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ABS > PANCREAS > Flashcards

PANCREAS Flashcards

1
Q

Cytology of this cyst shows pigmented histocytes

A

pseudocyst

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2
Q

cytology of this cyst shows bland periodic-acid Schiff +

A

serous cystic neoplasm

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3
Q

Viscosity is increased or high in which two cystic neoplasms?

A

MCN and IPMN

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4
Q

Amylase is high in which two cystic neoplasms

A

pseudocyst or IPMN

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5
Q

CEA is <200 in which neoplasms

A

Pseudocyst

<0.5 in SCN

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6
Q

CEA is >200 in what two cystic neoplasms

A

MCN and IPMN

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7
Q

Amylase is low but CEA is high

A

MCN

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8
Q

Amylase is high and CEA is high

A

IPMN

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9
Q

KRAS mutations are positive in which cystic neoplasms

A

MCN and IPMN

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10
Q

MCN are most commonly found in what location

A

tail of pancreas

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11
Q

Steatorrhea, diabetes, gallstones

A

Somatostatinoma

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12
Q

Where are somatostatinomas typically found

A

67% in the head

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13
Q

How often are somatostatinomas malignant

A

> 70%

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14
Q

Whipple’s triad

A

fasting hypoglycemia, neuroglycopenic symptoms, relief with glucose

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15
Q

How often are insulinomas malingnat?

A

Actually 90% are benign

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16
Q

Biology of gastrinoma

A

50% malignant 50% multiple

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17
Q

Glucagonoma are typically found

A

distal pancreas

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18
Q

VIPoma are typically found

A

distal pancreas

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19
Q

Enucleation can be considered in insulinomas of what size

A

<2 cm

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20
Q

Frey procedure

A

Lateral pancreaticojejunostomy with localized pancreatic head resection

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21
Q

Where do the short gastric arteries arise from?

A

both splenic artery and left gastroepiploic artery

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22
Q

Where does the right gastroepiploic artery arise from

A

gastroduodenal artery

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23
Q

Where does the left gastric artery arise fro,m

A

celiac trunk - supplies lesser curve

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24
Q

Where does the right gastric artery arise from

A

common hepatic artery

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25
Q

Sx of autoimmune pancreatitis

A

Elevated IgG4 (specific but not sensitive), xerostomia, xeropthalmia, mild renal insufficiency

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26
Q

Which type of autoimmune pancreatitis is more common

A

type 1

27
Q

Which type of autoimmune pancreatitis is associated with acute pancreatitis

A

Type 2 (seen in young)

28
Q

Associations with type 1 AIP

A

Sjogren syndrome, PSC

29
Q

Associations with AIP type II

A

IBD

30
Q

Low density, capsule like rim with focal mass
ERCP shows segmental or diffuse irregular narrowing of main duct usually accompanied by extrinsic stricture of distal bile duct

A

AIP

31
Q

In distal pancreatectomy and splenectomy, the IMV should be ligated if?

A

It enters the splenic vein lateral to the target lesion

32
Q

Splenic artery or splenic vein ligate dfirst?

A

Artery first, near its point of origin. THEN IMV if enters splenic vein to the left of the lesion and finally the splenic vein should be ligaated near the point of where it joins with SMV to form the portal vein

33
Q

A mutation in what is diagnostic for hereditary pancreatitis

A

PRSS1 gene (serine protease inherited via AD pattern, high penetrance)

34
Q

Insulin is secreted from?

A

B cells

35
Q

Glucagon is secreted from?

A

Alpha cells of pancreas

36
Q

Somatostatin is secreted from

A

D cells

37
Q

Elevated serum LDH or beta-2 microglobulin level and palpable abdominal mass

A

Pancreatic lymphoma

38
Q

Pancreatic adenoCA in distal pancreas - tx

A

distal panc with splenectomy

39
Q

Most appropriate tx for pancreatic divisum

A

ERCP with sphincterotomy

40
Q

70% of the pancreas is drained by which duct?

A

Ventral duct

41
Q

High risk stigmata assoc with IPMN

A

Enhancing mural nodule >5 mm, main duct dilation >10 mm, jaundice

42
Q

Worrisome stigmata of IPMN

A 
Growth >5 mm/2 years
Cyst size >3 cm
Enhancing mural nodule <5 mm
Enhancing thickened cyst wall
Main duct dfilation 5-9 mm; panc duct caliber change
Elevated serum CA 19-9
Pancreatitis
43
Q

Which pancreatic neoplasm has central calicification

A

serous cystic neoplasm

44
Q

Which two pancreatic neoplasms have capsules

A

SCN or MCN

45
Q

Where are pseudopapillary neoplasms found?

A

throughout pancreas

46
Q

In pancreatic divisum, the major drainage of the pancreas is done by?

A

the dorsal duct which opens up into the MINOR papilla

47
Q

Whcih hormone causes increased intestinal secretion but inhibits gastrin release

A

Vasoactive peptide

48
Q

Which hormone stimulates pancreatic duct cells to secrete pancreatic fluid and bicarbonate

A

Secretin

49
Q

Most potent stimulator of pancreatic enzyme secretion

A

Cholecystokinin

50
Q

Which imaging modality is best for evaluation of pancreatic cystic lesions

A

MRCP

51
Q

Most consistently observed environmental risk for development of pancreatic CA

A

cigarette smoking

52
Q

MC chemo regimen for pancreatic lymphoma

A

cyclophosphamide, doxorubicin, vincristine,m prednisone

53
Q

which enzyme cleared fastest in course of pancreatitis

A

Amylase, <48 hours. Lipase and elastase remain elevated for >96 hours

54
Q

Peustow procedure

A

creation of retrocolic roux limb, opening of duct from head of pancreas to the tail, 1 or 2 layer side to side pancreaticojejunostomy

55
Q

Beger procedure

A

local resectio nfo pancreatic head with duodenal preservation, cfreation of retrocolic Roux limb, end to end pancreaticojejunostomy with pancreaticojejunostomy to the pancreatic head remnant
Key is preservation of posterior branch of GDA to maintain viability of duodenum and distal CBD

56
Q

Pancreatic leak defined as

A

drain amylase >3 times serum amylase on POD # 3

57
Q

Primary genetic abnormality believed to play a role in apncreatic cancer

A

KRAS2 oncogene
Activated by point mutation which causes constitutive activation and loss of regulation of mitogen-activated protein kinase cell signal transduction

58
Q

Which pancreatic enzyme is secereted into the pancreatic duct in its active form

A

Lipase

59
Q

what enzyme converts proelastase into elastase? where does it occur

A

trypsinogen i nthe duodenal lumen

60
Q

what 3 hormones inhibit pancreatic exocrine function

A

pancreatic polypeptide, somatostatin, and glucagon

61
Q

pancreatic secretion is stimulated. y what hormones

A

secretin and CCK and by parasympathetic vagal discharge

62
Q

Trypsin is secreted as tryspinogen by what cells

A

acinar cells

63
Q

What converts trypsinogen into trypsin

A

enterokinase (duodenum)

64
Q

borderline resectable pancreatic CA have NO involvement of

A

celiac axis or hepatic artery bifurcation

ABS (23 decks)

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