PANCREAS Flashcards
Cytology of this cyst shows pigmented histocytes
pseudocyst
cytology of this cyst shows bland periodic-acid Schiff +
serous cystic neoplasm
Viscosity is increased or high in which two cystic neoplasms?
MCN and IPMN
Amylase is high in which two cystic neoplasms
pseudocyst or IPMN
CEA is <200 in which neoplasms
Pseudocyst
<0.5 in SCN
CEA is >200 in what two cystic neoplasms
MCN and IPMN
Amylase is low but CEA is high
MCN
Amylase is high and CEA is high
IPMN
KRAS mutations are positive in which cystic neoplasms
MCN and IPMN
MCN are most commonly found in what location
tail of pancreas
Steatorrhea, diabetes, gallstones
Somatostatinoma
Where are somatostatinomas typically found
67% in the head
How often are somatostatinomas malignant
> 70%
Whipple’s triad
fasting hypoglycemia, neuroglycopenic symptoms, relief with glucose
How often are insulinomas malingnat?
Actually 90% are benign
Biology of gastrinoma
50% malignant 50% multiple
Glucagonoma are typically found
distal pancreas
VIPoma are typically found
distal pancreas
Enucleation can be considered in insulinomas of what size
<2 cm
Frey procedure
Lateral pancreaticojejunostomy with localized pancreatic head resection
Where do the short gastric arteries arise from?
both splenic artery and left gastroepiploic artery
Where does the right gastroepiploic artery arise from
gastroduodenal artery
Where does the left gastric artery arise fro,m
celiac trunk - supplies lesser curve
Where does the right gastric artery arise from
common hepatic artery
Sx of autoimmune pancreatitis
Elevated IgG4 (specific but not sensitive), xerostomia, xeropthalmia, mild renal insufficiency
Which type of autoimmune pancreatitis is more common
type 1
Which type of autoimmune pancreatitis is associated with acute pancreatitis
Type 2 (seen in young)
Associations with type 1 AIP
Sjogren syndrome, PSC
Associations with AIP type II
IBD
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
AIP
In distal pancreatectomy and splenectomy, the IMV should be ligated if?
It enters the splenic vein lateral to the target lesion
Splenic artery or splenic vein ligate dfirst?
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
A mutation in what is diagnostic for hereditary pancreatitis
PRSS1 gene (serine protease inherited via AD pattern, high penetrance)
Insulin is secreted from?
B cells
Glucagon is secreted from?
Alpha cells of pancreas
Somatostatin is secreted from
D cells
Elevated serum LDH or beta-2 microglobulin level and palpable abdominal mass
Pancreatic lymphoma
Pancreatic adenoCA in distal pancreas - tx
distal panc with splenectomy
Most appropriate tx for pancreatic divisum
ERCP with sphincterotomy
70% of the pancreas is drained by which duct?
Ventral duct
High risk stigmata assoc with IPMN
Enhancing mural nodule >5 mm, main duct dilation >10 mm, jaundice
Worrisome stigmata of IPMN
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
Which pancreatic neoplasm has central calicification
serous cystic neoplasm
Which two pancreatic neoplasms have capsules
SCN or MCN
Where are pseudopapillary neoplasms found?
throughout pancreas
In pancreatic divisum, the major drainage of the pancreas is done by?
the dorsal duct which opens up into the MINOR papilla
Whcih hormone causes increased intestinal secretion but inhibits gastrin release
Vasoactive peptide
Which hormone stimulates pancreatic duct cells to secrete pancreatic fluid and bicarbonate
Secretin
Most potent stimulator of pancreatic enzyme secretion
Cholecystokinin
Which imaging modality is best for evaluation of pancreatic cystic lesions
MRCP
Most consistently observed environmental risk for development of pancreatic CA
cigarette smoking
MC chemo regimen for pancreatic lymphoma
cyclophosphamide, doxorubicin, vincristine,m prednisone
which enzyme cleared fastest in course of pancreatitis
Amylase, <48 hours. Lipase and elastase remain elevated for >96 hours
Peustow procedure
creation of retrocolic roux limb, opening of duct from head of pancreas to the tail, 1 or 2 layer side to side pancreaticojejunostomy
Beger procedure
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
Pancreatic leak defined as
drain amylase >3 times serum amylase on POD # 3
Primary genetic abnormality believed to play a role in apncreatic cancer
KRAS2 oncogene
Activated by point mutation which causes constitutive activation and loss of regulation of mitogen-activated protein kinase cell signal transduction
Which pancreatic enzyme is secereted into the pancreatic duct in its active form
Lipase
what enzyme converts proelastase into elastase? where does it occur
trypsinogen i nthe duodenal lumen
what 3 hormones inhibit pancreatic exocrine function
pancreatic polypeptide, somatostatin, and glucagon
pancreatic secretion is stimulated. y what hormones
secretin and CCK and by parasympathetic vagal discharge
Trypsin is secreted as tryspinogen by what cells
acinar cells
What converts trypsinogen into trypsin
enterokinase (duodenum)
borderline resectable pancreatic CA have NO involvement of
celiac axis or hepatic artery bifurcation
