I - Pancreas

Question 1

Weight of pancreas

Answer 1

75-100grams

Question 2

Uncinate process

Answer 2

Projection from lower part of head to the left behind the SMA

Question 3

Main pancreatic duct

Answer 3

Wirsung (MW)

Question 4

Accessory duct

Answer 4

Sartorini (sss)

Question 5

Most common congenitl anomaly of the pancreas

Answer 5

Pancreas divisum

• predispose to acute and chronic pancreatitis
• functional obstruction of duct of santorini

Question 6

Describe annular pancreas

Answer 6

• 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)

Question 7

Blood supply of pancreas

Answer 7

Splenic artery
Superior pancreaticoduodenal artery
Inferior pancreaticoduodenal artery

Question 8

Differentiate uncinate process vs annular pancreas vs SMA syndrome

Answer 8

Duodenal compression:

• annular pancreas - D2
• SMA syndrome - D3
• unicinate process - part of head of pancreas related to SMA

Question 9

Fox sign

Answer 9

Ecchymosis of the inguinal ligament

Question 10

Bryan sign

Answer 10

Bluish discoloration of scrotum

Question 11

Pathognomonic pf pancreatic infection

Answer 11

Abnormal extraluminal gas bubbles

Question 12

Indications for surgical intervention

Answer 12

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

Question 13

BISAP

Answer 13

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

Question 14

Most commonly performed surgery for chronic pancreatitis

Answer 14

Puestow-Gillesby

Longitudinal Roux en Y pancreaticojejunostomy

Question 15

Enlarged palpable gallbladder

Answer 15

Courvoisier gallbladder

Question 16

Mobilization of fixed portion of duodenum. What’s the significance?

Answer 16

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.

Question 17

Components of whipple

Answer 17

Head of pancreas
Gallbladder
Cystic duct
CBD
Whole of duodenum
Part of jejnum
Antrum of stomach

Question 18

Presence of necrolytic migratory erythema

Answer 18

Glucagonoma

Question 19

Describe glucagonoma

Answer 19

Necrolytic migratory erythema
Glucagon >500pg/mL
Usually at body and tail

Question 20

Describe VIPOMA

Answer 20

Usually at the tail

Question 21

Describe insulinoma

Answer 21

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

Question 22

2nd most common islet-cell tumo

Answer 22

Non-functioning islet cell tumor (following insulinoma)

• elevated PP as marker
• usually malignant

Question 23

Parameters for initial admission in RANSON’s

Answer 23

Age>70
WBC > 18,000
Glucose > 220
LDH > 400
AST > 250

Question 24

Parameters during the initial 48 h for ranson’s

Answer 24

Hct fall > 10 points
Bun elevation > 2mg/dL
Serum Ca < 8mg/dL
Base deficit > 5mEq/L
Estimated fluid sequestration > 4L

Question 25

Interpretation of ranson

Answer 25

<2 points, 0% mortality
3-5 signs, 10-20% mortality
>7 signs, 50% mortality

Question 26

Ecchymosis along the inguinnal ligament

Answer 26

Fox sign

Question 27

Bluish discoloration of scrotum

Answer 27

Bryan sign