PANCREAS 1.1 Flashcards
1
Q
What is the anatomical position of the pancreas?
A
A retroperitoneal organ that lies obliquely from the C-loop of the duodenum to the splenic hilum.
2
Q
What are the functions of the pancreas?
A
The pancreas functions as both an endocrine and exocrine organ.
3
Q
How long is the pancreas and what is its weight in adults?
A
It is 15-20 cm long and weighs about 75-100 g.
4
Q
What embryological structures form the pancreas?
A
The pancreas forms from the fusion of a ventral bud and a larger dorsal bud.
5
Q
Which parts make up the pancreas?
A
The pancreas consists of the head, uncinate process, neck, body, and tail.
6
Q
Where does the head of the pancreas lie?
A
The head is disc-shaped within the concavity of the C-shaped duodenum.
7
Q
What is the function of the main pancreatic duct (Wirsung)?
A
It drains pancreatic enzymes into the duodenum via the ampulla of Vater.
8
Q
What is the accessory pancreatic duct (Santorini)?
A
It is a secondary duct, often absent, that drains the upper half of the pancreas.
9
Q
What is pancreatic divisum?
A
A congenital anomaly where the pancreatic ducts fail to fuse, potentially leading to pancreatitis.
10
Q
What is the treatment for symptomatic pancreatic divisum?
A
Operative or endoscopic sphincteroplasty of the minor papilla and accessory duct.
11
Q
What is annular pancreas?
A
A developmental anomaly where pancreatic tissue encircles the duodenum, potentially causing obstruction.
12
Q
What is the surgical treatment for annular pancreas?
A
Duodenal bypass procedures such as gastrojejunostomy or duodenojejunostomy.
13
Q
What arteries supply blood to the pancreas?
A
The pancreas is supplied by branches from the celiac and superior mesenteric arteries.
14
Q
What veins drain blood from the pancreas?
A
The pancreaticoduodenal veins drain into the superior mesenteric vein and hepatic portal vein.
15
Q
What nerves innervate the pancreas?
A
Parasympathetic innervation from the vagus nerve and sympathetic innervation from splanchnic nerves.
16
Q
What are the primary symptoms of pancreatic malignancy?
A
Jaundice, severe abdominal pain, and obstruction.
17
Q
What is a palliative procedure for pancreatic cancer pain?
A
Injecting alcohol near the celiac plexus to alleviate pain.
18
Q
What are the two main functions of the pancreas?
A
Endocrine (hormone secretion) and exocrine (digestive enzyme release).
19
Q
What percentage of the pancreas is exocrine tissue?
A
85% of the pancreas is made up of exocrine tissue.
20
Q
What hormone does the beta cell secrete, and what is its function?
A
Insulin, which decreases gluconeogenesis and increases glucose uptake.
21
Q
What is the function of glucagon?
A
Increases hepatic glycogenolysis and gluconeogenesis.
22
Q
What is the role of somatostatin in the pancreas?
A
It inhibits gastrointestinal secretion and endocrine peptide release.
23
Q
What cell type secretes pancreatic polypeptide, and what is its function?
A
PP cells secrete pancreatic polypeptide, which inhibits pancreatic exocrine secretion.
24
Q
What is the role of amylin (IAPP)?
A
Counter-regulates insulin secretion and function.
25
What is acute pancreatitis?
Acute pancreatitis is an inflammatory disorder of the pancreas characterized by edema, necrosis, and potential complications.
26
What are the two main common causes of acute pancreatitis?
The two most common causes are alcohol and gallstones.
27
What does the 'common channel theory' state regarding gallstone-related pancreatitis?
It states that obstruction by a stone causes bile to flow back to the pancreas, leading to damage by bile salts.
28
What effect does alcohol have on the pancreas to cause pancreatitis?
Alcohol causes spasm of the sphincter of Oddi, decreases blood flow to the pancreas, and is a metabolic toxin to acinar cells.
29
What is the main pathophysiological mechanism in acute pancreatitis?
Acute pancreatitis is caused by acinar cell injury, which may result from gallstone obstruction, alcohol irritation, or blocked pancreatic juice flow.
30
What initiates the acinar cell injury in pancreatitis?
Activation of digestive zymogens within the acinar cells initiates cell injury, leading to inflammation and potential systemic effects.
31
What are some clinical presentations of acute pancreatitis?
Common presentations include epigastric pain radiating to the back, nausea, vomiting, and signs of systemic inflammation.
32
What are Grey Turner, Cullen, Fox, and Bryant signs?
These are signs of retroperitoneal hemorrhage, seen as ecchymosis in different body regions.
33
What does the Grey Turner sign indicate and where does it appear?
Grey Turner sign is flank ecchymosis, indicating retroperitoneal hemorrhage.
34
What does the Cullen sign indicate and where does it appear?
Cullen sign is periumbilical ecchymosis, indicating retroperitoneal hemorrhage.
35
What does the Fox sign indicate?
Fox sign is ecchymosis along the inguinal ligament.
36
What does the Bryant sign indicate?
Bryant sign is bluish discoloration of the scrotum, often associated with retroperitoneal bleeding.
37
What should be monitored in patients with suspected pancreatitis?
Vital signs, oxygenation, hemodynamics, and kidney and metabolic function should be monitored.
38
What is the SOFA score used for in acute pancreatitis?
The SOFA score assesses sepsis risk and disease severity in patients with acute pancreatitis.
39
What is the 'cut-off sign' on an abdominal X-ray?
An abrupt termination of air in the left transverse colon, associated with inflamed pancreas.
40
Why is a CT scan preferred for diagnosing severe pancreatitis?
