Pancreas 1

Question 1

Most common pancreatic congenital abnormality? Subtypes?

Answer 1

Pancreas divisum

Complete - the dorsal pancreatic duct empties through minor papilla and ventral pancreatic duct empties through major papilla

Incomplete - dorsal pancreatic duct empties mainly through the minor papilla but a connection exists to major papilla

Reversed - dorsal pancreatic duct connects into the ventral duct

Question 2

A ring of pancreatic tissue surrounds the second portion of the duodenum – name? Radiographic sign? Associated with this genetic condition?

Answer 2

Annular pancreas

Double bubble sign

Down syndrome, intestinal malrotation, duodenal atresia

Question 3

Accessory pancreatic duct that empties into the minor papilla – name?

Answer 3

Santorini

Question 4

Drugs associated with pancreatitis?

Answer 4

azathioprine
Six-mercaptopurine
Valproate
ACE inhibitors
Lasix
Amniosalicylates

Question 5

Definition of severe acute pancreatitis?

Answer 5

Persistent organ failure over 48 hours

Question 6

Scoring system that measures mortality in pancreatitis?

Answer 6

BISAP

BUN>25
Impaired mental status
SIRS
Age over 60
Pleural effusion

Score over 2 predicts higher mortality

Question 7

Timing for ERCP in acute pancreatitis?

Answer 7

<24 hours if Cholangitis

24-72 if severe acute pancreatitis with elevated Billirubin and biliary obstruction

Elective if retain CBD stone and patient stable

Question 8

Vascular complication associated with acute necrotizing pancreatitis?

Answer 8

Splanchnic vein thrombosis

Question 9

Genes associated with chronic pancreatitis?

Answer 9

PRSS1 (serine protease 1 gene encoding cationic tripsinogen)

SPINK-1 (serine protease inhibitor Kazal type 1)

CFTR

Chymotrypsinogen C (CTRC)

Question 10

Autosomal dominant gene associated with chronic pancreatitis?

Answer 10

Chymotrypsinogen C (CTRC)

Question 11

Fecal elastase and serum trypsin abnormal levels that indicate chronic pancreatitis?

Secretin stimulation test?

Answer 11

Under 100; under 20

Under 80

Question 12

After choledochoduodenostomy, the distal CBD (below the CBD-duodenal anastomosis) can become obstructed with debris - name?

Answer 12

sump Syndrome

Question 13

Treatment associated with the highest long-term success for common bile duct strictures From chronic pancreatitis?

Answer 13

Surgical treatment (Choledochoduodenostomy or RnY choledochojejunostomy)

Question 14

Treatment of gastric varices due to splenic vein thrombosis from chronic pancreatitis?

Answer 14

Splenectomy

Question 15

Bleeding into the pancreatic duct causing signs of G.I. bleeding — name?

Answer 15

hemossuccus pancreaticus

Question 16

Pseudoaneurysms (as a complication of chronic pancreatitis) mostly arise from this artery?

Answer 16

Splenic artery

Question 17

Steatorrhea occurs when pancreatic exocrine gland function reaches this level?

Answer 17

<10%

Question 18

Uncoated pancreatic enzyme replacement therapy should be coupled with?

Answer 18

Acid suppression

Question 19

Starting dose of pancreatic enzyme replacement therapy?

Answer 19

500 units per kilogram per meal

Question 20

complication of too much pancreatic enzyme replacement therapy?

Answer 20

Fibrosing colonopathy

Question 21

Diabetes from endocrine dysfunction generally has greater incidence of this symptom?

Answer 21

Hypoglycemia due to concurrent alpha cell destruction (decreased production)