Fiser: Pancreas

Question 1

blood supply: head of pancreas

Answer 1

superior: off GDA
Inferior: pancreaticoduodenal ateries

Question 2

blood supply: body of pancreas

Answer 2

great, inferior and dorsal pancreatic arteries (all off splenic aa)

Question 3

Blood supply: tail of pancreas

Answer 3

splenic, gastroepiploic and caudal pancreatic arteries

Question 4

ductal cells of pancreas secrete what?

Answer 4

HCO3- solution

Question 5

Acinar cells of pancreas secrete what?

Answer 5

digestive enzymees

Question 6

what is the only pancreatic enzyme thats secreted in active form?

Answer 6

amylase

Question 7

Secretion: Alpha islet cells

Answer 7

glucagon

Question 8

Secretion: Beta Islet Cells

Answer 8

insulin

Question 9

Secretion: Delta islet cells

Answer 9

somatostatin

Question 10

Secretion: PP or F islet cells

Answer 10

pancreatic polupetide

Question 11

what activated typsinogen to trypsin?

Answer 11

enterokinase: released from duodenum

Question 12

Action of: secretin

Answer 12

release of bicarb from pancreas (secreted from the duodenum)

Question 13

Action of CCK

Answer 13

release of pancreatic enzymes (secreted from the duodenum)

Question 14

Action of Somatostatin

Answer 14

decreases exocrine function of pancreas

Question 15

two pancreatic ducts and embryology

Answer 15

1. ventral pancreatic bud -> duct of wirsung, this bud migrates posterior and clockwise (uncinate and inferior head)
2. dorsal pancreatic bud -> duct of santorini, this bud forms the body, tail and superior aspect of head

Question 16

pathophysiology of annular pancreas

Answer 16

forms from the ventral pancreatic bud from failure of clockwise rotation

Question 17

what will you se on ERCP for pancreas divisum?

Answer 17

minor papilla will show long duct of santorini, major will have short duct of wirsung (opposite of what it should be)

Question 18

buzzword: chain of lakes

Answer 18

chronic panceratitis, alternating segments of dilation and stenosis of pancreatic duct

Question 19

genetic mutation found in 95% of pancreatic adenocarcinomas?

Answer 19

p16 mutation (tumor suppressor, binds cyclin complexes)

Question 20

what’s whipple’s triad?

Answer 20

• symptoms of insulinoma
  1. Fasting hypoglycemia (<50)
  2. Symptoms of hypoglycemia
  3. Relief with glucose

Question 21

how to diagnose insulinoma?

Answer 21

insulin to glucose ration >0.4, increase C peptide and proinsulin

Question 22

NET: refractory PUD and diarrhea, how to diagnose?

Answer 22

Gastinoma, diagnose with gastrin >200 (usually 1,000’s) and secretin stimulation test -> increased gastrin (normal is decreased)

Question 23

single best study for localizing a gastrinoma?

Answer 23

octreotide scan

Question 24

NET and how to diagnose: diabetes, stomatitis, dermatitis

Answer 24

Glucagonoma, diagnose with a fasting glucose level

Question 25

NET and how to diagnose: watery diarrhea, hypokalemia, achlorhydria

Answer 25

VIPoma, see increased VIP levels

Question 26

NET and how to diagnose: diabetes, gallstones, steatorrhea

Answer 26

somatostatinoma, fasting somatostatin level

Question 27

what are the criteria for performing diagnostic laparoscopy in pancreatic cancer?

Answer 27

1. Large tumors (>3cm)
2. Significantly elevated CA 19-9
3. Equivocal CT
4. Pancreatic body and tail tumors

Question 28

what is the treatment for autoimmune pancreatitis?

Answer 28

corticosteroids for 2-4 weeks or until symptoms resolve (must rule out pancreatic cancer)

Question 29

what is genetic mutation behind hereditary pancreatitis?

Answer 29

PRSS1: cationic trypsinogen gene mutation