Pancreas

Question 1

55 M h/o chron and, MRCP w large mass at HOP with distal ductal dilation >7cm , EUS no malignanxy. Procedure/Tx?

Answer 1

Beger - duod preserving pancreatic head resection

Question 2

Distal pancreatectomy - consideration of vasculature

Answer 2

Control splenic artery/vein
If IMV enters SV LATERAL to target lesion = ligate

If IMV enters SMV medial to target, can be spared

Question 3

Auto immune Panc Dx

Answer 3

1. high IgG concentration
2. associated AI dz
3. strictures of the PD

For lymphplasmacytic SP do ERCP

Question 4

50 M infected panc s/p perc drain placement, upsize drain with 72 hours fever, inc fever and Leuko, next best step?

Answer 4

Endoscopic necrosectomy

Question 5

True re: management of pancreatic mucinous neoplasms?

Where is it usually located and how does that change operative mgmt?

Answer 5

mucinous cystic neoplasms found in the tail of the pancreas, allowing spleen preseving distal panc

Question 6

Panc necrosis with sepsis/HDU, tx?

Answer 6

IR drain

Question 7

Whipple steps

Answer 7

1. explore peritoneum
2. Right colon mobilizes (CattellBraash) exposing SMV
3. Kocher at level of aorta with attentionto lymph nodes and great vessels
4. transverse meso seperated off the head of pancreas
5. lesser sac entered through gastrocolic
6. Ligate right gastroepiploic at DMV to allow SMV to be dissected away from the neck of panc
7. Once SMV dissection and HOP mobilizrd, the GB removed and Common hepatic duct dissected.
   ETC

Question 8

ERCP cystic lesion communicating w branch duct in 74 F w jaundice. High CEA and Amylase. Dx?

Answer 8

Branch duct IDPN

Question 9

sterile or infected panc necrosis?

Answer 9

CT guided perc needle asp w gram stain and culture

Question 10

MC etiology cystic lesion of pancreas

Answer 10

acute pancreatitis

Question 11

48 F w panc necrosis s/p VARD on POD5, hematemesis, definitive mgmt?

Answer 11

CT mesenteric angiogram w embolization

Question 12

64 M painless jaundice and 10 lb w/l, 1 cm periampullary adeno with spread to duod SM w/o mets dz. Mgmt?

Answer 12

whipple

Question 13

68 M abdo pain and weight loss with 4 cm panc cyst communicating with dilated main panc duct. What would the analysis of cystic fluid show?

Answer 13

high viscosity
high CEA
high amylase

Intraductal pap mucinous neoplasm IPMN

Question 14

h/o panc, 3 mos later, CT w 6cm area with enhancing wall and pockets of air. In additon to Abx, next step in mgmt

Answer 14

panc abscess needs endoscopic drainage

Question 15

h/o panc 6 weeks ago now w early satiety. CT wouls show what?

Answer 15

A homogenous well circumscribed round fluid collection with a hyper dense capsule – pseudocyst

Question 16

65 M with constitutional sis, 6 cm pan head mass and LAD

Answer 16

primary panc lymphoma - ususally B cell

Question 17

64 M h/o UC, pain radiating back with normal labs, panc head mass and elevated IgG. Management?

Answer 17

AI panc – needs biopsy

Question 18

Exposure of which vessels during distal panc?

Answer 18

Splenic artery and vein

Question 19

technique for open panc debridement

Answer 19

bluntly with finger dissection

Question 20

ETOH hx w greasy stool

Answer 20

Exocrine panc insufficiency - - high carbs low fat diet with enzymes

Question 21

61 F with 2cm panc mass with EUS showing 8mm panc duct. Mgmt?

Answer 21

IPMN – anatomic resection with negative margins

Question 22

ATL criteria of Panc, panc necrosis def?

Answer 22

interstial fat tissue death with vessel damage affecting acing, islet and ductal cells

Question 23

Grade 3 panc injury; what blood vessel

Answer 23

distal panc, splenic artery supplies the body and tail of the panc

Question 24

35 M benign adenoma, does not want Whipple. Mgmt?

Answer 24

transduodenal excision of tumor

Question 25

CT w left sided psudocyst in the retroperitoneum. Mgmt?

Answer 25

Roux en Y cyst Jejunostomy

Question 26

Principle resection Whipple

Answer 26

Esablish plane between panc neck and PV before resection

Question 27

Intervention for panc pseudocyst?

Answer 27

> 6 cm after 6 weeks obs

Question 28

Imaging finding of abutment of less that 180 degrees of SMA, considered?

Answer 28

borderline resectable disease