Liver, Biliary Tract, Pancreas Quiz
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Questions and Answers

Which of the following is a characteristic finding of acute pancreatitis on imaging?

  • Gallbladder stones
  • Necrosis involving the pancreatic parenchyma (correct)
  • Ultrasound evidence of cholangitis
  • Enlarged bile ducts

    • What is the main characteristic of interstitial edematous pancreatitis (IEP)?

  • Presence of gallbladder stones
  • Peripancreatic tissue necrosis
  • Non-necrotizing inflammation of the pancreas (correct)
  • Necrotizing inflammation of the pancreas

    • Which sign is associated with acute pancreatitis and indicates retroperitoneal bleeding?

  • Cullen's sign
  • Reynolds' pentad
  • Charcot's triad
  • Grey Turner's sign (correct)

    • What is the recommended treatment for bile duct stones in case of failed standard stone extraction?

    <p>Intraoperative ERCP or laparoscopic bile duct exploration in combination with cholecystectomy</p> Signup and view all the answers

    What are the three main categories of cholangitis described in the text?

    <p>Primary, secondary, and immune cholangitis</p> Signup and view all the answers

    What is the main characteristic of necrotizing pancreatitis?

    <p>Necrosis involving the pancreatic parenchyma</p> Signup and view all the answers

    Which imaging method is recommended in case of strong clinical suspicion of gallbladder stones and negative abdominal ultrasound?

    <p>MRI</p> Signup and view all the answers

    What are the two main signs used to diagnose acute pancreatitis?

    <p>Charcot's triad and Cullen's sign</p> Signup and view all the answers

    What is the main characteristic of Charcot’s triad?

    <p>Jaundice</p> Signup and view all the answers

    Which procedure may be performed for bile duct stones if there is a failed standard stone extraction?

    <p>Extracorporeal shock wave lithotripsy</p> Signup and view all the answers

    What are the two main characteristics of Reynolds' pentad?

    <p>Confusion and Shock</p> Signup and view all the answers

    Which stage of ascites reflects a more deranged circulatory state?

    <p>Hepatorenal syndrome (HRS)</p> Signup and view all the answers

    What is the most common type of bacterial infection in hospitalized cirrhotic patients?

    <p>Spontaneous bacterial peritonitis (SBP)</p> Signup and view all the answers

    What is the key factor in the pathogenesis of Hepatic Encephalopathy?

    <p>Ammonia</p> Signup and view all the answers

    Which stage of Hepatic Encephalopathy presents with gross disorientation and bizarre behavior?

    <p>Grade III</p> Signup and view all the answers

    What is asterixis in the context of Hepatic Encephalopathy?

    <p>Inability to maintain a position, demonstrated by jerking movements of the outstretched hands when bent upward at the wrist.</p> Signup and view all the answers

    Jaundice can result from an increase in bilirubin production or a decrease in hepatobiliary elimination of bilirubin. Which type of jaundice is characterized by decreased hepatocellular uptake of unconjugated bilirubin?

    <p>Hepatic (hepatocellular) jaundice</p> Signup and view all the answers

    The optimal treatment for non-obstructive jaundice (i.e., liver disease) is directed toward:

    <p>Cessation of ethanol</p> Signup and view all the answers

    'Cholestasis' is defined as stagnation or a marked reduction in bile secretion and flow, and can be due to a functional impairment of the hepatocytes or due to an obstruction at any level of the excretory pathway of bile. What type of jaundice is associated with cholestasis?

    <p>Extrahepatic (obstructive) jaundice</p> Signup and view all the answers

    'Cholangitis' refers to inflammation and fibrosis of the hepatobiliary system characterized by eventual narrowing and obstruction of the bile ducts. What is the primary therapeutic intervention for managing cholangitis?

    <p>Liver transplantation</p> Signup and view all the answers

    'Biliary colic' is characterized by episodic attacks of severe pain in the right upper abdominal quadrant or epigastrium, often with radiation to the right back or shoulder. How is a patient with biliary colic typically treated?

    <p>NSAIDs ± spasmolytics and opioids</p> Signup and view all the answers

    What is a characteristic symptom of gallbladder stones?

    <p>Pain that spreads to the right shoulder or back</p> Signup and view all the answers

    What do NSAIDs ± spasmolytics and opioids help manage in patients with biliary colic?

    <p>Severe pain in the upper right or center abdomen</p> Signup and view all the answers

    Which of the following represents a high risk of variceal bleeding according to HVPG?

    <p>HVPG &gt; 12mmHg</p> Signup and view all the answers

    What is the most common cause of cirrhosis in the United States?

    <p>Alcoholic liver disease</p> Signup and view all the answers

    Which physical examination finding is associated with alcoholic liver disease?

    <p>Dupuytren’s contracture</p> Signup and view all the answers

    What is the primary laboratory finding in alcoholic liver disease?

