Thomas First Aid Gi

Front 1

what parts of GI tract are retroperitoneal? Pancreas? Abdominal vasculature?

Back 1

GI Tract- 2,3,4th part of duodenum, ascending and descending colon
tail of pancreas
abdominal aorta and IVC

Front 2

what ligament is remnant of fetal umbilical vein?

Back 2

falciform (contains ligamentum teres, connects liver to ant. abdominal wall)

Front 3

what are the components of the portal triad and what ligament contains them

Back 3

Portal Triad- Hepatic Artery, Portal Vein, Common Bile Duct

Hepatoduodenal ligament

Front 4

what ligament contains the gastric arteries

Back 4

gastrohepatic ligament

Front 5

what ligament contains the gastroepiploic arteries

Back 5

gastrocolic ligament

Front 6

what ligament contains the short gastric arteries

Back 6

gastrosplenic ligament (greater curvature of stomach and spleen) contains GASTRIC arteries because gastric comes first

Front 7

what ligament contains the splenic artery and vein

Back 7

splenorenal ligament
contains SPLENIC artery because spleen comes first

Front 8

Layers of gut (4)

Back 8

mucosa (epithelium, lamina propria, muscularis mucosa), submucosa (includes Meissner's/Submucosal nerve plexus), muscularis externa (inner layer circular layer, Auerbach's/Myenteric nerve plexus, outer longitudinal layer), Serosa

Front 9

what is order of fast to slow basal electric rhythm for stomach, duodenum, ileum

Back 9

fastest- duodenum
middle- ileum
slowest- stomach

Front 10

of small intestine, which sections have:
brunner's glands
crypts of liberkuhn
Plicae circulares
Peyer's patches

Back 10

all- crypts of liberkuhn
jejunum and ileum- plicae circulares
brunner's glands- duodenum
peyer's patches- ileum

Front 11

which region of colon has crypts but no villi?

Back 11

colon

Front 12

what arteries come off aorta at each of the following levels:
T12
L1 (2)
L2
L3
L4

Back 12

T12- Celiac Trunk
L1- Renal Arteries, SMA
L2- Testicular/Ovarian Arteries
L3- IMA
L4- bifurcation of aorta

Front 13

Celiac Trunk supplies what structures

Back 13

stomach, liver, spleen, proximal duodenum, gallbladder, pancreas

Front 14

what part of GI is watershed region

Back 14

splenic flexure

Front 15

stomach arteries:
all come off what artery
lesser curvature supplied by
greater curvature supplied by
only arteries without anastamoses

Back 15

Celiac trunk
lesser curvature- left and right gastric arteries
greater curvature- left and right gastroepiploic arteries
no anastamoses- short gastric arteries

Front 16

3 areas of anastamoses seen in portal HTN and their associated vein anastamoses

Back 16

esophagus (left gastric (backed up) - esophageal vein)
umbilicus (periumbilical (backed up) - superficial and inferior epigastric)
rectum (superior rectal (backed up)- inferior rectal)

Front 17

pectinate line: hemorrhoid development above vs. below, cancer type above vs below

Back 17

above pectinate line:
adenocarcinoma
internal hemorrhoids indicate portal HTN,NOT PAINFUL

below pectinate line:
squamous cell carcinoma
external hemorrhoids painful (somatic innervation)

Front 18

tumors that arise in head of pancreas can block what duct

Back 18

common bile duct

Front 19

Femoral structures organization (5)
what structures in femoral sheath?

Back 19

NAVEL with venous near the penis
nerve, artery, vein, empty space, lymphatics

femoral sheath- artery, vein, lymphatics, NOT NERVE

Front 20

Direct vs Indirect hernia
which goes through abdominal wall, which through deep inguinal canal?
which do old men get?
which medial and which lateral to inferior epigastric artery

Back 20

Direct- old men have weaker abdominal walls, direct protrusion (like Dad). This is Medial to inf. epigastric artery
Indirect- occurs in infants and younger men and goes through deep inguinal canal. Deep inguinal canal more lateral, so lateral to inferior epigastric artery. Can form a hydrocele in infants.

