VA AM Report Pearls
1. LT taught us that if a patient with biliary obstruction has a persistently elevated bili >15 you ought to have a higher suspicion for malignancy or another cause of persistent obstruction.
2. There is something called Spyglass® Cholangioscopy which is performed in conjunction with ERCP to directly visualize the bile ducts. This helps the endoscopist to obtain higher yield biopsies of suspicious lesions. It has interventional capabilities as well since the device can perform laser lithotripsy of biliary or pancreatic stones. This procedure is currently not available here at the VA but look out for it at a super-specialized endoscopy shop near you.
3. A quick differential for aortitis can be a nice thing to have in your pocket. It includes:
Inflammatory: e.g. GCA, Takayasu arteritis, IgG4 Disease, RA, SLE, Behcet Disease, Relapsing polychondritis, Sarcoidosis
Infectious: Syphilis, M. tuberculosis, Salmonella, S. pneumoniae
4. The National Bowling Stadium in Reno (the Taj Mahal of tenpins) houses 78 lanes of bowling and can hold up to 1,100 spectators for big tournaments. Find out more here: https://en.wikipedia.org/wiki/National_Bowling_Stadium