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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
Complications following pancreatic necrosis?
ARDS, coagulopathy (protease-related)
26
Treatment of pancreatic fistulas?
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
27
Etiology of chronic pancreatitis?
#1 EtOH #2 idiopathic
28
Expectant management of pancreatic pseudocyst for how long?
3mo
29
Radiographic findings of chronic pancreatitis?
CT: shrunken gland with calcifications US: \>4mm pancreatic duct ERCP: chain of lakes (very sensitive)
30
Pathophysiology of chronic pancreatitis?
Irreversible parenchymal fibrosis, islet cells usually preserved
31
Surgical options for chronic pancreatitis?
Puestow procedure for ducts \>8mm (side-side panc-J) Distal panc for normal duct/failed Puestow Whipple
32
Treatment for chronic pancreatitis?
Supportive care, pain control, nutritional support; surgery for pain interfering with QOL, to r/o malignancy
33
Treatment for bleeding gastric varices due to splenic v. thrombosis?
Splenectomy
34
Complications of Whipple?
#1 is delayed gastric emptying (reglan), anastamotic breakdown, marginal ulceration, abscess/infection, pancreatitis, fistulas, bleeding
35
Most common cause of splenic v. thrombosis?
Chronic pancreatitis
36
Fraction of pancreatic neoplasms that are nonfunctional endocrine tumors?
1/3
37
% of nonfunctional endocrine tumors that are malignant?
90%
38
Chemo used for nonfunctional endocrine tumors?
5FU, streptozocin
39
Nonfunctional endocrine tumors most common site of metastasis?
Liver
40
Most common islet cell tumor?
Insulinoma
41
What is Whipple's triad?
Symptomatic hypoglycemia, fasting hypoglycemia (\<50), relief with glucose
42
% of insulinomas that are benign?
85-95%
43
Treatment for insulinoma?
Enucleation (2cm), streptozocin, octreotide, 5FU for mets
44
Most common pancreatic islet cell tumor associated with MEN1
Gastrinoma - 25% associated with MEN1
45
Boundaries of the gastrinoma triangle?
CBD and cystic duct, neck of pancreas, 3rd portion of the duodenum
46
Symptoms of gastrinoma?
Refractory ulcer disease, diarrhea improved with H2 blockers
47
Treatment of gastrinoma?
Enucleation if \>2 cm
48
How is diagnosis of gastrinoma made?
Serum gastrin \>200 (1000s diagnostic), secretin stim test (gastrin remains high)
49
What do you do if you can't find the gastrinoma?
Open the duodenum, somatostatin receptor scintigraphy
50
Symptoms of somatostatinoma?
Diabetes, gallstones, steatorrhea, hypochlorydia
51
Diagnosis of somatostatinoma?
Fasting somatostatin level
52
Treatment of somatostatinoma?
Resection with cholecystectomy
53
Symptoms of glucagonoma?
Diabetes, stomatitis, dermatitis, weight loss
54
Treatment of glucagonoma?
Supportive care, glucose control, octreotide Resection if amenable
55
Symptoms of VIPoma (Verner-Morrison syndrome)?
Watery diarrhea, hypokalemia, achlorydia (WDHA)
56
Diagnosis of VIPoma?
Increased VIP levels, confirmed by repeat CT/MRI locate and stage Somatostatin receptor scintigraphy if uncertain or mets
57
Most common location of glucagonoma?
Distal pancreas
58
% of function that must be lost before pancreatic insufficiency develops?
90%
59
Most common location of VIPoma?
Distal pancreas
60
Symptoms of pancreatic adenocarcinoma?
Weight loss (most common), jaundice, painless
61
5 yr survival with pancreatic adenocarcinoma?
20% with resection
62
#1 risk factor for pancreatic adenocarcinoma?
Smoking
63
What makes pancreatic adenocarcinoma unresectable at time of diagnosis?
Invasion of portal vein, SMV, or retro-peritoneum Mets to peritoneum, omentum, liver, celiac or SMA nodal system 50% of patients unresectable
64
Treatment for pancreatic insufficiency?
High carb, high protein, low fat diet with enzyme replacement
65
% of pancreatic adenocarcinoma found in the head of the pancreas?
70%
66
% of exocrine pancreas tumors that are ductal adenocarcinomas?
90%
67
Which tumor of the exocrine pancreas is considered premalignant?
Mucinous cystadenoma
68
Chemotherapy for pancreatic adenocarcinoma?
Gemcitabine (with XRT)
69
Signs of carcinoma on ERCP?
Duct with irregular narrowing, displacement, destruction
70
Treat VIPoma
Replace fluids and lytes Octreotide Distal pancreatectomy F/u 12 mo w/ VIP level, CT/MRI

Jaspie - Surgery (18 decks)

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