Week 6 - Liver, Gallbladder, Bile Duct, Pancreas

Front 1

RUQ pain to back, n/v, fever, worse s/p fatty foods

Back 1

acute cholecystitis

Front 2

best 1st test for suspected cholecystitis

Back 2

U/S

Front 3

tx of cholecystitis

Back 3

cholecystectomy
(perc cholecytostomy if unstable)

Front 4

RUQ pain, high bili & alk phos:

Back 4

choledocholithiasis

Front 5

how to dx choledocholithiasis

Back 5

U/S will show CBD stone

Front 6

tx of choledocholithiasis

Back 6

chole +/- ERCP to remove stone

Front 7

RUQ pain, fever, jaundice, dec BP & AMS

Back 7

ascending cholangitis

Front 8

tx of ascending cholangitis

Back 8

fluids & broad spec abx; ERCP & stone removal

Front 9

choledochal cysts - type 1 ?

Back 9

fusiform dilation of CBD

Front 10

how to tx choledocal cysts (type 1)

Back 10

(fusiform dilation of CBD)
tx w/excision

Front 11

choledochal cysts - type 5 ?

Back 11

- Caroli's dz
- cysts in intrahepatic ducts

Front 12

tx for choledochal cysts (type 5)

Back 12

needs liver transplant
(cysts in intrahepatic ducts)

Front 13

risk factors for cholangiocarcinoma

Back 13

1) primary sclerosing cholangitis (UC)
2) liver flukes
3) thorothrast exposure

Front 14

tx of cholangiocarcinoma

Back 14

surgery +/- radiation

Front 15

AST = 2x ALT

Back 15

alcoholic hepatitis (reversible)

Front 16

AST > ALT & high (1000s)

Back 16

viral hepatitis

Front 17

AST & ALT high s/p hemorrhage, surgery, sepsis

Back 17

shock liver

Front 18

med tx for cirrhosis & portal HTN

Back 18

- SS & VP vasoconstrict to dec portal pressure
- b-blockers also dec portal pressure

Front 19

when do you tx esoph varices (in cirrhosis/portal HTN) & how?

Back 19

- DON'T NEED TO TX PROPHYLACTICALLY
- band/burn once they bleed once

Front 20

TIPS relieves portal HTN, but...

Back 20

worsens hepatic encephalopathy

Front 21

how do you tx worsened hepatic encephalopathy (in cirrhosis pts)?

Back 21

LACTULOSE
(helps rid body of ammonia)

Front 22

risk factors for hepatocellular carcinoma:

Back 22

- chronic hep B > hep C
- cirrhosis for any reason
- plus alfatoxin or carbon tetrachloride

Front 23

how do you dx hepatocellular carcinoma?

Back 23

- w/high AFP (in 70%)
- CT/MRI

Front 24

tx for hepatocellular carcinoma:

Back 24

- can surgically remove solitary mass
- use rads/cryoablation for pallation of multiple

Front 25

woman on OCP → palpable abd mass or spontaneous rupture → hemorrhagic shock

Back 25

hepatic adenoma

Front 26

how to dx hepatic adenoma?

Back 26

U/S or MRI

Front 27

how to tx hepatic adenoma?

Back 27

- d/c OCPs
- resect if large or pregnancy is desired

Front 28

- 2nd MC benign liver tumor
- W>M, but less likely to rupture
- no tx needed
???

Back 28

focal nodular hyperplasia

Front 29

MC bugs indicated in bacterial liver abscess

Back 29

- e. coli
- bacteriodes
- enterococcus

Front 30

tx of bacterial liver abscess

Back 30

surgical drainage & IV abx

Front 31

RUQ pain, profuse sweating & rigors, palpable liver:

Back 31

entamoeba histolytica

Front 32

tx for entamoeba histolytica

Back 32

METRONIDAZOLE
(DON'T drain it)

Front 33

pt from mexico p/w RUQ pain & large liver cysts on U/S:

Back 33

Enchinococcus

Front 34

how is enchinococcus transmitted?

Back 34

hydatic cyst parasite from dog feces

Front 35

what lab findings accompany enchinococcus liver cysts?

Back 35

eosinophilia, +Casoni skin test

Front 36

how to tx enchinococcus liver cysts?

Back 36

- ALBENDAZOLE
- & surgery to remove ENTIRE cyst
- rupture = anaphylaxis

Front 37

MEG pain straight through to back:

Back 37

pancreatitis

Front 38

MC etiologies of pancreatitis:

Back 38

gallstones & etoh

Front 39

how to dx pancreatitis

Back 39

- inc amylase & lipase
- CT is best imaging test

Front 40

BEST imaging test for pancreatitis dx?

Back 40

CT

Front 41

tx of pancreatitis:

Back 41

- NG suction
- NPO
- IV rehydration
- observation

Front 42

bad prognostic factors for pancreatitis:

Back 42

- old
- WBC > 16k
- gluc > 200
- LDH > 350
- AST > 250
- drop in hct
- dec calcium
- acidosis
- hypox

Front 43

complications of pancreatitis

Back 43

- pseudocyst (no cells!)
- hemorrhage
- abscess
- ARDS

Front 44

chronic MEG pain, DM, malabsorption (steatorrhea):

Back 44

chronic pancreatitis

Front 45

chronic pancreatitis can cause splenic vein thrombosis, which leads to...?

Back 45

gastric varices

Front 46

courvoisier's sign

Back 46

- large, nontender GB, itching & jaundice
- seen when panc adenocarcinoma is in head of panc

Front 47

trousseau's sign

Back 47

- migratoy thrombophlebitis
- seen w/pancreatic adenocarcinoma

Front 48

sxs of pancreatic adenocarcinoma

Back 48

- usu no sxs til advanced
- courvoisier's sign
- trousseau's sign

Front 49

dx pancreatic adenocarcinoma w/...

Back 49

EUS & FNA bx

Front 50

tx pancreatic adenocarcinoma w/...

Back 50

WHIPPLE procedure

Front 51

when can you tx pancreatic adenocarcinoma w/a whipple procedure?

Back 51

if...
- no mets outside abd
- no extension into SMA or portal vein
- no liver mets
- no peritoneal mets

Front 52

what is WHIPPLE'S TRIAD?

Back 52

- used to dx pancreatic insulinoma
- sxs (sweat, tremors, hunger, szs) + BGL <45 + sxs resolve w/gluc admin

Front 53

lab findings w/insulinoma

Back 53

- inc insulin
- inc c-peptide
- inc pro-insulin

Front 54

sxs of glucagonoma

Back 54

- hyperglycemia
- diarrhea
- wt loss
- characteristic rash

Front 55

characteristic rash of glucagonoma?

Back 55

necrolytic migratory erythema

Front 56

characteristics of somatistatinoma:

Back 56

- commonly malignant
- see malabsorp, steatorrhea, etc from exocrine panc malfxn

Front 57

sxs of VIPoma

Back 57

- watery diarrhea
- hypokalemia
- dehydration
- flushing
(similar to carcinoid synd)

Front 58

tx of VIPoma

Back 58

OCTREOTIDE
(can help sxs)