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Rosalynn's ABSITE > Pancreas > Flashcards

Pancreas Flashcards

1
Q

What is the duct Wirsung?

A

major pancreatic duct that forms in head and joins CBD to form common pancreaticobiliary channel proximal to ampulla of Vater

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2
Q

What is the duct of Santorini?

A

accessory pancreatic duct that drains the anterior portion of the pancreatic head

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3
Q

what is the blood supply to the head of the pancreas?

A

anterior and postero-superior pancreaticoduodenal arteries from GDA

forms collaterals with branches of SMA (inferoanterior and posterior pancreaticoduodenal arteries)

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4
Q

what is the venous drainage?

A

drains into portal system via SMV and splenic veins

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5
Q

which enzyme is responsible for pancreatic necrosis in the presence of bile?

A

phospholipase A

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6
Q

what is high output pancreatic fistula?

A

more than 200 ml/day

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7
Q

what are other causes of pancreatitis

A 
hypercalcemia
trauma
hyperlipidemia
pancreatic duct obstruction
ischemia
drugs
familial
idiopathic
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8
Q

what are the main causes of pancreatitis

A

gallstones and alcohol

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9
Q

how is pancreatitis dx?

A

needs 2 of the 3:
abdominal pain
serum amylase or lipase at least 3 times the upper limit of normal
characteristic findings of pancreatitis on CT

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10
Q

which enzyme is implicated in the etiology of pancreatitis?

A

trypsin

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11
Q

which serum enzyme rises within 2 hours of onset of pancreatitis and peaks within 48 hrs?

A

amylase

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12
Q

what are the early Ranson criteria (on admission)?

A 
Glucose > 200
age > 55 
LDH > 350 
AST > 250 
WBC >16k
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13
Q

what are the late ransom criteria (48 hours)?

A 
calcium < 8
Hct drop > 10%
PaO2 < 60 mmHg
BUN increase by 5 or more
base deficit > 4
fluid sequestration > 6 L
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14
Q

initial management of pancreatic duct stricture from chronic pancreatitis

A

pancreatic duct stenting

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15
Q

What is a Duval procedure?

A

distal pancreatectomy with end to end pancreaticojejunostomy

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16
Q

what is a Puestow procedure?

A

longitudinal pancreaticojejunostomy
lateral side to side pancreaticojejunostomy

most widely used and preferred for chronic pancreatitis with dilation of the pancreatic duct (7 mm or more); pancreatic resection, pancreatic denervation, islet cell transplantation (for T1DM)

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17
Q

what is a Frey procedure?

A

coring out diseased portion of pancreatic head with longitudinal dissection of pancreatic duct toward the tail and then lateral pancreaticojejunostomy for chronic pancreatitis

reserved for smaller inflammatory masses of the head and dilated pancreatic ducts (7 mm or more)

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18
Q

What is a Beger procedure?

A

duodenum preserving pancreatic head resection
uses 2 anastomoses with RNY jejunal loop to pancreatic tail remnant (end to side) and to the excavated pancreatic head (side to side)

For patients with a large inflammatory mass in the head with no evidence of distal ductal dilation – makes the end to side PJ the most appropriate anastomosis

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19
Q

what are the 4 types of acute pancreatitis complications per the revised Atlanta classification?

A
  1. acute peri pancreatic fluid collection or post necrotic/peripancreatic fluid collection (within 4 weeks), categorized as sterile or infected
  2. pancreatic pseudocyst or walled off necrosis (within 4 weeks), categorized as sterile or infected
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20
Q

How to manage a pseudocyst?

A

supportive for 4-6 weeks

if no resolution, wait until thick fibrous wall and do internal cyst drainage via open or endoscopic cystgastrostomy, cystojejunostomy, or cystuodenostomy

always perform biopsy to r/o malignancy

external drainage can be done for infected collections of pseudocysts

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21
Q

indication for surgical intervention for pseudocyst

A

has not resolved in 6 weeks and persistently greater than 6 cm

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22
Q

how is infected peripancreatic fluid collection or infected walled off necrosis dx?

A

CT guided perc FNA

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23
Q

what abs is used for pancreatic necrosis involving > 30% of the gland?

A

imipenem or meropenem

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24
Q

pancreatic tumor that exhibits sunburst central calcifications on CT scan?