Front 21

femoral hernia protrudes below what and through what, who usually gets it

Back 21

3rd type of hernia, protrudes below inguinal ligament and through femoral canal. women get this one

Front 22

a hernia going medial to inferior epigastric artery, lateral to rectus abdominis, above inguinal ligament is what type

Back 22

Direct

Front 23

G cells
found where
secrete what, fxn

Back 23

antrum of stomach
Gastrin
increase HCl, motility

Front 24

I cells
found where
secrete what, fxn

Back 24

CCK
small intestine
pancreatic secretions

Front 25

S cells
found where
secrete what, fxn

Back 25

Secretin
small intestine
pancreatic HCO3

Front 26

D cells
found where
secrete what, fxn

Back 26

somatostatin
GI and pancreatic islets
inhibit all actions of digestion

Front 27

K cells
found where
secrete what, fxn

Back 27

GIP
small intestine
increase insulin secretion

Front 28

VIP hormone fxns (2)

Back 28

increases water and electrolyte secretion in intestine, decreases motility

Front 29

Motilin hormone fxn
found where

Back 29

increase peristalsis
in small intestine

Front 30

how are secretin and CCK fxns tied together?

Back 30

CCK (from I cells) induces pancreatic enzyme secretion

Secretin (from S cells) induces pancreatic HCO3 secretion

both by fatty acid intake

Front 31

3 substances that increase gastric acid secretion

Back 31

histimine, ACh, gastrin

Front 32

4 substances that decrease gastric acid secretion

Back 32

somatostatin, GIP, prostaglandins, secretin

Front 33

Pepsin fxn, produced by what cells

Back 33

protein digestion
produced by Chief cells in stomach

Front 34

2 products secreted by Parietal cells

Back 34

Intrinsic Factor (binds B12)
Gastric Acid

Front 35

is salivary secretion stimulated by sympathetic or parasympathetic activity

Back 35

both (T1-T3 superior cervical ganglion, glossopharyngeal and facial nerve fibers)

Front 36

Parotid, Sublingual, Submandibular glands: which most serous, which most mucinous

Back 36

Serous on sides= parotid
Mucinous in middle= sublingual

Front 37

How does Gastrin secretion stimulate HCl production

Back 37

Gastrin from G cells stimulates ECL cells which release histimine to parietal cells that secrete HCl into stomach. This is most important mechanism of gastric secretion

Front 38

atropine blocks vagal stimulation of what cells

Back 38

parietal cells

Front 39

Cimetidine mechanism in stomach

Back 39

blocks histimine from ECL cells from stimulating parietal cells to produce HCl

Front 40

Brunner's glands
fxn
location and depth
hypertrophy seen in what

Back 40

fxn- secrete alkaline mucus in duodenum
location- in duodenal submucosa (ONLY SUBMUCOSAL glands in GI)
hypertrophy seen in peptic ulcer disease

Front 41

Trypsinogen activated by what, fxn

Back 41

activated by enterokinase/enteropeptidase
trypsin activates many more zymogens including more trypsin

Front 42

what is rate limiting step in carbohydrate digestion

Back 42

oligosaccharide hydrolases on GI brush border than break oligosaccharides into monosaccharides

Front 43

Peyer's patches
fxn, location
2 populations of cells

Back 43

unencapsulated lymphoid tissue in ileum
M cells- take up antigen
B cells- secrete IgA (gains secretory component and then transported across epithelium)

Front 44

UDP gluconyltransferase action

partial UDP gluconyltransferase def is what syndrome

complate UDP gluconyltransferase deficiency is what syndrome

Back 44

adds gluconurate (with cofactor uridine) to bilirubin to conjugate it

paritial - Gilbert's syndrome

complete - Crigler-Najjar Syndrome

Front 45

what cell makes unconjugated bilirubin

Back 45

macrophage break down rbcs, heme to unconjugated bilirubin

Front 46

painless movable mass in parotid gland usually

Back 46

pleomorphic adenoma (benign but high rate of recurrance)

Front 47

achalasia is loss of what nerves?
increased risk of what?

