Diseases of the Pancreas

Question 1

Chronic pancreatitis management

Answer 1

Alcohol and smoking cessation are the main things

Can give pancreatic enzymes to take with meals to relax pancreas

ERCP if pancreatic duct stricture or stone

Question 2

The most worrisome part of acute pancreatitis is …

Answer 2

The body’s response to inflammation of the pancreas

Question 3

Compare and contrast acute peripancreatic fluid collection, pancreatic pseudocyst, acute necrotic collection, and walled off necrosis

Answer 3

Peripancreatic fluid collection:
- early phase
- no defined wall, homogenous
- sterile
- resolves on its own

Pancreatic pseudocyst:
- well defined wall
- no solid component
- see > 4 weeks
- result from disrupted pancreatic duct

Acute necrotic collection:
- occur in first 4 weeks
- fluid and solid necrosis

Walled off necrosis
- > 4 weeks after initial necrotizing pancreatitis
Mature, encapsulated collection of solid material and fluid

Question 4

Common causes of chronic pancreatitis

Answer 4

Alcohol (can have been sober for decades)

Tobacco

Genetic

Chronic obstruction (pancreas divisum)

Question 5

Most sensitive and specific lab value to diagnose acute pancreatitis

Answer 5

Lipase

(more sensitive and specific than amylase)

Question 6

Diagnosis methods for pancreas divisum

Answer 6

Secretin enhanced MRCP or ERCP

(can see bile ducts)

Question 7

Most common cystic tumor of the pancreas

Answer 7

Intraductal papillary mucinous neoplasm

Question 8

Criteria used to categorize acute pancreatitis

Answer 8

BISAP score

BUN >25
Impaired mental status
SIRS
Age >60
Pleural effusions

Question 9

Two most common causes of acute pancreatitis

Answer 9

Alcohol

Gallstones

Question 10

Differentiate mild, moderately severe, and severe acute pancreatitis

Answer 10

Mild:
- no organ failure
- no local or systemic complications

Moderately severe:
- Transient organ failure (resolves in 48h) and/or
- Local or systemic complications

Severe:
- Persistent organ(s) failure (>48h)

Question 11

This malformation of the pancreas is more common in patients with trisomy 21

Answer 11

Annular pancreas

Question 12

New onset diabetes in an elderly patient should suggest this type of pancreatic disease

Answer 12

Cystic tumor of pancreas

Question 13

Is chronic pancreatitis typically diagnosed early or late in the disease process?

Answer 13

Late

(very hard to diagnose)

Question 14

Physical exam signs of acute pancreatitis

Answer 14

Abdominal tenderness

Dyspnea or tachypnea

Grey Turner sign (bruised flank)
Cullen sign (bruised belly button)

Question 15

Name this condition where the ventral pancreas fails to fully rotate around the duodenum in development leading to bowel obstruction in newborns

Answer 15

Annular pancreas

Question 16

Best lab test for steatorrhea

Answer 16

Fecal elastase

Question 17

Name this condition where, in embryogenesis, the dorsal and ventral ducts of the pancreas fail to fuse leading to most pancreatic drainage to be done through the accessory papilla

Answer 17

Pancreas divisum

Question 18

Best imaging modality for chronic pancreatitis

Answer 18

Endoscopic ultrasound

Question 19

Diagnosis criteria for acute pancreatitis

Answer 19

Need two out of these three:

1. Characteristic abdominal pain
2. Amylase or lipase 3x upper limit of normal
3. Radiographic evidence of pancreatitis on cross sectional imaging

Question 20

Which cystic tumor of the pancreas has a honeycomb or central sunburst appearance on CT?

Answer 20

Serous cystadenoma

Question 21

Describe the condition of pancreatic rest and where it is most commonly seen

Answer 21

Ectopic pancreatic tissue

Most commonly found in the stomach (then GI tract)

Question 22

Symptoms of chronic pancreatitis

Answer 22

Epigastric pain that radiates to the back (initially intermittent, then chronic)

Nausea and vomiting

Exocrine insufficiency (maldigestion, weight loss, steatorrhea)

Endocrine insufficiency (diabetes)

Question 23

Symptoms of acute pancreatitis

Answer 23

Acute onset, persistent epigastric pain radiating to back

Nausea and vomiting