ABSITE LATEST 2026 COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS GRADED A+
✔✔Portal hypertension - ✔✔Normal pressure-5mmHg
PHTN when gradient is 8-10 (>10-->varices, >12-->variceal hemorrhage)
Cirrhosis causes sinusoidal HTN
Variceal hemorrhage is MC complication
✔✔Portal vein thrombosis - ✔✔Non-op management in pediatrics
✔✔Splenic vein thrombosis - ✔✔2/2-Left portal HTN, pancreatitis, surgery
If isolated-->splenectomy
✔✔esophageal varices - ✔✔Left gastric vein backs up to esophageal veins
✔✔Portal HTN treatment - ✔✔Octreotide-Decreases portal flow, causes splanchnic
constriction
Vasopressin-decreases splanchnic flow
Nitro-MOST potent splanchnic vasoconstrictor
BBlockers-for chronic tx, reduce portal flow
✔✔Variceal hemorrhage tx - ✔✔Blakemore tube
EGD with banding or sclerotherapy
TIPS
✔✔TIPS - ✔✔Shunt between IVC and hepatic veins/portal v.
✔✔Portal HTN shunts - ✔✔Non-selective: end to side (porto-caval) controls bleeding
but not ascites, side to side controls both but increases encephalopathy
Selective (Warren/distal splenorenal)-decompresses varices, less encephalopathy,
does not fix ascites
✔✔Sigiura procedure - ✔✔Gastro-esophageal devascularization for portal HTN/varices.
7cm of esophagus and upper 2/3 of lesser curvature
✔✔Most common location of accessory spleen - ✔✔Splenic hilum>pedicle>omentum
✔✔ITP - ✔✔Spleen produces platelet auto-Ab-->destruction of plts and sequestration of
plts
1st-Steroids, high dose IVIG, plasmapheresis, Rituximab
2nd-splenectomy if medical management fails or ICH
✔✔TTP - ✔✔plasmapheresis and splenectomy if that doesnt work
,✔✔Splenic cysts - ✔✔True-parasities, congenital, neoplastic
False-trauma, infarct, pancreatitis
-Asymptomatic, <5cm: conservative
-Symptomatic, >5cm: total or partial splenectomy or cyst fenestration
✔✔Splenic abscess - ✔✔MC G+, splenectomy is tx of choice
✔✔Splenectomy - ✔✔Post op: Howell-Jolly, Heinz, Pappenheimer bodies, sympathetic
pleural effusion, subphrenic abscess
✔✔OPSS/OPSI - ✔✔Overwhelming post-splenectomy infection
-Pneumococcus, H. Flu, Meningiococcus
-Highest risk within 2 years of splenectomy
-Vaxx 2 weeks pre-op if elective, 2 weeks post-op or on discharge if emergent
✔✔Pancreatic uncinate process - ✔✔Posterior to vessels, from ventral bud
✔✔Annular pancreas - ✔✔Duodenal compression or atresia
TX: duodenojejeunostomy, dont resect pancreas
✔✔Pancreas divisum - ✔✔Ventral and dorsal parts fail to fuse, accessory duct
abnormally large. Main duct small or absent.