Back 47

myenteric (auerbach's) plexus in musclaris externa

esophageal carcinoma

Front 48

2 secondary causes of achalasia

Back 48

CREST syndrome
chagas

Front 49

3 infections associated with esophagitis

Back 49

CMV, HSV-1, candida

Front 50

Mallory-Weiss syndrome vs Boerhaave syndrome

Back 50

Mallory Weiss- mucosal tear at gastroesophageal junction
Boerhaave syndrome- transmural esophageal rupture (usually due to violent retching)

Front 51

dysphgia, glossitis, iron-deficient anemia

Back 51

Plummer-Vinson Syndrome

Front 52

what is metaplastic change in Barrett's esophagus

Back 52

replacement of nonkeratinized stratified squamous epithelium with intestinal columnar epithelial cells

Front 53

2 causes of esophageal strictures

Back 53

lye ingestion
GERD

Front 54

progressive dysphagia of solids and liquids indicates

Back 54

achalasia (obstruction would be just solids)

Front 55

risk factors for esophageal cancer (6)
most common esophageal cancer in world
most common esophageal cancer in US

Back 55

ABCDEF
alcohol use
barrett's esophagus
cigarettes
diverticuli (Zenker's)
Esophagitis/Esophageal webs (Plummer-Vinson syndrome)
Familial

Worldwide- squamous cell carcinoma (middle 1/3 esophagus)
US- adenocarcinoma (bottom 1/3)

Front 56

malabsorptive syndrome with cardiac and neuro symptoms and PAS positive macrophages?

Back 56

Whipple's disease (Troperyma whippelii)

Front 57

section of bowel absorption:
iron
folate
B12

Back 57

iron- duodenum (Fe2+)
folate- jejunum
B12- terminal ileum

Front 58

Celiac sprue primarily affects what region of bowel

Back 58

proximal small intestine

Front 59

why can lactose and other disaccharide absorption be inhibited after viral diarrheas and other abdominal injury?

Back 59

because disaccharidases are located at brush border and damage to tips can cause deficiency

Front 60

Abetalipoproteinemia mech and problems

Back 60

not Apo-B--> no creation of chylomicrons--> fat accumulation in enterocytes. causes malabsorption and neurological deificiencies
retinitis pigmentosum

Front 61

3 causes of pancreatic insufficiency

Back 61

pancreatic cancer, chronic pancreatitis, cystic fibrosis

Front 62

Celiac Sprue changes:
2 abs seen
change in jejunum structure
skin disorder association
malignancy association

Back 62

abs: transglutaminase (screening ab), gliadin
jejunum change: blunting of villi with crypt hyperplasia
skin disorder association: herpetitis dermatiformis
malignancy risk: T-cell lymphoma

Front 63

Curling's vs. Cushing's ulcer in acute gastritis

Back 63

Curling's- seen in burn patients, decreased plasma volume causes epithelial sloughing
Cushing's - brain injury, increased vagal stimulation causes increased ACh stimulation of parietal cells--> acid production

BURN your hand on CURLING iron, and always CUSHion the BRAIN

Front 64

NSAID mechanism of acute gastritis

Back 64

decreased prostaglandin production that provides GI mucosal protection

Front 65

2 types of chronic gastritis, location and cause of each

Back 65

Type A- autoimmune (to parietal cells in Fundus/Body--> pernicious anemia and/or achlohyrdia)

Type B- caused by H. Pylori infection

Front 66

H. pylori infection increases risk of what malignancy

Back 66

MALT lymphoma

Front 67

stomach rugae hypertrophy (like brain gyri) seen in what disease? 1 cell population decreased, increased,, risk for what

Back 67

Menetier's disease
decrease in parietal cells
increase in mucosal cells
precancerous

Front 68

when adenocarcinoma of stomach is diffusely infiltrative, see what gross finding

Back 68

Linitis plastica (thickened, "leather bottle" appearance of stomach)

Front 69

signet ring cells in ovary tissue indicate

Back 69

Krukenburg tumor (stomach adenocarcinoma met)

Front 70

2 nodes seen in stomach cancer

Back 70

periumbilical (Sister Mary Joseph)
left supraclavicular (Virchow's node)

Front 71

4 risk factors for stomach adenocarcinoma cancer (most stomach cancers are this type)

Back 71

achlorhydria, Type A blood, chronic gastritis,nitrosamines (smoked foods)

Front 72

duodenal vs. gastric ulcers
which always associated with H. Pylori infection?
weight gain?
increased gastric acid secretion?

