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Fiser ABSITE Review + Decker + TrueLearn > Chapter 33 - Pancreas > Flashcards

Chapter 33 - Pancreas Flashcards

2
Q

Pancreas alpha cells secrete what?

A

Glucagon

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3
Q

Pancreas beta cells secrete what?

A

Insulin

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4
Q

Pancreas delta cells secrete what?

A

Somatostatin

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5
Q

PP cells secrete what?

A

Pancreatic polypeptide

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6
Q

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

A

Islet cells

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7
Q

Pancreas islet cells secrete what?

A

VIP, serotonin, neuropeptide Y, gastrin-releasing peptide

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8
Q

Secretin causes excretion of what in the pancreas?

A

HCO3-

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9
Q

CCK causes excretion of what in the pancreas?

A

Enzymes

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10
Q

ACh causes excretion of what in the pancreas?

A

Enzymes and HCO3-

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11
Q

Somatostatin causes what in the pancreas?

A

Decreased exocrine function of pancreas

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12
Q

What is the only pancreatic enzyme secreted in active form?

A

Amylase - hydrolyzes alpha 1-4 glucose chains

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13
Q

Pancreas ventral bud forms what?

A

Uncinate and inferior portion of the head, Duct of Wirsung

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14
Q

Dorsal pancreatic bud forms what?

A

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

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15
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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16
Q

Migration of ventral pancreatic bud?

A

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

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17
Q

Genetic syndrome associated with annular pancreas?

A

Down Syndrome

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18
Q

Radiographic findings of annular pancreas?

A

Double bubble on x ray

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19
Q

Ranson’s criteria: on admission

A 
Age >55
WBC >16
Glucose >200
AST >250
LDH >300
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20
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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21
Q

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

A

Duodenum; surgical resection only if symptomatic

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22
Q

Treatment for annular pancreas?

A

Duodenojejunostomy or duodenoduodenostomy and sphincteroplasty; pancreas NOT resected

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23
Q

% of time surgery required for pancreatic necrosis?

A

10% (due to infection)

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24
Q

Major risk factor for pancreatic necrosis?

A

Obesity

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25
Q

% of time pancreatic necrosis occurs following pancreatitis?

A

15%

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26
Complications following pancreatic necrosis?
ARDS, coagulopathy (protease-related)
27
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
28
Etiology of chronic pancreatitis?
``` #1 EtOH #2 idiopathic ```
29
Expectant management of pancreatic pseudocyst for how long?
3mo
30
Radiographic findings of chronic pancreatitis?
CT: shrunken gland with calcifications US: >4mm pancreatic duct ERCP: chain of lakes (very sensitive)
31
Pathophysiology of chronic pancreatitis?
Irreversible parenchymal fibrosis, islet cells usually preserved
32
Surgical options for chronic pancreatitis?
Puestow procedure for ducts >8mm (side-side panc-J) Distal panc for normal duct/failed Puestow Whipple
33
Treatment for chronic pancreatitis?
Supportive care, pain control, nutritional support; surgery for pain interfering with QOL, to r/o malignancy
34
Treatment for bleeding gastric varices due to splenic v. thrombosis?
Splenectomy
35
Complications of Whipple?
#1 is delayed gastric emptying (reglan), anastamotic breakdown, marginal ulceration, abscess/infection, pancreatitis, fistulas, bleeding
36
Most common cause of splenic v. thrombosis?
Chronic pancreatitis
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
Treatment of gastrinoma?
Enucleation if >2 cm
49
How is diagnosis of gastrinoma made?
Serum gastrin >200 (1000s diagnostic), secretin stim test (gastrin remains high)
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
Treatment of glucagonoma?
Supportive care, glucose control, octreotide | Resection if amenable
56
Symptoms of VIPoma (Verner-Morrison syndrome)?
Watery diarrhea, hypokalemia, achlorydia (WDHA)
57
Diagnosis of VIPoma?
Increased VIP levels, confirmed by repeat CT/MRI locate and stage Somatostatin receptor scintigraphy if uncertain or mets
58
Most common location of glucagonoma?
Distal pancreas
59
% of function that must be lost before pancreatic insufficiency develops?
90%
60
Most common location of VIPoma?
Distal pancreas
61
Symptoms of pancreatic adenocarcinoma?
Weight loss (most common), jaundice, painless
62
5 yr survival with pancreatic adenocarcinoma?
20% with resection
63
#1 risk factor for pancreatic adenocarcinoma?
Smoking
64
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
65
Treatment for pancreatic insufficiency?
High carb, high protein, low fat diet with enzyme replacement
66
% of pancreatic adenocarcinoma 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
71
Treat VIPoma
Replace fluids and lytes Octreotide Distal pancreatectomy F/u 12 mo w/ VIP level, CT/MRI

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