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Jaspie - Surgery > 13 - Pancreas > Flashcards

13 - Pancreas Flashcards

1
Q

Pancreas alpha cells secrete what?

A

Glucagon

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2
Q

Pancreas beta cells secrete what?

A

Insulin

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3
Q

Pancreas delta cells secrete what?

A

Somatostatin

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4
Q

PP cells secrete what?

A

Pancreatic polypeptide

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5
Q

Which pancreas cells receive the majority of blood supply relative to size?

A

Islet cells

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6
Q

Pancreas islet cells secrete what?

A

VIP, serotonin, neuropeptide Y, gastrin-releasing peptide

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7
Q

Secretin causes excretion of what in the pancreas?

A

HCO3-

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8
Q

CCK causes excretion of what in the pancreas?

A

Enzymes

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9
Q

ACh causes excretion of what in the pancreas?

A

Enzymes and HCO3-

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10
Q

Somatostatin causes what in the pancreas?

A

Decreased exocrine function of pancreas

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11
Q

What is the only pancreatic enzyme secreted in active form?

A

Amylase - hydrolyzes alpha 1-4 glucose chains

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12
Q

Pancreas ventral bud forms what?

A

Uncinate and inferior portion of the head, Duct of Wirsung

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13
Q

Dorsal pancreatic bud forms what?

A

Body, tail, superior aspect of pancreatic head; Duct of Santorini

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14
Q

What is an annular pancreas? What causes it?

A

2nd portion of duodenum trapped in pancreatic band, can lead to early obstruction; due to failure of rotation of ventral bud

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15
Q

Migration of ventral pancreatic bud?

A

Migrates posteriorly, to the right, and clockwise to fuse with dorsal bud

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16
Q

Genetic syndrome associated with annular pancreas?

A

Down Syndrome

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17
Q

Radiographic findings of annular pancreas?

A

Double bubble on x ray

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18
Q

Ranson’s criteria: on admission

A

Age >55 WBC >16 Glucose >200 AST >250 LDH >300

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19
Q

Ranson’s criteria: after 48h

A

Hct decrease by 10% BUN increase by 5 Ca <8 mg pO2 <60 Base deficit >4 Fluid sequestration >6000

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20
Q

Most common site of heterotopic pancreas? How is it treated?

A

Duodenum; surgical resection only if symptomatic

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21
Q

Treatment for annular pancreas?

A

Duodenojejunostomy or duodenoduodenostomy and sphincteroplasty; pancreas NOT resected

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22
Q

% of time surgery required for pancreatic necrosis?

A

10% (due to infection)

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23
Q

Major risk factor for pancreatic necrosis?

A

Obesity

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24
Q

% of time pancreatic necrosis occurs following pancreatitis?

A

15%

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25
Q

Complications following pancreatic necrosis?

A

ARDS, coagulopathy (protease-related)

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26
Q

Treatment of pancreatic fistulas?

A

Allow to close if <200ml/d: 50-80% success in 4-6 wks Follow up w/ CT or MRI after 6-8 wks Stent via ERCP if psx sx or expansion on f/u CT/MRI If still persists or can’t do ERCP: anastomose vs resect

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27
Q

Etiology of chronic pancreatitis?

A

1 EtOH #2 idiopathic

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28
Q

Expectant management of pancreatic pseudocyst for how long?

A

3mo

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29
Q

Radiographic findings of chronic pancreatitis?

A

CT: shrunken gland with calcifications US: >4mm pancreatic duct ERCP: chain of lakes (very sensitive)

30
Q

Pathophysiology of chronic pancreatitis?

A

Irreversible parenchymal fibrosis, islet cells usually preserved

31
Q

Surgical options for chronic pancreatitis?

A

Puestow procedure for ducts >8mm (side-side panc-J) Distal panc for normal duct/failed Puestow Whipple

32
Q

Treatment for chronic pancreatitis?

A

Supportive care, pain control, nutritional support; surgery for pain interfering with QOL, to r/o malignancy

33
Q

Treatment for bleeding gastric varices due to splenic v. thrombosis?

A

Splenectomy

34
Q

Complications of Whipple?