    <p>Hyperbilirubinemia</p> Signup and view all the answers

    What is the most common complication of cirrhosis?

    <p>Ascites</p> Signup and view all the answers

    What is the significance of the HVPG when it exceeds 20mmHg?

    <p>High risk of treatment failure and rebleeding</p> Signup and view all the answers

    Which condition is characterized by marked abdominal distension according to the grading system for ascites?

    <p>Grade 3</p> Signup and view all the answers

    'The word ascites is of Greek origin (askos) and means bag or sac.' This statement implies that ascites refers to:

    <p>'Pathologic fluid collection within the abdominal cavity'</p> Signup and view all the answers

    'Patients with cirrhosis are susceptible to a variety of complications' implies that cirrhosis leads to:

    <p>'Reduced life expectancy'</p> Signup and view all the answers

    What does the HVPG represent?

    <p>Gradient between pressures in the portal vein and the inferior vena cava</p> Signup and view all the answers

    What does HVPG > 10mmHg signify?

    <p>High risk of variceal bleeding</p> Signup and view all the answers

    Which two conditions are the most common causes of cirrhosis in the United States?

    <p>Alcoholic liver disease and hepatitis C</p> Signup and view all the answers

    Study Notes

    Imaging in Pancreatitis

    • Acute pancreatitis on imaging is characterized by a "pancreatic heterogeneity" with edematous and necrotic areas
    • Interstitial edematous pancreatitis (IEP) is characterized by pancreatic edema with no necrosis
    • The "Grey Turner sign" is associated with acute pancreatitis and indicates retroperitoneal bleeding

    Treatment of Bile Duct Stones

    • The recommended treatment for bile duct stones in case of failed standard stone extraction is endoscopic papillary large balloon dilation (EPLBD) or surgical intervention
    • EPLBD may be performed for bile duct stones if there is a failed standard stone extraction

    Cholangitis

    • The three main categories of cholangitis are:
      • Primary sclerosing cholangitis (PSC)
      • Secondary sclerosing cholangitis (SSC)
      • Cholangiocarcinoma
    • The main characteristic of Charcot’s triad is:
      • Jaundice
      • Fever
      • Right upper quadrant pain
    • Reynolds' pentad is characterized by:
      • Jaundice
      • Fever
      • Right upper quadrant pain
      • Shock
      • Altered mental status
    • The primary therapeutic intervention for managing cholangitis is antibiotics

    Hepatic Encephalopathy

    • The key factor in the pathogenesis of Hepatic Encephalopathy is the failure to detoxify ammonia
    • Stage III of Hepatic Encephalopathy presents with gross disorientation and bizarre behavior
    • Asterixis in the context of Hepatic Encephalopathy is a flapping tremor of the hands

    Jaundice

    • Jaundice can result from an increase in bilirubin production or a decrease in hepatobiliary elimination of bilirubin
    • Gilbert syndrome is a type of jaundice characterized by decreased hepatocellular uptake of unconjugated bilirubin
    • The optimal treatment for non-obstructive jaundice (i.e., liver disease) is directed toward treating the underlying liver disease

    Cholestasis

    • Cholestasis is defined as stagnation or a marked reduction in bile secretion and flow
    • Cholestasis can be due to a functional impairment of the hepatocytes or due to an obstruction at any level of the excretory pathway of bile
    • Cholestasis is associated with conjugated hyperbilirubinemia

    Biliary Colic

    • Biliary colic is characterized by episodic attacks of severe pain in the right upper abdominal quadrant or epigastrium, often with radiation to the right back or shoulder
    • A patient with biliary colic is typically treated with pain management using NSAIDs ± spasmolytics and opioids
    • A characteristic symptom of gallbladder stones is biliary colic

    Cirrhosis

    • HVPG > 12mmHg represents a high risk of variceal bleeding
    • The most common cause of cirrhosis in the United States is hepatitis C
    • A physical examination finding associated with alcoholic liver disease is palmar erythema
    • The primary laboratory finding in alcoholic liver disease is elevated AST and ALT with an AST:ALT ratio > 2
    • The most common complication of cirrhosis is ascites
    • HVPG > 20mmHg signifies a high risk of decompensation and mortality in cirrhotic patients
    • Grade 3 ascites is characterized by marked abdominal distension
    • Ascites refers to the accumulation of fluid in the peritoneal cavity
    • Cirrhosis leads to susceptibility to various complications, such as ascites, variceal bleeding, and hepatic encephalopathy
    • HVPG represents the hepatic venous pressure gradient, which is the difference in pressure between the wedged hepatic vein pressure and the free hepatic vein pressure.

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    Test your knowledge on liver, biliary tract, and pancreas with this quiz. Topics include portal hypertension, portal venous system, and hepatic venous pressure gradient.

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