PANCREAS

Question 1

MC congenital anomaly of the pancreas

Functional obstruction of duct of Santorini

Answer 1

Pancreas Divisum

Question 2

2nd part of the duodenum surrounded by a rim of pancreatic tissue
May cause proximal small intestinal obstruction

Answer 2

Annular Pancreas

Question 3

Grey Turner sign

Answer 3

Blood extends to the flank tissues —> FLANK ecchymosis

Question 4

Cullen sign

Answer 4

Blood dissects up to the FALCIFORM ligament —> PERIUMBILICAL ecchymosis

Question 5

Fox Sign

Answer 5

Ecchymosis of the INGUINAL ligament

Question 6

Bryan Sign

Answer 6

Bluish discoloration of the SCROTUM

Question 7

Diagnostic gold standard of acute pancreatitis

Answer 7

Abdominal CT scan

Question 8

Ranson Prognostic Signs (Acute Pancreatitis NOT due to gallstones)

Answer 8

SIGNS AT ADMISSION

	> 55 y/o
	WBC > 16 000
	FBS > 200 mg/dL
	LDH > 350 units/mL
	SGOT > 250 units/mL

INITIAL 48 HOURS

	hct fall > 10 pts
	BUN elevation >5 mg/dL
	serum Ca <8 mg/dL
	PO2 <60 mmHg
	base deficit >4 mEq/L
	fluid deficit >6L

<2 pts - 0 %
3-5 signs - 10-20%
>7 signs - 50%

Question 9

Xray findings (acute pancreatitis)

Answer 9

calcification in the lesser sac and pancreas
gas formation in the lesser sac (abscess formation)
blurred psoas shadow (retroperitoneal pancreatic necrosis)
cut off sign (colonic spasm adjacent to an inflamed pancreas)
reversed 3 or inverted 3 sign (focal duodenal and jejunal ileus in the area of the head of the pancreas)

Question 10

Diagnostic gold standard of Acute Pancreatitis

Answer 10

Abdominal CT scan

MILD - interstitial edema
SEVERE - (+) necrosis

pancreatic swelling, peripancreatic infiltrates, fluid collections and fat necrosis and areas of 
nonenhancement of the pancreas

pathognomonic of pancreas infection - abnormal extraluminal gas bubbles

Question 11

Indications for Pancreatic Protocol CT scan

Answer 11

significant clinical deterioration and elevated CRP
suspicion of local pancreatic complications
suspected bowel ischemia
acute bleeding
abdominal compartment syndrome

Question 12

MC complication of chronic pancreatitis

Answer 12

Pseudocyst

chronic collection o pancreatic fluid surrounded by a nonepithelialized wall of granulation 	tissue 	and fibrosis