A

1 is delayed gastric emptying (reglan), anastamotic breakdown, marginal ulceration, abscess/infection, pancreatitis, fistulas, bleeding

35
Q

Most common cause of splenic v. thrombosis?

A

Chronic pancreatitis

36
Q

Fraction of pancreatic neoplasms that are nonfunctional endocrine tumors?

A

1/3

37
Q

% of nonfunctional endocrine tumors that are malignant?

A

90%

38
Q

Chemo used for nonfunctional endocrine tumors?

A

5FU, streptozocin

39
Q

Nonfunctional endocrine tumors most common site of metastasis?

A

Liver

40
Q

Most common islet cell tumor?

A

Insulinoma

41
Q

What is Whipple’s triad?

A

Symptomatic hypoglycemia, fasting hypoglycemia (<50), relief with glucose

42
Q

% of insulinomas that are benign?

A

85-95%

43
Q

Treatment for insulinoma?

A

Enucleation (2cm), streptozocin, octreotide, 5FU for mets

44
Q

Most common pancreatic islet cell tumor associated with MEN1

A

Gastrinoma - 25% associated with MEN1

45
Q

Boundaries of the gastrinoma triangle?

A

CBD and cystic duct, neck of pancreas, 3rd portion of the duodenum

46
Q

Symptoms of gastrinoma?

A

Refractory ulcer disease, diarrhea improved with H2 blockers

47
Q

Treatment of gastrinoma?

A

Enucleation if >2 cm

48
Q

How is diagnosis of gastrinoma made?

A

Serum gastrin >200 (1000s diagnostic), secretin stim test (gastrin remains high)

49
Q

What do you do if you can’t find the gastrinoma?

A

Open the duodenum, somatostatin receptor scintigraphy

50
Q

Symptoms of somatostatinoma?

A

Diabetes, gallstones, steatorrhea, hypochlorydia

51
Q

Diagnosis of somatostatinoma?

A

Fasting somatostatin level

52
Q

Treatment of somatostatinoma?

A

Resection with cholecystectomy

53
Q

Symptoms of glucagonoma?

A

Diabetes, stomatitis, dermatitis, weight loss

54
Q

Treatment of glucagonoma?

A

Supportive care, glucose control, octreotide Resection if amenable

55
Q

Symptoms of VIPoma (Verner-Morrison syndrome)?

A

Watery diarrhea, hypokalemia, achlorydia (WDHA)

56
Q

Diagnosis of VIPoma?

A

Increased VIP levels, confirmed by repeat CT/MRI locate and stage Somatostatin receptor scintigraphy if uncertain or mets

57
Q

Most common location of glucagonoma?

A

Distal pancreas

58
Q

% of function that must be lost before pancreatic insufficiency develops?

A

90%

59
Q

Most common location of VIPoma?

A

Distal pancreas

60
Q

Symptoms of pancreatic adenocarcinoma?

A

Weight loss (most common), jaundice, painless

61
Q

5 yr survival with pancreatic adenocarcinoma?

A

20% with resection

62
Q

1 risk factor for pancreatic adenocarcinoma?

A

Smoking

63
Q

What makes pancreatic adenocarcinoma unresectable at time of diagnosis?

A

Invasion of portal vein, SMV, or retro-peritoneum Mets to peritoneum, omentum, liver, celiac or SMA nodal system 50% of patients unresectable

64
Q

Treatment for pancreatic insufficiency?

A

High carb, high protein, low fat diet with enzyme replacement

65
Q

% of pancreatic adenocarcinoma found in the head of the pancreas?

A

70%

66
Q

% of exocrine pancreas tumors that are ductal adenocarcinomas?

A

90%

67
Q

Which tumor of the exocrine pancreas is considered premalignant?

A

Mucinous cystadenoma

68
Q

Chemotherapy for pancreatic adenocarcinoma?

A

Gemcitabine (with XRT)

69
Q

Signs of carcinoma on ERCP?

A

Duct with irregular narrowing, displacement, destruction

70
Q

Treat VIPoma

A

Replace fluids and lytes Octreotide Distal pancreatectomy F/u 12 mo w/ VIP level, CT/MRI

Jaspie - Surgery (18 decks)

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