglobinemia, UC, can lead to secondary biliary cirrhosis
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What are the things that can lead to gall stones
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Inc cholesterol and/or bilirubin dec bile salts, and gallbladder stasis
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Chol stones - radio lucent or opaque?
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Lucent with 10-20% opaque due to calcifications
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What are the rfs for cholesterol stones
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Obese, crohns, CF, advanced age, clofibrate, estrogen, multiparity, rapid weight loss, native american
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What are black stones assoc with
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hemolysis
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What are brown stones assoc with
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infection (Ecoli, ascaris or cloronichis)
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What is charcots triad of cholangitis
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Jaundice, fever, RUQ
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Why would you see air in the biliar tree
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bc a gallstone caused a fistula bn the gallbladder and SI it can cause a gall stone to get stuck in the ileocecal valve - gallstone ileus.
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What are the causes of acute panc
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GET SMASHED
Gallstone ERCP Trauma Steroids Mumps Autoimmune dz Scorpion sting Hyperlipidemia/Hypercalcemia Ethanol Drugs (sulfa) |
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What is the clinical presentation of acute panc
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epigastric abd pain radiating to back, anorexia, nausea, pain worse supine
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What can acute panc lead to
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DIC, ARDS, diffuse fat nec, hypocal (secondary to panc ca soap deposits) see PSEUDOCYSTS, hemorrhage, infection and multiorgan failure
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What is the cullen sign
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blusih discoloration around the umnilicus--> hemoperitoneum
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What can chonic panc lead to
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Pan insufficiency - steatorrhea, fat soluble vit def and DM
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What is chronic calcifying panc strongyly associated with
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alcoholism and smoking, inc risk of panc cancer
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What are the tumor parkers for panc adenocarcimona
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CEA and ca 19-9
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where are the tumors most often seen
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Pan head --> obstructive jaundice
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How does panc cancer present
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abd pain that radiates to the back, weight loss (malabs and anor), migratory thrombophlebitis, obstructive jaundice with palpable gallbladder (couvosseirs sign
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What is the presentation and labs of someone with biliary tract dz
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Pruritis, jaundice, dark urine, light stools, hepatosplenomegaly, labs - inc conjug bili, inc choles, inc alk phos
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