Liver, Gallbladder & Pancreas Integrative Cases - Franco & Stein Flashcards Preview

M2 GI/Nutrition > Liver, Gallbladder & Pancreas Integrative Cases - Franco & Stein > Flashcards

Flashcards in Liver, Gallbladder & Pancreas Integrative Cases - Franco & Stein Deck (15)
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1
Q

What is the worst possible Child-Pughs score?

What survival does it correspond to?

A

C (>9)

10-15% after 5 years.

2
Q

What is asterixis? What is it a consequence of?

How would you treat this?

A

Flapping tremor of the hand upon wrist extension or gripping. A consequence of hepatic encephalopathy.

Treated with lactulose (trap ammonia, kill bacteria, clear them)

3
Q

A chronic liver disease patient presents with a pleural effusion. What are two possible causes for this?

Which is more likely if this is unilateral?

A

Hepatopulmonary syndrome, hepatic hydrothorax (ascites spread through the diaphragm).

Hepatic hydrothorax presents often with right-sided unilateral effusion.

4
Q

What two diagnostic criteria make for a hepatocellular carcinoma diagnosis?

A

Positive imaging for a lesion and an alpha-fetoprotein of >200.

5
Q

What are the Milan criteria?

A

Criteria to determine if a patient with HCC is eligible for liver transplant.

Patients must have either one cancerous lesion <5cm or 2-3 with non exceeding 3cm.

6
Q

What is the benefit of transarterial chemoembolization?

What can it be used for?

A

This procedure directs a payload of chemotherapy or radiation to a hepatic site, plugging up the artery it travels through to prevent backwash of the hazardous treatment.

7
Q

Why should radiofrequency ablation be done away from bile ducts?

Away from vasculature?

A

It may burn bile ducts.

Vessels act as heatsinks, reducing efficacy.

8
Q

What is the significance of osmotic diarrhea?

Steatorrhea?

A

Indicates incomplete absorption of lumenal contents.

Indicates failed fat absorption; could be due to loss of bile or pancreatic lipase.

9
Q

What genetic tests can be done to narrow a pancreatitis differential down?

A

Look at trypsin inhibitor genes (SPINK1, CFTR, PRSS1)

10
Q

What could early satiety indicate?

A

(ignoring esophageal & gastric pathologies)

Mass effect due to pancreatic mass (cyst, pseudocyst, or tumor).

11
Q

What makes pseudocysts “pseudo”?

A

They are not bound by an epithelium, and are therefore not true cysts.

12
Q

What lab signs can indicate a pancreatic adenocarcinoma?

What imaging signs?

A

Labs: Increased carbonic anhydrase 19-9

Imaging: Besides a large honking mass, look for the “double-duct” sign.

13
Q

Why are DVTs seen in pancreatic adenocarcinomas?

A

Any cancer can cause hypercoagulable state (by consuming anticoagulant factors or upregulating procoagulant factors)

14
Q

How is a case of acute pancreatitis treated?

A

Supportive only! Give fluids, pain management, and (presumably parenteral) nutrition. Antibiotics if needed.

15
Q

What is the most common infectious cause of hepatocellular carcinoma in the western world?

How can it be treated?

A

Hepatitis C infection.

ALCOHOL ABSTINENCE, pegylated interferon, and antivirals (eg ribavirin)