Back 72

H. pylori infection- duodenal (only 70% in stomach)
weight gain- duodenal (feels better when eating)
increased gastric acid secretion- can be with duodenal (ZE syndrome), both can also be due to decreased mucosal protection

Front 73

cobblestone mucosa, creeping fat, and "string sign" on barium swallow x ray with rectal sparing

Back 73

Chron's disease
"a FAT GRANny (granuloma) and and old CRONe skipping down a COBBLESTONE road away from a WRECK (rectal sparing)

Front 74

Chron's vs. Ulcerative Colitis
which has granulomas
which has pseudopolyps
which has loss of haustra
which has higher incidence of colorectal cancer

Back 74

pseudopolyps, loss of haustra (lead pipe appearance on x-ray), and higher risk of colorectal cancer: Ulcerative Colitis
-Adam is fucked, will get colorectal cancer, pseudopolyps, loss of haustra

granulomas: Chron's (the transmural inflammation one)

Front 75

recurrent abdominal pain that improves with defecation, think

Back 75

IBD

Front 76

Chron's vs. Ulcerative Colitis
for which are uveitis, rheumatoid disorders more common associations?
which is more associated with primary sclerosing cholangitis?

Back 76

Chron's - uveitis, ankylosing spondylitis, immune disorders

Ulcerative Colitis - primary sclerosing cholangitis

Front 77

true diverticulum

Back 77

Meckel's diverticulum (all three layers outpuch (mucosa, submucosa, muscularis)

Front 78

Diverticulosis association, usual presentation

Back 78

many diverticuli, associated with low fiber diets
presentation- asymptomatic or painless bleeding. rarely vague discomfort

Front 79

halitosis, dysphagia, obstruction in throat

Back 79

Zenker's diverticulum (false diverticulum from herniation of mucosal tissue at pharynx/esophageal junction)

Front 80

What is most common congenital anomaly of GI tract and what 2 ectopic tissues can it contain?

Back 80

Meckel's diverticulum (true diverticulum from vitilline duct/yolk sac). can contain gastric tissue (gastrin secretion) or pancreatic tissue (pancreatic hormone secretion)

also most common cause of bleeding in infants

Front 81

the 5 twos of meckel's diverticulum

Back 81

2 inches long
2 feet from end of ileum
2% of population
presents in first 2 years of life
may have 2 types of epithelia (gastric, pancreatic)

Front 82

common location of volvulus

Back 82

cecum and sigmoid colon

Front 83

intussusception usually in adults or kids

Back 83

kids

Front 84

Hirschprung's disease mech?

Back 84

Hirschprungs is development of toxic megacolon because of failure of neural crest cells to go all the way to rectum so no distal myenteric plexi

Front 85

4 GI conditions at elevated risk in down syndrome

Back 85

Hirschprung's disease
Duodenal atresia
celiac disease
annular pancreas

Front 86

presentation of Ischemic colitis

Back 86

pain after eating--> weight loss

Front 87

tortuous dilation of vessels that can cause bleeding, usually seen in cecum, terminal ileum, ascending colon

Back 87

angiodysplasia

Front 88

Colonic polyps
most often in what part of colon
which type of polyp has increased malignant potential: tuberous or villous?

Back 88

often rectosigmoid
most colonic polyps (90%) are non-neoplastic. Adenomatous polyps are precancerous, and villous (finger-like) polyps indicate a higher malignant potential

can obsruct, bleed, or secrete mucus causing secretory diarrhea

Front 89

are juvenile polyps associated with increased malignant potential?

Back 89

if one, no
if many = jevenile polyposis syndrome and increased risk of adenocarcinoma

Front 90

multiple GI nodules, hyperpigmented mouth, lips, hands
Inheritance?
increased risk?

Back 90

Peutz-Jegher syndrome
nodules are noncancerous hamartomas
AD
increased risk of CRC and other visceral malignancies

Front 91

thousands of pancolonic polyps?
gene, chromosome

Back 91

Familial Adenomatous Polyposis
APC, 5q

100% will get colorectal cancer

Front 92

pancolonic polyps plus bone/soft tissue tumors, retinal hyperplasia

Back 92

Gardener's syndrome

Front 93

pancolonic polyps plus malignant CNS tumor

Back 93

Turcot's Tumor (TURcot = TURban) (medulloblastoma)

Front 94

Familial Adenomatous Polyposis vs. Hereditary Non-Polyposis Colorectal Cancer
inheritance
gene or gene fxn
area of colon always involved

Back 94

FAP- AD, APC, rectum always involved

HNPCC- AD, DNA mismatch repair gene mutation (due to microsatellite instability), proximal colon always involved

Front 95

distal colon vs proximal colon Colorectal cancer presentation:
-colicky pain with hematochezia
-dull pain with iron-def. anemia

Back 95

distal colon- colicky pain

proximal colon- dull pain and anemia

Front 96

GI barium "apple core lesion" indicates what?
marker?

