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CORE: GI > Pancreas > Flashcards

Pancreas Flashcards

1
Q

solid pancreatic neoplasms

A

ductal adenocarcinoma, acinar cell carcinoma

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2
Q

cystic epithelial neoplasms

A

serous cystic, mucinous cystic, SPEN, IPMN

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3
Q

endocrine epithelial neoplasms

A

insulinoma, gastrinoma, glucagonoma, VIPoma, somatostatinoma

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4
Q

most common pancreatic tumor

A

ductal adenocarcinoma

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5
Q

pancreatic ductal adenocarcinoma

A

patients > 60, mostly male

risks: smoking, alcohol, chronic pancreatitis

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6
Q

pancreatic ductal adenocarcinoma imaging findings

A

pancreatic mass, most comspicuous on late arterial phase for a hypoenhancing tumor

usually in pancreatic head; ductal dilation, double duct sign

T1 hypointense, ill defiend hypovascular mass

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7
Q

pancreatic ductal dilation ddx

A

autoimmune panceatitis, groove pancreatitis, cystic pancreatic tumor, neuroendocrine tumor, duodenal GIST, peripancreatic LN, pancreatic met (RCC, thyroid, melanoma), lymphoma

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8
Q

unresectable vs resectable pancreatic ductal adenocarcinoma

A

unresectable: encasement >180 degrees of SMA, venous invasion, or mets
resectable: no celiac/SMA, portal vein invasion; limited extension to duodenum/stomach/CBD

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9
Q

acinar cell carcinoma

A

rare aggressive variant of pancreatic adenocarcinoma

exclusive in elderly males

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10
Q

lipase hypersecretion syndrome

A

subcutaneous fat necrosis, bone infarcts (polyarthralgia), eosinophilia

seen in acinar cell carcinoma in which large amount of lipase is present

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11
Q

serous cystadenoma

A

grandmother tumor

many small cysts that may have a solid appearance on CT; hypervascular

does not cause pancreatic duct dilation or tail atrophy

central stellate calcification

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12
Q

mucinous cystic neoplasm

A

mother tumor

single or few large cysts >2 cm; typically in body/tail

has a capsule (similar to SPEN)

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13
Q

treatment of mucinous cystic neoplasm

A

resection due to malignant potential

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14
Q

SPEN

A

daughter tumor; young women/children

large mass with heterogenous solid/cystic area; hemorrhage typical; capsule (similar to mucinous cystic neoplasm)

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15
Q

IPMN

A

grandfather tumor; elderlym men (although large age/sex variability)

sidebranch vs main duct (more malignant); nodular/enhancing component most concerning for malignancy

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16
Q

IPMN view on endoscopy

A

fish mouth papilla pouring out mucin; lesion contiguous with duct/sidebranch

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17
Q

IPMN treatment/followup

A

follow-up: simple cysts <1 cm followed annually

treatment: resect if >3 cm in size, mural nodule, or dilation of pancreatic duct >1 cm

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18
Q

pancreatic neuroendocrine tumor types

A

hyperfunctioning vs nonfunctioning (larger at diagnosis; mimic cystic neoplasms, central necrosis/calcification)

typically hypervascular; solid unless large
hypervascular liver mass with associated pancreatic mass, likely metastatic PNET

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19
Q

hyperfunctioning PNET tumors

A

insulinoma, gastrinoma, glucagonoma, VIPoma, somatostatinoma

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20
Q

most common PNET

A

insulinoma

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21
Q

insulinoma

A

hypoglycemia; present early and have best prognosis

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22
Q

whipple triad

A

insulinoma: hypoglycemia, clinical symptoms of hypoglycemia, alleviation of symptoms after glucose admin

23
Q

gastrinoma

A

hypersecretion of gastric acid in Zollinger-Ellison syndrome

associated with MEN1 (usually multiple and located in duodenum)

24
Q

gastrinoma triangle

A

location of gastrinomas in area bounded by cystic duct/CBD, duodenum, and neck/body of pancreas

25
Q

complication of gastrinoma

A

high gastrin levels –> carcinoid tumors in stomach (regress after gastrinoma resected)

