Pathology Notes

Practice question answers Exocrine pancreas/gallbladder © Jun Wang, MD, PhD 1. D. Any patient with acute onset of epigastric pain should be considered for acute pancreatitis . The two most commonly used lab tests are amylase and lipase. Bilirubin levels are used to determine possible causes of jaundice, not for pancreatitis. CA19-9 may be increased in mucinous neoplasms, including pancreatic adenocarcinoma and ovarian mucinous neoplasms . Culture is for bacterial infection. Elevation of troponin can be seen in myocardial injury, and other non-cardiac conditions, such as sepsis, chronic kidney disease, etc. 2. A. Diagnosis of acute pancreatitis requires two of three criteria, acute abdominal pain, lipase or amylase levels three times or more above the upper limits and/or radiologic findings of signs of inflammation, such enlargement and exudates. Barium swallow can be used to detect esophagus abnormalities, such tumors , or achalasia . D-dimer is used to detect coagulation

Practice questions, exocrine pancreas/gallbladder © Jun Wang, MD, PhD 1. Use this case and this image for the next four questions . A 41-year-old woman presents with worsening dull epigastric pain, nausea and vomiting for 2 days. The pain is not related to activity, but start radiating to back in the last 4 hours. Her past medical history include chronic cholecystitis, hyperlipidemia, chronic gastritis and reflux esophagitis. She denies alcohol or tobacco use. Her vital signs are normal. Physical examination reveals slight sclera icterus, central epigastric tenderness and decreased bowel sound. No rebound or guarding is noted. Murphy sign is negative. Initial laboratory tests are within normal range except a white blood cell count of 17 x 10 9 /L (normal 4.5 – 10.5 x 10 9 /L). EKG and abdominal plain X-ray exam is unremarkable. What blood test is likely to confirm the diagnosis? A. Bilirubin B. CA19-9 C. Culture D. Lipase E. Troponin 2. A 41-year-old woman present