Back 96

Colorectal cancer, CEA

Front 97

2 molecular pathways exist that can lead to Colorectal Cancer. Example of one is Familial Adenomatous Polyposis, other is Hereditary Nonpolyposis colorectal cancer. What is pathway of each?

Back 97

HNPCC- microsatellite instability (15% of cancers). no specific pathway

FAP and others - APC (colon at risk)--> K-RAS (adenoma) --> loss of p53 (carcinoma)

Front 98

wheezing, right sided heart murmur, flushing, diarrhea indicate what disease?
most commonly malignant in which intestine?
when do they produce these symptoms?
what seen on EM?

Back 98

Carcinoid tumor (a neuroendocrine tumor)
most commonly malignant in small intestine
produce symptoms when serotonin-producing. cells metastasize past liver.
on EM= "dense core bodies"

Front 99

fetor hepaticus (breath smells like freshly opened corpse), spider nevi, testicular atrophy seen in

Back 99

liver cirrhosis

Front 100

micronodular vs. macronodular cirrhosis, which caused by:
alcohol
postinfectious
drugs
hematochromatosis
Wilson's disease

Back 100

Micronodular < 3 mm (due to metabolic insult)
alcohol
Wilson's disease
Hemachromatosis

Macronodular (due to injury causing hepatocyte necrosis)
postinfectious
drug-induced

Front 101

histological "bridging fibrosis" in liver

Back 101

cirrhosis

Front 102

>1.5 AST/ALT indicates

AST/ALT indicates

increased AST indicates

Back 102

>1.5 AST/ALT - alcoholic hepatitis (you're toASTed with alcoholic hepatitis)

AST/ALT - viral hepatitis

AST - myocardial infarction

Front 103

2 conditions seen with increased amylase

Back 103

pancreatitis, mumps

Front 104

decreased ceruloplasm seen in

Back 104

Wilson's disease

Front 105

changes in alkaline phosphatase seen in (3)

Back 105

bile duct disease, hepatocellular carcinoma, bone disease

Front 106

child post viral infection with fatty liver, hypoglycemia, coma?
what is mechanism

Back 106

Reye's syndrome
aspirin use during viral infection causes decreased beta ovidation of fatty acids and inhibits mitochondrial activity.

Front 107

hepatic steatosis occurs with what type and duration of alcohol intake

Back 107

short term and moderate, we can all get fatty liver changes after weekend drinking

Front 108

Intracytopasmic eosinophilic inclusions in hepatocytes are ?
seen in what condition

Back 108

Mallory Body

alcoholic hepatitis

Front 109

in alcoholic cirrhosis fibrosis occurs around what structure

Back 109

central vein (zone 3)

Front 110

aflatoxin in peanuts can predispose to what malignancy?

Back 110

hepatocellular carcinoma

Front 111

Hepatocellular carcinoma
common marker
may lead to what syndrome
usually metastasizes by what method

Back 111

marker = AFP
may lead to Budd-Chiari syndrome
usually metastasizes hematogenously

Front 112

nutmeg liver
2 causes
can cause necrosis of what lobular region

Back 112

right sided heart failure, Budd-Chiari (backup of blood into liver)
centrilobular region

Front 113

Budd-Chiari syndrome
what is it
4 associations

Back 113

occlusion of IVC/ hepatic veins causing centrilobular necrosis and death.
Associations = pregnancy, Renal cell carcinoma, polyceythemia vera, hypercoagulable state

Front 114

PAS-positive non-infectious aggregates in liver are what, in what area of cells? Expression type of trait?

Back 114

misfolded alpha-1 antitrypsin molecules that can't leave hepatocyte ER
codominant trait

Front 115

2 sources of urobilinogen

Back 115

-from conversion of bile-secreted conjugated bilirubin by bacteria in gut
-some gets directly formed by heme metabolism

Front 116

what types of jaundice cause decreased urine urobilinogen secretion? increased?

