Hepatobiliary and Pancreatic Disorders Flashcards

Which endoscopic procedure is used to treat acute gallstone pancreatitis complicated by cholangitis?

Answer: ERCP with sphincterotomy and stone extraction

ERCP with sphincterotomy and stone extraction within 24-72 hours is the standard of care for gallstone pancreatitis complicated by cholangitis or persistent biliary obstruction.

A patient with known Wilson's disease presents with neuropsychiatric symptoms and liver disease. Which finding on slit-lamp exam confirms the diagnosis?

Answer: Kayser-Fleischer rings

Kayser-Fleischer rings are golden-brown copper deposits in Descemet's membrane of the cornea, seen in nearly all Wilson's disease patients with neurological involvement.

A nurse is preparing a patient for endoscopic ultrasound (EUS)-guided drainage of a pancreatic pseudocyst. Which nursing assessment is most important pre-procedure?

Answer: Verify NPO status and review coagulation parameters including INR and platelet count

EUS-guided drainage is an invasive procedure requiring adequate NPO status to minimize aspiration risk and normal coagulation to prevent bleeding complications.

Which condition is most strongly associated with the development of primary sclerosing cholangitis (PSC)?

Answer: Ulcerative colitis

Approximately 70-80% of PSC patients have concurrent ulcerative colitis, making it the strongest associated inflammatory bowel disease condition.

A patient with hemochromatosis is found to have a serum ferritin of 2,800 ng/mL and transferrin saturation of 72%. What is the first-line treatment?

Answer: Therapeutic phlebotomy weekly until ferritin < 50 ng/mL

Therapeutic phlebotomy is the cornerstone treatment for hereditary hemochromatosis, removing approximately 250 mg of iron per unit of blood until ferritin is normalized to below 50 ng/mL.

During a biliary sphincterotomy, the patient develops acute onset of severe abdominal pain and hypotension. A post-procedure CT shows free air under the diaphragm. What complication has occurred?

Answer: Duodenal perforation

Free intraperitoneal air after ERCP with sphincterotomy indicates duodenal perforation, a rare but serious complication requiring urgent surgical or interventional management.

A patient with non-alcoholic fatty liver disease (NAFLD) is progressing to NASH with fibrosis. Which intervention has the strongest evidence for improving liver histology?

Answer: Sustained weight loss of ≥ 7-10% body weight

Sustained weight loss of at least 7-10% body weight is the most effective intervention for reducing hepatic steatosis, inflammation, and fibrosis in NASH.