TX: papillotomy of minor papilla
✔✔Pancreatic secretions (exocrine) - ✔✔Water and bicarb (Secretin, VIP stimulates)
Enzymes (CCK, Vagus stimulates)
Amylase and Lipase active on secretion
Trypsin, chymotrypsin inactive on secretion
Somatostatin inhibits pancreatic secretions
✔✔Pancreatic secretions (endocrine) - ✔✔Alpha-glucagon
Beta-insulin
Delta-somatostatin
D-gastrin, PPP
✔✔Insulinoma - ✔✔Mostly benign
Whipple's triad
Enucleation OK
✔✔Glucagonoma - ✔✔80% are malignant
Necrolytic migratory erythema, DM, glossitis
Resection
✔✔Gastrinoma - ✔✔60% malignant
Gastrinoma triangle
, Refractory, odd location, multiple tumors
Resection
✔✔WDHA syndrome - ✔✔50% malignant, most metastatic at diagnosis
VIP (PPP, GIP)oma with dehydration, hypokalemia, achlorhydria, acidosis,
hypercalcemia, hyperglycemia
Flushing and hypotension
Resection
✔✔Antibiotics in pancreatitis - ✔✔Imepenem-BUT only if hemorrhagic and associated
w/severe necrosis
✔✔Pancreatic abscess - ✔✔100% mortality if not drained, 30-50% if drained
✔✔Auto immune pancreatitis - ✔✔Hyper IgG4
TX with steroids
Plasma cells seen on bx
✔✔Puestow procedure - ✔✔Side-to-side anastomosis of the pancreas and jejunum
(pancreatic duct is filleted open)
✔✔Chronic pancreatitis surgery - ✔✔Puestow, Frey(sub-total ventral head removal),
Beger(duodenum preserving pancreatic head) if dilated duct
Whipple if non-dilated duct
✔✔Pancreatic cancer - ✔✔-90% KRAS, 50% HER2NEU, 10% BRCA2
-CEA, CA 19-9
-Resectable-No vascular extension, stage 1,2
-Non-resectable-Celiac, SMA encasement, occlusion of SMV/PV, stage 3
-FOLFIRINOX-3 mos pre & post op if resectable
-6 mos pre-op chemo and radiation if borderline resectable
✔✔Pancreatic cancer surgical treatment - ✔✔Negative margins are the goal
Whipple: 1/3 stomach, 1/3 pancreas, GB, CBD, duodenum
Pancreatic anastomosis is the one most likely to leak-treat with octreotide
✔✔Pancreatic pseudocysts - ✔✔TX with percutaneous aspiration, endoscopic
drainage, cyst-gastrostomy/jejeunostomy +/-anastomosis to pancreatic duct
✔✔Pancreatic cystic neoplasms - ✔✔Serous-Low malignant potential
Mucinous->3cm, calcifications, higher malignant potential. Resection
IPMN-Main duct=high malignant potential(resection), side branch=less potential(resect
if >4cm), mixed=intermediate risk
DX-CT, EUS/bx, CEA, CA 19-9, Amylase
QUESTIONS AND ANSWERS GRADED A+
✔✔Portal hypertension - ✔✔Normal pressure-5mmHg
PHTN when gradient is 8-10 (>10-->varices, >12-->variceal hemorrhage)
Cirrhosis causes sinusoidal HTN
Variceal hemorrhage is MC complication
✔✔Portal vein thrombosis - ✔✔Non-op management in pediatrics
✔✔Splenic vein thrombosis - ✔✔2/2-Left portal HTN, pancreatitis, surgery
If isolated-->splenectomy
✔✔esophageal varices - ✔✔Left gastric vein backs up to esophageal veins
✔✔Portal HTN treatment - ✔✔Octreotide-Decreases portal flow, causes splanchnic
constriction
Vasopressin-decreases splanchnic flow
Nitro-MOST potent splanchnic vasoconstrictor
BBlockers-for chronic tx, reduce portal flow
✔✔Variceal hemorrhage tx - ✔✔Blakemore tube
EGD with banding or sclerotherapy
TIPS
✔✔TIPS - ✔✔Shunt between IVC and hepatic veins/portal v.
✔✔Portal HTN shunts - ✔✔Non-selective: end to side (porto-caval) controls bleeding
but not ascites, side to side controls both but increases encephalopathy
Selective (Warren/distal splenorenal)-decompresses varices, less encephalopathy,
does not fix ascites
✔✔Sigiura procedure - ✔✔Gastro-esophageal devascularization for portal HTN/varices.
