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Fiser's ABSITE Ryan SHORT > Chapter 33 - Pancreas > Flashcards

Chapter 33 - Pancreas Flashcards

2
Q

What is the only pancreatic enzyme secreted in active form?

A

Amylase - hydrolyzes alpha 1-4 glucose chains

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3
Q

Alpha cells secrete what?

A

Glucagon

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4
Q

Beta cells secrete what?

A

Insulin

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5
Q

Delta cells secrete what?

A

Somatostatin

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6
Q

PP cell secrete what?

A

Pancreatic polypeptide

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7
Q

Islet cells secrete what?

A

VIP, serotonin, neuropeptide Y, gastrin-releasing peptide

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8
Q

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

A

Islet cells

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9
Q

Secretin causes excretion of what?

A

HCO3-

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10
Q

CCK causes excretion of what?

A

Enzymes

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11
Q

ACh causes excretion of what?

A

Enzymes and HCO3-

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12
Q

Somatostatin leads to what?

A

Decreased exocrine function of pancreas

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13
Q

Migration of ventral pancreatic bud?

A

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

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14
Q

Ventral bud forms what?

A

Uncinate and inferior portion of the head, Duct of Wirsung

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15
Q

Dorsal pancreatic bud forms what?

A

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

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16
Q

What is an annular pancreas?

A

2nd portion of duodenum trapped in pancreatic band; due to failure of rotation of ventral bud

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17
Q

Radiographic findings of annular pancreas?

A

Double bubble on x ray

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18
Q

Syndrome associated with annular pancreas?

A

Down Syndrome

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19
Q

Treatment for annular pancreas?

A

Duodenojejunostomy or duodenoduodenostomy and sphincteroplasty; pancreas NOT resected

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20
Q

Most common site of heterotopic pancreas?

A

Duodenum; surgical resection only if symptomatic

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21
Q

Ranson’s criteria: on admission

A

Age >55, WBC >16, glucose >200, AST >250, LDH >300

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22
Q

Ranson’s criteria: after 48h

A

Hct decrease by 10%, BUN increase by 5, Ca 4, pa02 6L

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23
Q

% of time pancreatic necrosis occurs following pancreatitis?

A

15%

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24
Q

% of time surgery required for necrosis?

A

10% (due to infection)

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25
Q

Risk factor for pancreatic necrosis?

A

Obesity

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

Fiser's ABSITE Ryan SHORT (50 decks)

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