I - Pancreas Flashcards
Weight of pancreas
75-100grams
Uncinate process
Projection from lower part of head to the left behind the SMA
Main pancreatic duct
Wirsung (MW)
Accessory duct
Sartorini (sss)
Most common congenitl anomaly of the pancreas
Pancreas divisum
- predispose to acute and chronic pancreatitis
- functional obstruction of duct of santorini
Describe annular pancreas
- 2nd part of duodenum surrounded by a rim of pancreatic tissue
- may cause proximal small bowel obstruction
- double bubble sign
- associated with down syndrome (also duodenal atresia)
Blood supply of pancreas
Splenic artery
Superior pancreaticoduodenal artery
Inferior pancreaticoduodenal artery
Differentiate uncinate process vs annular pancreas vs SMA syndrome
Duodenal compression:
- annular pancreas - D2
- SMA syndrome - D3
- unicinate process - part of head of pancreas related to SMA
Fox sign
Ecchymosis of the inguinal ligament
Bryan sign
Bluish discoloration of scrotum
Pathognomonic pf pancreatic infection
Abnormal extraluminal gas bubbles
Indications for surgical intervention
Diagnostic uncertainty
Intraabdominal catastrophe untrelated to necrotizing pancreatitis (e.g.perforforated viscus)
Infected necrosis documented by FNA or extraluminal gas on CT
Severe sterile necrosis
Symptomatic organized pancratic necrosis
BISAP
BUN > 25mg/dL (8.9mmol/L) Impaired mental status SIRS Age > 60 Pleural effusion Presence of three or more of these factors was associated with substantially increased risk for in-hospital mortality among patients with acute pancreatitis
Most commonly performed surgery for chronic pancreatitis
Puestow-Gillesby
Longitudinal Roux en Y pancreaticojejunostomy
Enlarged palpable gallbladder
Courvoisier gallbladder
Mobilization of fixed portion of duodenum. What’s the significance?
Kocher’s maneuver. If you can’t do this, abort whipple, do double bypass instead (bypass obstructed bile and gastric outlet obsturction, then celiac plexus blockade.
Components of whipple
Head of pancreas Gallbladder Cystic duct CBD Whole of duodenum Part of jejnum Antrum of stomach
Presence of necrolytic migratory erythema
Glucagonoma
Describe glucagonoma
Necrolytic migratory erythema
Glucagon >500pg/mL
Usually at body and tail
Describe VIPOMA
Usually at the tail
Describe insulinoma
90% benign, solitary and sporaidc
Evenly distributed throught head, body, and tail,
Simple enucleation as treatment EXCEPT if close to main pancreatic duct and is more than 2 cm
2nd most common islet-cell tumo
Non-functioning islet cell tumor (following insulinoma)
- elevated PP as marker
- usually malignant
Parameters for initial admission in RANSON’s
Age>70 WBC > 18,000 Glucose > 220 LDH > 400 AST > 250
Parameters during the initial 48 h for ranson’s
Hct fall > 10 points Bun elevation > 2mg/dL Serum Ca < 8mg/dL Base deficit > 5mEq/L Estimated fluid sequestration > 4L
Interpretation of ranson
<2 points, 0% mortality
3-5 signs, 10-20% mortality
>7 signs, 50% mortality
Ecchymosis along the inguinnal ligament
Fox sign
Bluish discoloration of scrotum
Bryan sign