Back 116

decreased urine urobilinogen seretion = hepatocellular (this could also be normal) and obstructive.

increased urobiliogen secretion = hemolytic (because some urobilinogen produced directly from heme metabolism)

Front 117

hyperbilirubinemia with black liver?
what is defect, what type of bilirubin accumulation

Back 117

Dubin-Johnson syndrome (DUBIN was BLACK stain on medical community because he showed his JOHNSON to kids, now he can only get CONJUGAL visits)
defect in conjugated bilirubin secretion out of hepatocyte = conjugated hyperbilirubinemia. benign condition

Front 118

Rotor's syndrome is even more mild form of what syndrome

Back 118

Dubin-Johnson syndrome
(both have conjugated hyperbilirubinemia, benign, Rotor's doesn't have black liver)

Front 119

Crigler-Najjar syndrome, mech and treatment for each type

Back 119

absent UDP gluconyltransferase

type 1 (more severe) = hemodialysis and phototherapy
type 2 (less severe) =
responds to phenobarbital

Front 120

Wilson's disease
problem, inheritance, signs (7)

Back 120

inability to excrete copper into circulation as ceruloplasmin
AR inheritance
ABCCCD (H)
Asterixis
Basal ganglia degeneration (of putamen, Parkinson-like characteristics)
Corneal Deposits (Kayser-Fleishler rings)
Choreiaform movements
Carcinoma (hepatocellular)
Dementia
Hemolytic anemia

Front 121

Wilson's disease tx

Back 121

penicillamine

Front 122

Cirrhosis, diabetes, hyperpigmentation?
primary and secondary cause
increased risk for what two conditions

Back 122

Hemachromatosis
primary- AR trait
secondary- to multiple transfusions (like in Beta thalassemia major)
Risks= CHF, hepatocellular carcinoma

Front 123

Hemachromatosis findings:
ferratin? iron? TIBC? transferrin?

associated with what HLA

Back 123

ferratin, iron increase
TIBC, FREE transferrin decrease (though transferrin SATURATION increases)
HLA-A3

Ramsey has his A game in group of 3 in Miami

Front 124

3 conditions associated with pruritis, jaundice, dark urine, light stools, hepatsplenomegaly, increased conjugated bilirubin and increased alkaline phosphatase

Back 124

primary biliary cirrhosis (autoimmune)
secondary biliary cirrhosis (extrahepatic biliary obstruction)
Primary sclerosing cholangitis

Front 125

bile duct "onion skinning" and alternating stricture and dilation ("beading") of hepatic bile ducts?
associated with what lab finding, what condition?

Back 125

Primary sclerosing cholangitis
hypergammaglobulinemia (increased IgM)
associated with Ulcerative Colitis

Front 126

Primary biliary cirrhosis
what is mechanism, histo finding, antibody finding

Back 126

autoimmune lymphoid and granuloma destruction of hepatic ducts.
ANTI-MITOCHONDRIAL ab (includes increased IgM, like primary sclerosing cholangitis)

Front 127

complication of secondary biliary cirrhosis?

Back 127

ascending cholangitis secondary to the obstruction by gallstone, biliary stricture, chronic pancreatitis, or pancreatic head carcinoma

Front 128

fever and RUQ pain? fever, RUQ pain, jaundice?

Back 128

fever and RUQ pain = cholecystitis

fever, RUQ pain, jaundice = Charcot's triad = cholangitis

Front 129

4 F's for gallstones

Back 129

Female (estrogens)
Fertile (multiparity)
Fat
Forty

high in native american population

Front 130

Biliary colic is what? can present without pain in what population

Back 130

obstruction of common bile duct by gallstone causing bile duct contraction. may not be painful in diabetics

Front 131

2 infectious cause of cholcystitis

Back 131

CMV (but usually by gallstone) or cryptosporidium, immunocompromised

Front 132

Acute Pancreatitis causes (10)

Back 132

GET SMASHED
gallstones
ethanol
Trauma
Steroids
Mumps
Autoimmune diseases
Scorpion sting
Hypercalcemia/Hperlipidemia
ERCP
Drugs (sulfa)

Front 133

5 acute pancreatitis complications

Back 133

ARDS
DIC
hypocalcemia
multiorgan failure
pseudocyst formation

Front 134

abdominal pain radiating to back with redness/tenderness on palpation of extremities, obstructive jaundice, weight loss?
2 tumor markers
2 risk factors for condition
why such bad prognosis

Back 134

pancreatic adenocarcinoma

the redness swelling of extremities is migrating thrombophlebitis
CEA, CA 19-9
smoking and chronic pancreatitis (but NOT ETOH)
usually by presentation it has already metastasized (avg. prognosis 6 months)