 Type III: Pre-pyloric; High acid secretion

 PEEP  ↑ FRC  Type IV: Lesser curve along cardia; ↓ Mucosal protection
 Aging  ↑FRC, ↓FEV1 & VC  Type V: Ulcer due to NSAIDs
 Minute Vent = TV x RR Functional Endocrine Pancreatic Tumors –
 Insulinoma: Most common; Evenly distributed throughout pancreas; Whipple’s triad (hypoglycemia, sx of hypoglycemia,
 ↑PEEP or FiO2  ↑O2
relief w/ glucose); <2cm  enucleate; >2 cm  rsxn
 ↑RR or volume  ↓CO2  Gastrinoma: Head of pancreas; Gastrinoma triangle (CBD, neck of pancreas, D3); Secretin  ↑Gastrin; <2cm 
enucleate; >2 cm  rsxn
 Glucagonoma: Distal pancreas; Diabetes, stomatitis, necrolytic migratory erythema
 VIPoma: Distal pancreas; Watery diarrhea, hypokalemia, achlorhydria
 Somatostatinoma: Head of pancreas; Diabetes, gallstones, steatorrhea

Pancreatic Cystic Masses –

 Mucinous Cystic Neoplasm: 99% women, age 40-50 (“mom”); Malignant potential; Macrocystic w/ septae, usually single,
+/- peripheral calcification; Ovarian-like stroma; 95% in tail & body; ↓amylase, ↑CEA, ↑viscosity, +mucin; Tx  rsxn
 Verbal:  Serous Cystic Neoplasm: 75% women, age 60-70 (“grandma”); Benign; Lobulated, microcystic, +/- central scar w/
o 5 – Oriented calcification, cuboidal cells; ↓amylase, ↓CEA, ↓viscosity, +glycogen; Tx  rsxn if symptoms, >4 cm, or concerning
GCS – o 4 – Confused features
 Motor (most important for prognosis): o 3 – Inappropriate words
 Main-duct IPMN: M=W, age 60-80; Malignant potential; Dilated pancreatic duct; ↑amylase, ↑CEA, ↑viscosity, +mucin,
o 6 – Follows commands o 2 – Incomprehensible sounds
+KRAS (80%); Tx  rsxn
o 5 – Localizes pain o 1 – No response
 Branch-duct IPMN: M=W, age 60-80; Malignant potential; Cluster of grapes appearance; ↑amylase, ↑CEA, ↑viscosity,
o 4 – Withdraws from pain
+mucin, +KRAS (80%); Tx  symptomatic (rsxn), >3cm (rsxn), 2-3 cm (EUS), <2 cm (serial imaging)
o 3 – Decorticate
o 2 – Decerebrate
Endoleaks –
o 1 – No response
 Type I: Proximal (Ia) or distal (Ib) graft attachment sites; Tx  extension cuffs
 Eye Opening:
 Type II: Most common; Collaterals/back-bleeding (eg, lumbar vessel); Tx  observe unless ↑pressure
o 4 – Spontaneous opening
 Type III: Graft overlap sites; Tx  secondary endograft
o 3 – Opens to command
o 2 – Opens to pain  Type IV: Graft wall porosity or suture holes; Tx  observe
o 1 – No response  Type V: Endotension; Expansion of aneurysm w/o evidence of leak; Tx  repeat EVAR vs open repair

