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    ABSITE Pearls

    Uploaded by

    James Joseph
    This document provides a summary of 33 questions related to the ABSITE exam on topics related to the pancreas, biliary system, and liver. Key points covered include the mechanisms of hypotension in acute pancreatitis, diagnostic criteria for pancreatitis, management of gallstone pancreatitis, features differentiating pancreatic cysts and neoplasms, treatment of pancreatic pseudocysts, variants of hepatic arterial anatomy, and surgical management of biliary and pancreatic injuries and cancers.

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    ABSITE Pearls

    Uploaded by

    James Joseph
    111 views4 pages
    This document provides a summary of 33 questions related to the ABSITE exam on topics related to the pancreas, biliary system, and liver. Key points covered include the mechanisms of hypotension in acute pancreatitis, diagnostic criteria for pancreatitis, management of gallstone pancreatitis, features differentiating pancreatic cysts and neoplasms, treatment of pancreatic pseudocysts, variants of hepatic arterial anatomy, and surgical management of biliary and pancreatic injuries and cancers.

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    This document provides a summary of 33 questions related to the ABSITE exam on topics related to the pancreas, biliary system, and liver. Key points covered include the mechanisms of hypotension in acute pancreatitis, diagnostic criteria for pancreatitis, management of gallstone pancreatitis, features differentiating pancreatic cysts and neoplasms, treatment of pancreatic pseudocysts, variants of hepatic arterial anatomy, and surgical management of biliary and pancreatic injuries and cancers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    111 views4 pages

    ABSITE Pearls

    Uploaded by

    James Joseph
    This document provides a summary of 33 questions related to the ABSITE exam on topics related to the pancreas, biliary system, and liver. Key points covered include the mechanisms of hypotension in acute pancreatitis, diagnostic criteria for pancreatitis, management of gallstone pancreatitis, features differentiating pancreatic cysts and neoplasms, treatment of pancreatic pseudocysts, variants of hepatic arterial anatomy, and surgical management of biliary and pancreatic injuries and cancers.

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    © All Rights Reserved
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    ABSITE Pearls

    1. What is the mechanism of hypotension in severe cases of acute pancreatitis?

    Fluid sequesteration in the intestine and retroperitoneum, systemic vascular


    effects of kinins and TNF, vomiting, and bleeding

    2. T/F: Idiopathic acute pancreatitis may be the result of occult biliary microlithiasis
    or biliary sludge

    True

    3. When and where is iatrogenic injury to the CBD most common?

    During lap chole at the triangle of Calot

    4. What is the most common lipid profile associated with pancreatitis?

    Type V (increased triglycerides)

    5. What is the optimal method of determining whether a pancreatic phlegmon is


    infected? What is the treatment if infected?
    o CT to look for retroperitoneal air
    o CT-guided aspiration of fluid
    6. How does excess lipid promote pancreatitis?

    Toxic action of fatty acids released by lipase in the pancreas

    7. What is the role of abdominal US in pancreatitis?

    Detection of biliary obstruction and evaluation of pseudocysts

    8. What percentage of CBD stones pass spontaneously?

    90%

    9. What should be the initial management of gallstone pancreatitis?


    o Admission, NPO, IV hydration, trend liver enzymes for fist 24-36 hrs
    o ERCP
    o Lap chole in future
    10. What are the management options for a CBD stone detected during IOC?
    o Laparoscopic basket retrieval
    o Fogarty balloon retrieval
    o Forcible saline injection
    o Postop ERCP
    o CBD exploration
    11. Ranson's Criteria @ 48 hrs?
    o Fall in Hct >10%
    o Rise in BUN >5%
    o Ca <8
    o PaO2 <60
    o Base deficit >4
    o Fluid sequestration >6L
    12. Ranson's criteria @ admission?
    o Age >70
    o WBC >18
    o Glucose >220
    o LDH >400
    o AST >250
    13. Should abx be given epirically to pts with severe pancreatitis?