A

serous cystadenoma

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25
Q

what are some inherited disorders that increase risk for pancreatic cancer

A 
MEN
hereditary pancreatitis
FAP (APC gene)
HNPCC (MLH1, MSH2, MSH6, PMS2, EPCAM)
VHL, Gardner syndrome
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26
Q

what imaging is beneficial for assessing T stage of tumor

A

endoscopic US

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27
Q

what chemo agents MC used for pancreatic cancer

A

5-FU and gemcitabine

5-FU potentiates radiation therapy

28
Q

FDA approved combo with gemcitabine for first line treatment of locally advanced, unresectable, or metastatic pancreatic cancer

A

Erlotinib (Tarceva)

29
Q

T1 pancreatic cancer

A

tumor limited to the pancreas < 2 cm

30
Q

T2 pancreatic cancer

A

tumor limited to pancreas >2 cm

31
Q

T3 pancreatic cancer

A

tumor extends beyond the pancreas but without involvement of the celiac axis or SMA

32
Q

T4 pancreatic cancer

A

tumor invades celiac axis or SMA (unresectable)

33
Q

what reconstruction is performed during standard whipple

A

end to side PJ, HJ, GJ

34
Q

what distinguishes mutinous cystic neoplasms from IPMN?

A

mutinous cystic neoplasm rarely communicates with main pancreatic duct

35
Q

should a mutinous cystic neoplasm be resected?

A

yes, malignant potential

36
Q

which islet cells do glucagonoma arise

A

alpha cells

37
Q

what is another name for VIPoma

A

Verner Morner Syndrome

38
Q

what is the triad of VIPoma

A

watery diarrhea, hypokalemia, achlorhydia

39
Q

what is treatment for VIPoma

A

enucleation or surgical resection depending on location

40
Q

what is the Whipple triad with insulinoma

A

symptoms of hypoglycemia with fasting
blood glucose < 50
relief of symptoms with glucose intake

41
Q

what test is dx for insulinoma

A

72 hour fast, insulin and glucose measured q6h, sx’s of hypoglycemia develop in 12 hours

insulin:glucose ratio > 0.3 or seum insulin > 6

42
Q

what is the treatment for insulinoma

A

enucleation

43
Q

what are the 4 D’s of glucagonoma?

A

diabetes, dermatitis, DVT, depression

44
Q

what is rarest pancreatic islet cell tumor?

A

somatostatinoma

45
Q

what study should be used to define extent of pancreatic islet tumors

A

octreotide scan

46
Q

what is the most malignant pancreatic endocrine tumor

A

gastrinoma

47
Q

what is the most benign pancreatic endocrine tumor

A

insulinoma

48
Q

what is the earliest manifestation of pancreatic transplant graft thrombosis?

A

hyperglycemia

49
Q

preferred treatment for annular pancreas

A

duodenodeuodenostomy or duodenojejunostomy

50
Q

branched duct IPMN can be observed if

A

less than 3 cm

51
Q

main duct IPMN should be resected if duct is

A

> 10 mm

52
Q

What gene is MC involved in adenocarcinoma?

A

KRAS

53
Q

palpable non painful gallbladder filled with back of bile

A

Courvoisier sign

54
Q

Blummer shelf

A

drop metastasis to the pelvis

55
Q

autoimmune pancreatitis has increased

A

IgG

56
Q

histology of MCN

A

ovarian like stroma

57
Q

What is the Bern procedure

A

modified Berger procedure involves resection of the head

pancreas not transected at level of portal vein

reconstruction with single anastomosis with RNY jejunal loop to pancreas

no difference in outcomes between Beger and Bern procedures

58
Q

For dilated duct and head involvement

A

Frey procedure

59
Q

normal or small duct with head involvement

A

Beger or Bern

60
Q

dilated duct without head involvement

A

Puestow

61
Q

IPMN should be resected if

A 
obstructive jaundice
enhancing solid components
main duct size 1 cm or more
symptomatic lesions
size 3 cm of more
62
Q

fish mouth sign

A

main duct IPMN

needs surgical resection with negative margins

63
Q

for grade III pancreatic trauma what vessels need to be exposed and preserved

A

splenic artery and vein

64
Q

what is the Cullen sign

A

retroperitoneal hemorrhage to periumbilical area

65
Q

what is the grey turner sign

A

retroperitoneal hemorrhage to flank

Rosalynn's ABSITE (33 decks)

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