7cm of esophagus and upper 2/3 of lesser curvature
✔✔Most common location of accessory spleen - ✔✔Splenic hilum>pedicle>omentum
✔✔ITP - ✔✔Spleen produces platelet auto-Ab-->destruction of plts and sequestration of
plts
1st-Steroids, high dose IVIG, plasmapheresis, Rituximab
2nd-splenectomy if medical management fails or ICH
✔✔TTP - ✔✔plasmapheresis and splenectomy if that doesnt work
,✔✔Splenic cysts - ✔✔True-parasities, congenital, neoplastic
False-trauma, infarct, pancreatitis
-Asymptomatic, <5cm: conservative
-Symptomatic, >5cm: total or partial splenectomy or cyst fenestration
✔✔Splenic abscess - ✔✔MC G+, splenectomy is tx of choice
✔✔Splenectomy - ✔✔Post op: Howell-Jolly, Heinz, Pappenheimer bodies, sympathetic
pleural effusion, subphrenic abscess
✔✔OPSS/OPSI - ✔✔Overwhelming post-splenectomy infection
-Pneumococcus, H. Flu, Meningiococcus
-Highest risk within 2 years of splenectomy
-Vaxx 2 weeks pre-op if elective, 2 weeks post-op or on discharge if emergent
✔✔Pancreatic uncinate process - ✔✔Posterior to vessels, from ventral bud
✔✔Annular pancreas - ✔✔Duodenal compression or atresia
TX: duodenojejeunostomy, dont resect pancreas
✔✔Pancreas divisum - ✔✔Ventral and dorsal parts fail to fuse, accessory duct
abnormally large. Main duct small or absent.
TX: papillotomy of minor papilla
✔✔Pancreatic secretions (exocrine) - ✔✔Water and bicarb (Secretin, VIP stimulates)
Enzymes (CCK, Vagus stimulates)
Amylase and Lipase active on secretion
Trypsin, chymotrypsin inactive on secretion
Somatostatin inhibits pancreatic secretions
✔✔Pancreatic secretions (endocrine) - ✔✔Alpha-glucagon
Beta-insulin
Delta-somatostatin
D-gastrin, PPP
✔✔Insulinoma - ✔✔Mostly benign
Whipple's triad
Enucleation OK
✔✔Glucagonoma - ✔✔80% are malignant
Necrolytic migratory erythema, DM, glossitis
Resection
✔✔Gastrinoma - ✔✔60% malignant
Gastrinoma triangle
, Refractory, odd location, multiple tumors
Resection
✔✔WDHA syndrome - ✔✔50% malignant, most metastatic at diagnosis
VIP (PPP, GIP)oma with dehydration, hypokalemia, achlorhydria, acidosis,
hypercalcemia, hyperglycemia
Flushing and hypotension
Resection
✔✔Antibiotics in pancreatitis - ✔✔Imepenem-BUT only if hemorrhagic and associated
w/severe necrosis
✔✔Pancreatic abscess - ✔✔100% mortality if not drained, 30-50% if drained
✔✔Auto immune pancreatitis - ✔✔Hyper IgG4
TX with steroids
Plasma cells seen on bx
✔✔Puestow procedure - ✔✔Side-to-side anastomosis of the pancreas and jejunum
(pancreatic duct is filleted open)
✔✔Chronic pancreatitis surgery - ✔✔Puestow, Frey(sub-total ventral head removal),
Beger(duodenum preserving pancreatic head) if dilated duct
Whipple if non-dilated duct
✔✔Pancreatic cancer - ✔✔-90% KRAS, 50% HER2NEU, 10% BRCA2
-CEA, CA 19-9
-Resectable-No vascular extension, stage 1,2
-Non-resectable-Celiac, SMA encasement, occlusion of SMV/PV, stage 3
-FOLFIRINOX-3 mos pre & post op if resectable
-6 mos pre-op chemo and radiation if borderline resectable
✔✔Pancreatic cancer surgical treatment - ✔✔Negative margins are the goal
Whipple: 1/3 stomach, 1/3 pancreas, GB, CBD, duodenum
Pancreatic anastomosis is the one most likely to leak-treat with octreotide
✔✔Pancreatic pseudocysts - ✔✔TX with percutaneous aspiration, endoscopic
drainage, cyst-gastrostomy/jejeunostomy +/-anastomosis to pancreatic duct
✔✔Pancreatic cystic neoplasms - ✔✔Serous-Low malignant potential
Mucinous->3cm, calcifications, higher malignant potential. Resection
IPMN-Main duct=high malignant potential(resection), side branch=less potential(resect
if >4cm), mixed=intermediate risk
DX-CT, EUS/bx, CEA, CA 19-9, Amylase
