other pancreas problems

Question 1

Management of pancreatic fistulas:

Answer 1

NPO, TPN, ERCP with stent placement

Question 2

Gold standard for diagnosis of pancreatic divisum:

Answer 2

MRCP

Question 3

Management of symptomatic pancreatic pseudocyst:

Answer 3

endoscopic intervention, surgical cystenterostomy

avoid percutaneous drainage due to risk of fistula

Question 4

Surgical cystogastrostomy should be considered for pancreatic pseudocysts that are sympatomatic and located where?

Answer 4

neck, body, tail

Question 5

What is a Frey procedure?

Answer 5

focal pancreatic head resection around diseased pancreas followed by lateral pancreaticojejunostomy (Puestow); used for chronic pancreatitis

Question 6

Surgical management for pseudocyst near/in close contact with the stomach?

Answer 6

cystogastrostomy

Question 7

surgical management for pseudocyst near the duodenum/head of the pancreas?

Answer 7

cystoduodenostomy

Question 8

surgical management for pseudocyst that is not near the stomach or duodenum?

Answer 8

roux en y cystojejunostomy

Question 9

asymptomatic pseudocyst management?

Answer 9

observation

Question 10

What is a Puestow procedure?

Answer 10

lateral pancreaticojejunostomy; need a dilated pancreatic duct

Question 11

What is a Beger procedure?

Answer 11

resection of the pancreatic head while maintaining biliary enteric continuity

Question 12

Borders of the gastrinoma triangle

Answer 12

confluence of cystic and common bile duct, 2nd and third portion of duodenum, neck and body of pancreas

Question 13

Treatment of symptomatic pancreatic divisum

Answer 13

ERCP with sphincterotomy of minor papilla

Question 14

treatment of autoimmune pancreatitis

Answer 14

steroids; can be difficult to distinguish from cancer on history and imaging

Question 15

how long do pseudocysts take to develop

Answer 15

4-8 weeks

Question 16

what percent of pseudocysts become symptomatic

Answer 16

50%

Question 17

type III sphincter of Oddi dysfunction tx:

Answer 17

medical therapy

Question 18

should antibiotics be given for pancreatitis?

Answer 18

no. unless complicated by necrosis

Question 19

genes associated with hereditary pancreatitis

Answer 19

PRSS1, SPINK

Question 20

cytology of pseudocyst:

Answer 20

pigmented histiocytes

Question 21

cytology of SCNs:

Answer 21

bland, period acid Schiff positive

Question 22

procedure for benign pancreatic inflammatory head mass with no distal ductal dilation:

Answer 22

Beger

Question 23

procedure for chronic pancreatitis with dilated duct but no head mass:

Answer 23

Puestow ( longitudinal pancreaticojejunostomy)

Question 24

procedure for chronic pancreatitis with inflammatory head mass and dilated pancreatic duct:

Answer 24

Frey (core out head of pancreas + Puestow)

Question 25

True or false. Serous cystadenomas usually do not communicate with the pancreatic ducts.

Answer 25

True

Question 26

What is a Puestow procedure?

Answer 26

lateral pancreaticojejunostomy; only possible with a dilated pancreatic duct (>6mm)

Question 27

Most common anatomy subtype of pancreatic divisum:

Answer 27

small ventral duct drains the major papilla and the large dorsal duct drains the minor papilla

Question 28

Minimum anastomotic length for a Puestow procedure:

Answer 28

6cm

Question 29

True or false. Somatostatin administration has been demonstrated to hasten the rate of pancreatic fistula closure.

Answer 29

False

Question 30

Treatment of annular pancreas

Answer 30

in children: duodenal bypass

in adults: wider options, pancreatic procedures, cholecystectomy, duodenal bypass

Question 31

True or false. For acute necrotizing pancreatitis, immediate surgery is an independent predictor of poor outcomes.

Answer 31

true

Question 32

True or false. Anatomic resection and necrosectomy are associated with similar rates of postop exocrine and endocrine insufficiency.

Answer 32

false. anatomic resections are associated with higher exocrine and endocrine insufficiency