    Yes, Imipenem most popular choice

    14. What are the primary cystic masses of the pancreas?


    o Serous cystadenoma
    o Mucinous cystadenoma
    o Cystadenocarcinoma
    o Intraductal papillary mucinous neoplasm
    o Pseudocyst
    15. What features differentiate pancreatic pseudocysts from cystic neoplasms?
    o Pseudocysts: h/o pancreatitis, no septations, high cyst amylase,
    connection to pancreatic duct, no epithelial layer
    o Neoplasm: calcification, septations, solid components, epithelial layer,
    no h/o pancreatitis, cyst CEA
    16. What is the treatment of mucinous cystadenoma of the pancreas?

    Resection - have potential for malignant transformation

    17. What are some differentiating features of mucinous cystadenomas from serous
    cystadenomas of the pancreas?

    Mucinous cystadenomas are typically larger with septations and peripheral


    calcifications on CT. Fluid in mucinous is pos for tumor markers (CEA, CA
    19-9) and low in glycogen (high in serous). Serous cystadenomas tend to have
    more central calcification with a "starburst" pattern of smaller cysts within a
    larger capsule

    18. What are the features of intraductal papillary mucinous neoplasm (IPMN)?

    Solitary cystic neoplasm near the head of the pancreas with mucin seen in the
    ampulla on ERCP. High rate of cyst malignancy, and oncologic resection is the
    treatment.

    19. What is the surgical treatment for a large (7cm) pancreatic pseudocyst inducing
    pain that fails to regress after 12 weeks?

    Enteric drainage wtih cyst gastrostomy or cystic jejunostomy

    20. What is the clinical presentation of familial Mediterranean fever?


    o Bouts of fever and abdominal pain as well as intermittent chest and joint
    pain.
    o Inheritance is AD.
    o Colchicine effective for prevention, anti-inflammatories during an acute
    attack
    21. What are the most common variants in origin of hepatic arteries?
    o Right hepatic - off SMA, 20%
    o Left hepatic - off left gastric, 10%
    22. What are the structures in the portal triad?
    o Portal vein - posterior
    o CBD - right anterior
    o Hepatic aa - left anterior
    23. What should be the steps when CBD injury is suspected in lap chole?

    Cholangiogram for define anatomy and injury followed by CBD repair over a
    T-tube for partial transection or choledochojejunostomy for complete
    transection

    24. What are the sonographic effects of gallstones on US?

    Acoustic shadowing behind the stones

    25. What bacteria are the most common agents of biliary sepsis?

    E coli and Klebsiella

    26. What artery is at risk in the crural dissection during lap Nissen?
    Aberrant Left hepatic arising off the left gastric (when present)

    27. T/F: The portal vein formed by the SMV and splenic vv sees highly regulated
    blood flow with its multiple valves
    o False.
    o Portal system is valveless
    28. What pleuropulmonary abnormalities may be seen in patients with pancreatitis?

    Elevated hemidiaphragm, atelectasis, pleural reaction or effusion, hypoxemia,


    acute lung injury

    29. What is the treatment of traumatic pancreatic transection with an intact ampulla of
    vater?
    o distal pancreatectomy with oversewing of the proximal pancreatic duct
    and drain placement.
    o In stable pts consider ERCP with pancreatic duct integrity being the
    primary variable for attempted pancreatic preservation vs resection
    30. When should surgical drainage of pancreatic pseudocyst be considered?
    o Large cysts (>5cm)
    o Cysts that do not resolve/decrease after 6 weeks
    o Infected pseudocysts
    31. What is the surgical option of a T1 adenocarcinoma found after lap chole?

    Nothing - lap chole is sufficient

    32. What is the treatment of a T3 adenocarcinoma of the gallbladder?

    Cholecystectomy + regional lymphadenectomy and liver segment V removal,


    portal triad skeletonization

    33. What is the triad of hemobilia?

    GI bleed, jaundice, RUQ pain

    34. What does Charcot's triad imply?

    Fever, RUQ pain, and jaundice indicative of cholangitis

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