Step 1: Gi Vii Gall/pancreas

Front 1

What is Gilbert Syndrome?
- sx?
- labs?

Back 1

mildly \\UDP-glucuronyl transferase or \\billirubin uptake.
- asx.... jaudice associated with stress.
- elevated unconjucated bilirubin w/o overt hemolysis.

Front 2

Pt presents early in life with jaundice, kernicterus (bilirubin in brain), and ^^ unconjucated bilirubin... dz?
- tx?
- prog?
- if the dz responds to phenobarbital, what would it be? Why?

Back 2

Crigler-Najjar syndrome type 1
- plasmapheresis and phototherapy
- poor, pt will die w/i few years.

- type II is a more mild dz... phenobarbital upregulates liver enzyme synthesis, so it can be used to treat this more mild form.

Front 3

Pt presents with grossly black liver... probably dz/defect?
- prog?
- same dz but w/o black liver?

Back 3

conjugated hyperbilirubinemia due to defective liver excretion = Dubin-Johnson Syndrome:
- benign.
- Rotor's syndrome.

Front 4

Pt presents with asterixis, parkinsonian tremor (basal ganglia sx), Dementia. May have hemolytic anemia. Pt displays coreiform movements.
- what dz is this?
- expected ceruloplasmin?
- why would you do an eye exam?
- what cancer are they at risk of developing?
- inheritance
- tx?

Back 4

Wilson's dz: Cu accumulation in liver, brain, cornea, kidneys, and joints.
- low
- look for corneal Cu deposits (Kayser-Fleischer rings) = dark rings around corneas.
- Hepatocellular carcinoma
- AR
- penicillamine.

Front 5

What is the classic triad for Hemochromatosis?
- results in what CV sx?
- elevated risk of which cancer?
- iron labs?
- inheritance of primary dz?
- cause of 2ndary dz?
- tx?
- ASSOCIATED WITH WHICH HLA?

Back 5

micronodular cirrhosis, DM, and skin pigmentation.
- CHF
- hepatocellular carcinoma
- ^^iron, ^^ferritin, \\TIBC/transferritin
- AR
- chronic transfusion
- repeated phelbotomy, deferoxamin
- HLA-A3

Front 6

Pt presents with hypergammaglobulinemia (IgM). Has a past hx significant for UC. Patient has pruritus, juandice, dark urine, light stools, and hepatosplenomegaly.
- dz?
- what is seen on ERCP?

Back 6

concentric "onion skin" bile duct fibrosis. Alternating strictures and dilation with "beading" of intra and extrahepatic bile ducts on ERCP.

Front 7

Pt presents with pruritus, jaundice, dark urine, light stools, hepatosplenomegaly. Labs show increase in conjucated bilirubin, ^^ cholesterol, and ^^ alk phos.
Pt has known history of gall calculi. Dz?
- causes?
- complications?

Back 7

Secondary biliary cirrhosis
- extrahepatic billiary obstruction (gallstone, biliary stricture, chronic pancreatitis, carcinoma of the head of the pancreas, primary sclerosing cholangitis) --> increased pressure in intrahepatic ducts --> injury/fibrosis and bile stasis
- complicated by ascending cholangitis

Front 8

Pt presents with pruritus, jaundice, dark urine, light stools, and hepatosplenomegaly. Labs show increase in conjucated bilirubin, ^^ cholesterol, and ^^ alk phos. No hypergammaglobulinemia. No UC. No hx of stones.
- look for what in serum to confirm dx?
- pathogenesis?

Back 8

^^ serum mitochondrial antibodies.
- autoimmune rxn --> lymphocytic infiltrate + GRANULOMAS.

Front 9

What are the two types of gallstones?
- seen in which populations?
- radiolucent/opaque?
- dx?
- tx?
- four F's of risk?
- Charcot's triad of cholangitis?
- what is murphy's sign?

Back 9

cholesterol: radiolucent; associated with obesity, Crohn's dz, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, and Native American origin.

pigment stones: radioopaque; seen in those with chronic hemolysis, alcoholic cirrhosis, advanced age, and biliary infection.

US

cholecystectomy

Female, Fat, Fertile, Forty

jaundice, RUQ pain, fever

inspiratory arrest on deep palpation.

Front 10

What is biliary colic?
- in whom does it present w/o pain?

Back 10

gallstones interferring with bile flow --> cause bile duct contraction.
- can present w/o pain in diabetics.

Front 11

When do you see ^^alkphos from cholecystitis?
- usually caused by what?
- rarely caused by which virus?

Back 11

only when the bile duct is involved.
- gallstones
- CMV

Front 12

What is the mnemonic for the causes of acute pancreatitis?

Back 12

GET SMASHED
Gallstones, Ethanol, Trauma
Steroids, Mumps, Autoimmune dz, Scorpion sting, HyperCa/Hyperlipidemia, ERCP, Drugs

Front 13

epigastric abdominal pain radiating to back, with anorexia and nausea -->
- labs?
- can it lead to hyper or hypo Ca? how?
- Two REALLY bad things it can cause?

Back 13

acute pancreatitis.
- elevated amylase; elevated lipase (higher specificity)
- can lead to HYPOcalcemia b/c the calcium all gets bound up in pancreatic soap deposits.
- DIC, ARDS

Front 14

What type of necrosis is often seen with acute pancreatitis?

Back 14

diffuse fat necrosis.

Front 15

Chronic calcifying pancreatitis is strong associated with what?
- raises risk of what?

Back 15

Alcoholism
- pancreatic cancer.

Front 16

What populations are at special risk for Pancreatic adenocarcinoma?

Back 16

Jewish and AA males.

Front 17

Abdominal pain radiating to back with WL. Pt has migratory redness and tenderness on palpation of extremitites, as well as signs of obstructive jaundice with a palpable gallbladder. Dx?
- markers?
- associated with cigarettes and EtOH?

Back 17

Pancreatic adenocarcinoma

Trousseau's sign and Courvoisier's sign.

CEA and CA-19-9

smoking but suprisingly NOT EtOh.