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Senior - Surgery 1 > 7 - Pancreas And Spleen > Flashcards

7 - Pancreas And Spleen Flashcards

1
Q

Fun facts about the pancreas

A

Located in the epigastrium

Shares common channel with the liver and gall bladder

Common bile duct

Empties into the duodenum at the ampulla of Vater through the sphincter of Oddi

“Common channel”

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2
Q

Endocrine functions of the pancreas

A

Islets of Langerhans

Insulin, glucagon, pancreatic polypeptide, somatostatin

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3
Q

Exocrine function of the pancreas

A

Acinar cells

Bicarb and amylase/lipase

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4
Q

MC patient age group for acute pancreatitis

A

40-70 yrs old

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5
Q

Most acute pancreatitis is how severe?

A

Mild, self-limiting (90% of cases)

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6
Q

MC cause of acute pancreatitis?

A

Gallstones

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7
Q

Alcohol consumption leads to what kind of acute pancreatitis?

A

REALLY SEVERE

Increased secretion of pancreatic enzymes

Auto-digestion of pancreas

Necrosis

Hemorrhage

Outlet obstruction (Oddi)

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8
Q

What impact does EtOH have on amylase?

A

It impairs production of amylase

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9
Q

Presentation of acute pancreatitis

A

Med-epigastric, boring pain radiating to the back

N/V

Peritonitis

TTP

Guarding

Tachycardia

Cullen’s and/or Grey-Turner’s sign

Ileus pattern

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10
Q

Workup for acute pancreatitis ?

A 
Resuscitate
NPO
CBC (increased crit if dehydrated)
elevated BUN
Hypokalemia if N/V
T. Bili elevated if stone
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11
Q

Imaging for acute pancreatitis

A

Plain films - calcifications or sentinel loop

US - gallstones, phlegmon, edema around pancreas

CT with contrast

MRI -> very diagnostic

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12
Q

What criteria used for acute pancreatitis ?

A

Ransons

2/3 of:

  1. Acute, severe, persistent epigastric pain
  2. High serum amylase or lipase
  3. CT or MRI findings
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13
Q

What does mild acute pancreatitis look like?

A

No rebound tenderness

Normal HCT and creatinine

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14
Q

Txt for acute pancreatitis

A

Resuscitate

Pain control

NPO (post-pyloric feeding)

ERCP is gallstone etiology

ABX against GNR’s if infection suspected (prophylaxis not recommended)

Surg for abscess or necrosis

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15
Q

MC cause of chronic pancreatitis?

A

EtOH abuse

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16
Q

Secondary causes of acute pancreatitis

A

Hyperproteinemia

Hypercalcuria

Cystic fibrosis

Autoimmune dz

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17
Q

Clinical tetrad of chronic pancreatitis?

A

Abd pain
Weight loss
Diabetes
Steatorrhea

KNOW THIS FOR SURE

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18
Q

Workup for chronic pancreatitis?

A

ERCP

Ductal dilation to 7mm
Clear stones from CBD
Dilation of stenosis

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19
Q

Management of chronic pancreatitis

A

EtOH cessation

PPI / H2RA

Control blood sugars

Small, frequent low-fat meals

Lipase and fat-soluble vitamin supplements

Surgery (last-ditch) drainage, resection

20
Q

How does pancreatic pseudocyst present?

A

Persistent elevation of amylase and early satiety

21
Q

Acute vs chronic pseudocyst

A

Acute - resolves 4-6 weeks

Chronic > 6 weeks

22
Q

Indications for surgery on pancreatic pseudocyst

A

Complications (hemorrhage, infection, leak)

Persistent sxs

PROCEDURE - percutaneous then tube drainage

Or

Internal cyst gastronomy

23
Q

Pancreatic trauma will present with:

A

Elevated serum amylase lipase

Epigastric pain

TTP

24
Q

Txt of pancreatic trauma

A

Mild - no surgery, self limited, follow up CT to evaluate for pseudocyst

SEVERE - surgery

25
Q

Risk factors for pancreatic CA

A

smoking, DM, genetic, chronic pancreatitis, high fat / low fiber diet

26
Q

Presentation of pancreatic CA

A

Epigastric pain
Jaundice
Weight loss
Palpable mass

Mostly thin, jaundiced, older man with new onset DM

Crappy survival rate

27
Q

Workup for pancreatic CA

A 
Liver enzymes
US
CT
MRCP
Bx
28
Q

Txt for pancreatic CA

A

Neoadjuvant chemo/radiation

Whipple procedure for adenocarcinoma of pancreatic head

29
Q

When to to Whipple?

A

Last ditch effort

Complications

30
Q

What is the MC pancreatic endocrine tumor?

A

Insulinoma

31
Q

What is Whipple’s triad?

A

Symptomatic, fasting hypoglycemia

Serum glucose <50

Relief of sxs of glucose

32
Q

Txt for insulinoma

A

Surgery with excellent long-term prognosis

33
Q

How does gastrinoma present?

A

Persistent PUD refractory to aggressive PPI therapy

34
Q

Workup for gastrinoma

A

Hold PPI’s and obtain serum gastrin level

Localization of tumor

35
Q

Where is gastinoma usually located?

A

Passaro’s triangle

36
Q

Management of gastrinoma

A

Screening for MEN-1 and management of comorbidities

Surgical resection once stabilized

Prognosis dependent on liver mets

Long-term (15yr) post-resection survival is 98% vs 74% for non-operative patients

37
Q

Functions of spleen

A

Filter blood
Host immune response
Storage of blood and lymphocytes

38
Q

How is the spleen well-visualized?

A

US
CT
MRI

39
Q

Hypersplenism vs splenomegaly?

A

Hyper - overactive spleen

Megaly - big spleen

40
Q

Causes of hypersplenism or splenomegaly ?

A 
Leukemias
Lymphomas
Portal HTN
Thalassemia
ITP/TTP
Sickle cell
Hereditary spherocytosis
41
Q

What is the second MC site of aneurym?

A

Splenic artery

42
Q

Management of splenic trauma

A

Try to txt nonoperativel if patient is hemodynamically stable

Serial abd exams

Surgery if they decomp

43
Q

Post-op complications splenectomy

A 
Bleeding
Infection
Colon / pancreatic injury
DVT
OPSI
44
Q

What is OPSI

A

Overwhelming Post Splenectomy Infection

Less than 1% of patients

Higher in children, immunocompromised, and trauma

Mitigated with vaccines

STREP PNEUMO, H. FLU, MENINGOCOCCUS

45
Q

What will most patients develop what after splenectomy?

A

Thrombocytosis (platelets under 700K)

Resolves within weeks/months

Mitigate with LMWH, SCDs and early post-op ambulation

46
Q

I don’t find health-related puns funny anymore

A

since I started suffering from an irony deficiency

Senior - Surgery 1 (8 decks)

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