other pancreas problems Flashcards
Management of pancreatic fistulas:
NPO, TPN, ERCP with stent placement
Gold standard for diagnosis of pancreatic divisum:
MRCP
Management of symptomatic pancreatic pseudocyst:
endoscopic intervention, surgical cystenterostomy
avoid percutaneous drainage due to risk of fistula
Surgical cystogastrostomy should be considered for pancreatic pseudocysts that are sympatomatic and located where?
neck, body, tail
What is a Frey procedure?
focal pancreatic head resection around diseased pancreas followed by lateral pancreaticojejunostomy (Puestow); used for chronic pancreatitis
Surgical management for pseudocyst near/in close contact with the stomach?
cystogastrostomy
surgical management for pseudocyst near the duodenum/head of the pancreas?
cystoduodenostomy
surgical management for pseudocyst that is not near the stomach or duodenum?
roux en y cystojejunostomy
asymptomatic pseudocyst management?
observation
What is a Puestow procedure?
lateral pancreaticojejunostomy; need a dilated pancreatic duct
What is a Beger procedure?
resection of the pancreatic head while maintaining biliary enteric continuity
Borders of the gastrinoma triangle
confluence of cystic and common bile duct, 2nd and third portion of duodenum, neck and body of pancreas
Treatment of symptomatic pancreatic divisum
ERCP with sphincterotomy of minor papilla
treatment of autoimmune pancreatitis
steroids; can be difficult to distinguish from cancer on history and imaging
how long do pseudocysts take to develop
4-8 weeks
what percent of pseudocysts become symptomatic
50%
type III sphincter of Oddi dysfunction tx:
medical therapy
should antibiotics be given for pancreatitis?
no. unless complicated by necrosis
genes associated with hereditary pancreatitis
PRSS1, SPINK
cytology of pseudocyst:
pigmented histiocytes
cytology of SCNs:
bland, period acid Schiff positive
procedure for benign pancreatic inflammatory head mass with no distal ductal dilation:
Beger
procedure for chronic pancreatitis with dilated duct but no head mass:
Puestow ( longitudinal pancreaticojejunostomy)
procedure for chronic pancreatitis with inflammatory head mass and dilated pancreatic duct:
Frey (core out head of pancreas + Puestow)
True or false. Serous cystadenomas usually do not communicate with the pancreatic ducts.
True
What is a Puestow procedure?
lateral pancreaticojejunostomy; only possible with a dilated pancreatic duct (>6mm)
Most common anatomy subtype of pancreatic divisum:
small ventral duct drains the major papilla and the large dorsal duct drains the minor papilla
Minimum anastomotic length for a Puestow procedure:
6cm
True or false. Somatostatin administration has been demonstrated to hasten the rate of pancreatic fistula closure.
False
Treatment of annular pancreas
in children: duodenal bypass
in adults: wider options, pancreatic procedures, cholecystectomy, duodenal bypass
True or false. For acute necrotizing pancreatitis, immediate surgery is an independent predictor of poor outcomes.
true
True or false. Anatomic resection and necrosectomy are associated with similar rates of postop exocrine and endocrine insufficiency.
false. anatomic resections are associated with higher exocrine and endocrine insufficiency