Respiratory Quotient –
ASA Classification –
 RQ >1 = lipogenesis (overfeeding):
 1 – Healthy
 5 – Moribund o CO2 buildup & difficulty weaning from vent
 2 – Mild disease w/o limitation
 6 – Donor  RQ <0.7 = ketosis & fat oxidation (starving)
 3 – Severe disease
 E – Emergency  Pure fat utilization  RQ = 0.7
 4 – Severe constant threat to life
 Pure protein utilization  RQ = 0.8
 Pure carbohydrate utilization  RQ = 1.0
MEN Syndrome (Autosomal Dominant) –
 MEN I: MENIN gene; Parathyroid hyperplasia (1st symptoms; Tx first); Pancreatic islet cell tumors (#1 Gastrinoma); BIRADS –
Pituitary Adenoma  0: Non-diagnostic; Repeat study
 MEN IIa: RET proto-oncogene; Parathyroid hyperplasia; Medullary thyroid CA (1st symptoms, diarrhea);  1: Normal/negative; Routine follow-up
Pheochromocytoma (Tx first)  2: Benign; Routine follow-up
 MEN IIb: RET proto-oncogene; Medullary thyroid CA (1st symptoms, diarrhea); Pheochromocytoma (Tx first); Mucosal  3: Probably benign; Short interval follow-up
neuromas; Marfanoid habitus  4: Suspicious; Core needle bx
 5: Highly suggestive of ca; Core needle bx
Hypersensitivity Reactions –  6: Known malignancy
 Type I: Immediate; Allergy, IgE activates mast cells (eg, bee stings, peanuts, anaphylaxis)
 Type II: Ig w/ cell antigen (eg, ABO incompatibility, Grave’s disease)
Vitamin Deficiencies –
 Type III: Ig w/ soluble antigen  Immune complex (eg, sick sinus syndrome, SLE)
 Thiamine (B1)  Wernicke’s encephalopathy
 Type IV: Delayed; T cells, no antibodies (eg, TB skin test, contact dermatitis, chronic rejection)
 Niacin (B3)  pellagra (diarrhea, dermatitis, dementia)
 Pyridoxine (B6)  glossitis, sideroblastic anemia
Liver Abscesses –
 Folate (B9)  glossitis, megaloblastic anemia
 Amebic: Entomoeba histolytica; single; 2/2 colitis; recent travel to Mexico; Tx  Flagyl
 Hydatid: Echinococcus; calcified, double wall; anaphylaxis if ruptures; Tx  Albendazole followed by rsxn  Cobalamin (B12)  glossitis, megaloblastic anemia, peripheral neuropathy
 Ascorbic Acid (C)  scurvy, follicular hyperkeratosis, perifollicular hemorrhage
 Pyogenic: Most common; E. Coli (MC); ascending infection from biliary tree; Tx  perc drain & abx
 Vitamin A  night blindness
Choledochal Cysts –  Vitamin D  rickets, osteomalacia
 Type I: Most common; Fusiform dilation of CBD; Tx  Rsxn & hepaticojejunostomy  Vitamin E  neuropathy, spinocerebellar ataxia, hemolytic anemia
 Type II: True diverticulum of CBD; Tx  Rsxn  Vitamin K  coagulopathy
 Type III: Dilation of distal CBD involving Sphincter of Oddi; Tx  Rsxn or marsupialization
Trace Element Deficiencies –
 Type IV: Multiple cysts intra- & extrahepatic; Tx  Rsxn, poss lobectomy, poss transplant
 Chromium  encephalopathy, hyperglycemia
 Type V (Caroli’s Dz): Intrahepatic cysts; Tx  Rsxn, poss lobectomy, poss transplant
 Selenium  cardiomyopathy
 Copper  pancytopenia
Gastric Ulcers –
 Zinc  poor wound healing, hair loss
 Type I: Lesser curve low along body of stomach; ↓ Mucosal protection
 Type II: Lesser curve & duodenal; High acid secretion
Equations –
 Ideal Body Weight:
o Men = 106 lbs + 6 lbs for every in. over 5 ft
o Women = 100 lbs + 5 lbs for every in. over 5 ft
 Nitrogen Balance = ([protein/6.25] – [24 h urine N + 4])
 CO = HR x SV
 SV (stroke volume) = EDV - ESV
 MAP = CO X SVR
 CI = CO/BSA
 Arterial O2 Content (CaO2)= (Hgb x 1.34 x SpO2) + (PO2 x 0.003)
 O2 Delivery = CO x CaO2
 O2 Consumption (VO2) = CO x (CaO2 – CvO2)
 Compliance = (∆Volume)/(∆Pressure)
 Minute Ventilation = TV x RR
 FENa = ([Naurine x Crplasma)/(Naplasma x Crurine)] x 100
 H2O deficit = (weight (kg) x 0.6) x ([Na/140] – 1)
 Serum Osmolarity = (2 x Na) + (BUN/2.8) + (Glucose/18)

Proto-Oncogenes –
 c-myc  Burkitt’s Lymphoma
 c-Kit  GIST (tyrosine kinase)
 N-myc  Neuroblastoma
 RET  MEN2a, MEN2b
 BRAF  Melanoma
 K-ras  Colorectal ca

Tumor Suppressor Genes –

 APC  Familial Adenomatous Polyposis
 BRCA1  Breast ca, Ovarian ca
 BRCA2  Breast ca (♀&♂), Pancreatic ca, Ovarian ca
 DCC  Colorectal ca
 p16  Familial melanoma, Pancreatic ca (CDKN2A)
 p53  Li Fraumeni
 VHL  von Hippel Lindau, Kidney ca, Retina ca, Brain ca
 WT-1  Wilm’s tumor
 MSH2, MLH1, MSH6, PMS2  DNA mismatch repair,
Lynch Syndrome

 Sensitivity = (TP)/(TP+FN) = Probability of a positive test given that the patient

has the disease (ie, rule out disease)
 Specificity = (TN)/(TN+FP) = Probability of a negative test given that the patient
does not have the disease (ie, rule in disease)
 Positive Predictive Value = (TP)/(TP+FP)
 Negative Predictive Value = (TN)/(TN+FN)