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Questions and Answers
Which of the following is a characteristic finding of acute pancreatitis on imaging?
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)?
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?
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?
What is the recommended treatment for bile duct stones in case of failed standard stone extraction?
What are the three main categories of cholangitis described in the text?
What are the three main categories of cholangitis described in the text?
What is the main characteristic of necrotizing pancreatitis?
What is the main characteristic of necrotizing pancreatitis?
Which imaging method is recommended in case of strong clinical suspicion of gallbladder stones and negative abdominal ultrasound?
Which imaging method is recommended in case of strong clinical suspicion of gallbladder stones and negative abdominal ultrasound?
What are the two main signs used to diagnose acute pancreatitis?
What are the two main signs used to diagnose acute pancreatitis?
What is the main characteristic of Charcot’s triad?
What is the main characteristic of Charcot’s triad?
Which procedure may be performed for bile duct stones if there is a failed standard stone extraction?
Which procedure may be performed for bile duct stones if there is a failed standard stone extraction?
What are the two main characteristics of Reynolds' pentad?
What are the two main characteristics of Reynolds' pentad?
Which stage of ascites reflects a more deranged circulatory state?
Which stage of ascites reflects a more deranged circulatory state?
What is the most common type of bacterial infection in hospitalized cirrhotic patients?
What is the most common type of bacterial infection in hospitalized cirrhotic patients?
What is the key factor in the pathogenesis of Hepatic Encephalopathy?
What is the key factor in the pathogenesis of Hepatic Encephalopathy?
Which stage of Hepatic Encephalopathy presents with gross disorientation and bizarre behavior?
Which stage of Hepatic Encephalopathy presents with gross disorientation and bizarre behavior?
What is asterixis in the context of Hepatic Encephalopathy?
What is asterixis in the context of Hepatic Encephalopathy?
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?
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?
The optimal treatment for non-obstructive jaundice (i.e., liver disease) is directed toward:
The optimal treatment for non-obstructive jaundice (i.e., liver disease) is directed toward:
'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?
'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?
'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?
'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?
'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?
'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?
What is a characteristic symptom of gallbladder stones?
What is a characteristic symptom of gallbladder stones?
What do NSAIDs ± spasmolytics and opioids help manage in patients with biliary colic?
What do NSAIDs ± spasmolytics and opioids help manage in patients with biliary colic?
Which of the following represents a high risk of variceal bleeding according to HVPG?
Which of the following represents a high risk of variceal bleeding according to HVPG?
What is the most common cause of cirrhosis in the United States?
What is the most common cause of cirrhosis in the United States?
Which physical examination finding is associated with alcoholic liver disease?
Which physical examination finding is associated with alcoholic liver disease?
What is the primary laboratory finding in alcoholic liver disease?
What is the primary laboratory finding in alcoholic liver disease?
What is the most common complication of cirrhosis?
What is the most common complication of cirrhosis?
What is the significance of the HVPG when it exceeds 20mmHg?
What is the significance of the HVPG when it exceeds 20mmHg?
Which condition is characterized by marked abdominal distension according to the grading system for ascites?
Which condition is characterized by marked abdominal distension according to the grading system for ascites?
'The word ascites is of Greek origin (askos) and means bag or sac.' This statement implies that ascites refers to:
'The word ascites is of Greek origin (askos) and means bag or sac.' This statement implies that ascites refers to:
'Patients with cirrhosis are susceptible to a variety of complications' implies that cirrhosis leads to:
'Patients with cirrhosis are susceptible to a variety of complications' implies that cirrhosis leads to:
What does the HVPG represent?
What does the HVPG represent?
What does HVPG > 10mmHg signify?
What does HVPG > 10mmHg signify?
Which two conditions are the most common causes of cirrhosis in the United States?
Which two conditions are the most common causes of cirrhosis in the United States?
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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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