26
Q

3rd most common pancreatic endocrine tumor, prognosis

A

glucagonoma; poor prognosis

27
Q

VIPoma/somatostatinoma prognosis

A

rare; poor prognosis

28
Q

normal duct anatomy

A

main pancreatic duct > duct of Wirsung > major papilla (ampulla of Vater)

duct of Santorini drains the minor papilla

sphincter of Oddi surrounds ampulla of Vater

29
Q

Santorini relation to duct of Wirsung

A

Santorini is suprior, drains into the small/minor papilla

30
Q

stable anatomy in the pancreas

A
  1. CBD always drains to major papilla/meets duct of Wirsung
  2. main pancreatic duct drains pancreatic tail
  3. duct of santorini always drains minor papilla
31
Q

most common congenital pancreatic anomaly

A

pancreas divisum; failure of fusion of ventral/dorsal pancreatic ducts

32
Q

how does pancreas divisum cause pancreatitis

A

obstruction at minor papilla from a Santorinicele; focal dilation of terminal duct of Santorini

33
Q

crossing sign

A

CBD crossing over the main duct to join the duct of Wirsung

CBD courses towards the ventral duct to empty into major papilla

main pancreatic duct drains separately into minor papilla

34
Q

annular pancreas

A

pancrease completely surounds duodenum, secondary t oincomplete rotation of pancreatic bud

35
Q

annular pancreas complications

A

pancreatitis, PUD, duodenal obstruction (differential or double bubble sign in kids)

36
Q

common channel syndrome

A

pancreaticobiliary maljunction

missing thin septum dividing CBD and duct of Wirsung&raquo_space; major papilla; reflux between two systems

mild form of choledochocele&raquo_space;cholangiocarcinoma??

37
Q

systemic diseases affecting pancreas

A

VHL, CF, scwachman-Diamond, obesity, exogenous steroid use

38
Q

VHL pancreas?

A

serous cystadenoma, PNET tumors

39
Q

CS in pancreas?

A

most common cause of childhood pancreatic atrophy

fatty atrophy or pancreatic cystosis (innumerable cyst replacements)

40
Q

schwachman diamond

A

rare inherited disorder;

diffuse fatty replacement of pancreas&raquo_space; pancreatic exocrine insufficeincy, neutropenia, bone dysplasia

41
Q

obesity/steroids affect on pancreas

A

fatty atrophy

42
Q

intrapancreatic accessory spleen

A

mimics hypervascular pancreatic neoplasm

similar intensity to spleen on MRI

43
Q

diagnosis of an intrapancreatic accessory spleen

A

MRI diagnostic

NM Tc99m sulfur colloid or RBC scintigraphy can confirm diagnosis in ambiguous cases

44
Q

ideal phase of imaging for pancreatitis

A

pancreatic parenchymal phase (late arterial ~40 sec after IV contrast)

45
Q

when is CT imaging not indicated in pancreatitis

A

mild acute pancreatitis, if pt improving (negative or mildly edematous)

46
Q

grading systems for pancreatitis

A

Balthazar and CT severity index (CTSI)

47
Q

balthazar grading system

A

A: Normal-appearing pancreas
B: Focal or diffuse pancreatic enlargement
C: Mild peripancreatic inflammatory changes
D: Single fluid collection
E: Two or more fluid collections

increased mortality (54% in E) with increasing grade

48
Q

CT severity index (CTSI)

A

integrates Balthazar with necrosis;

Assigns 0–4 points for Balthazar A–E, with 0 points for Balthazar A and 4 points for Balthazar E.
Adds 0–6 points for necrosis to create a total score from 0-10. 0 points: 0% necrosis
2 points: <30% necrosis
4 points: 30–50% necrosis 6 points: >50% necrosis

CTSI 10: 92% morbidity

49
Q

pancreatitis complications

A

pancreatic necrosis, fluid collection, pseudocyst, pancreatic absess; extrapancreatic pseudocyst, perihilar renal inflammation, bowel involvement, arterial bleeding, pseduoaneudrysm (splenic artery), venous thrombosis

50
Q

chronic pancreatitis

A

calcifications in the distribution of the pancreatic duct

51
Q

autoimmune pancreatitis, associations

A

inflammatory lymphoplasmacystic infiltrate (IgG4 levels elevated)

associated with Sjogren

52
Q

imaging findings of autoimmune pancreatitis

A

diffuse sausage shaped enlargement of the entire pancreas

treatment: steroids

53
Q

groove pancreatitis, population, ddx

A

uncommon form of focal pancreatitis between head of pancreas/duodenum/CBD

young men who are heavy drinkers

ddx: adenocarcinoma of pancreas

54
Q

histopathologic hallmark of groove pancreatitis

A

fibrosis in pancreaticoduodenal groove; duodenal thickening; cystic change

CORE: GI (9 decks)

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