CT scan can reliably detect pancreatic necrosis, hemorrhage, and other severe changes that ultrasound may miss.
41
What ultrasound findings suggest mild pancreatitis?
Mild pancreatitis may show no abnormalities or mild peripancreatic fluid collections on ultrasound.
42
What is the purpose of Ranson’s criteria in pancreatitis?
Ranson’s criteria are used to assess mortality risk in acute pancreatitis.
43
What is the gold standard imaging modality for diagnosing pancreatitis?
Abdominal CT scan is the gold standard for diagnosing acute pancreatitis.
44
What is the general management approach for acute pancreatitis?
Management includes fluid resuscitation, monitoring, analgesia, and nutritional support.
45
When are prophylactic antibiotics indicated in acute pancreatitis?
Antibiotics are reserved for documented cases of infected pancreatic necrosis.
46
What is the purpose of ERCP in acute pancreatitis?
ERCP is used for patients with biliary pancreatitis complicated by cholangitis or bile duct obstruction.
47
When is laparotomy indicated in acute pancreatitis?
Laparotomy is indicated for acute abdomen, failed drainage, or compartment syndrome.
48
What is the importance of nutritional support in acute pancreatitis?
Proper nutrition supports recovery, with enteral nutrition preferred over parenteral in severe cases.
49
How does alcohol affect the acinar cells in acute pancreatitis?
Alcohol acts as a metabolic toxin and causes ischemic injury to acinar cells.
50
What does the SOFA scoring system include?
SOFA scoring assesses
PaO2/FiO2,
platelet count,
bilirubin,
hypotension,
GCS, and
creatinine.
51
What are some complications associated with acute pancreatitis?
Complications include pancreatic necrosis, sepsis, shock, organ failure, and pseudocyst formation.
52
What can be seen on a CT scan in mild pancreatitis?
Mild pancreatitis may show interstitial edema of the pancreas.
53
What can be seen on a CT scan in severe pancreatitis?
Severe pancreatitis may show pancreatic necrosis with air pockets and fluid collections.
54
What is the 'step-up approach' in pancreatitis management?
It involves gradual intervention, starting with non-surgical methods before progressing to surgery if needed.
55
What is necrosectomy?
Necrosectomy is the debridement of necrotic pancreatic tissue, used in severe pancreatitis cases with necrosis.
56
When might pancreatic pseudocysts form in acute pancreatitis?
Pseudocysts can form as a complication due to fluid collections following inflammation or necrosis.
57
When does a pancreatic abscess typically occur after the initial pancreatitis attack?
Occurs 2-6 weeks after the initial attack.
58
What is the treatment for a pancreatic abscess?
Treated by external drainage, either percutaneous or open.
59
What are the indications for surgical intervention in acute pancreatitis?
Diagnostic uncertainty, intra-abdominal catastrophe unrelated to necrotizing pancreatitis, infected necrosis documented by FNA or extraluminal gas on CT scan, severe sterile necrosis, symptomatic organized pancreatic necrosis.
60
How long is the wait period before surgery for symptomatic organized pancreatic necrosis?
Typically a wait period of 4-6 weeks is advised to allow inflammation to decrease.
61
What is catheter drainage in treating pancreatic necrosis?
A least invasive technique where a catheter is placed percutaneously through the retroperitoneum or transabdominally, often successful without surgery.
62
What is the purpose of video-assisted retroperitoneal debridement (VARD)?
It allows the removal of large pieces of necrosis with the use of large-bore surgical drains for continuous lavage.
63
What is one advantage of endoscopic transluminal necrosectomy?
Requires no abdominal incision, has no risk for incisional hernia, and does not create an external pancreatic fistula.
64
What is the main disadvantage of endoscopic transluminal necrosectomy?
Multiple repeated procedures may be needed to remove sufficient necrosis.
65
What is the role of open necrosectomy in treating necrotizing pancreatitis?
It is the reference standard for treatment and involves open or closed packing or continuous closed postoperative lavage.
66
What is chronic pancreatitis?
An incurable, progressive inflammatory condition that leads to irreversible destruction of pancreatic tissue.
67
What is the most common cause of chronic calcific pancreatitis?
Alcohol use is the most common cause.
68
What type of mutation is associated with hereditary chronic pancreatitis?
Autosomal dominant mutations in PRSS1 & SPINK1 genes.
69
What nutritional factor is linked to tropical chronic pancreatitis?
Cassava root, which contains toxic glycosides that form hydrocyanic acid, leading to free radical injury to the pancreas.
70
What is the cause of chronic obstructive pancreatitis?
It can be due to tumors, strictures, gallstones, or congenital issues like pancreas divisum causing duct obstruction.
71
What type of immune cells predominate in chronic inflammatory pancreatitis?
Mononuclear cells predominate in the fibrosis and loss of acinar cells.
72
What is characteristic of chronic autoimmune pancreatitis?
It is a non-obstructive, diffuse infiltrative disease with mononuclear cell infiltration and increased autoantibodies.
73
Which autoimmune conditions are associated with chronic autoimmune pancreatitis?
Sjogren’s syndrome, rheumatoid arthritis, Type I diabetes, primary sclerosing cholangitis, and cirrhosis.
74
Is surgical treatment recommended for chronic autoimmune pancreatitis?
No, these patients are typically not candidates for surgery; steroid therapy is used instead.
75
What radiologic feature on an abdominal ultrasound is commonly seen in chronic pancreatitis?
Heterogeneity of the pancreatic parenchyma with dilated ductal systems and cyst formation.
76
What is the role of CT scan in diagnosing chronic pancreatitis?
CT provides visualization of duct dilation, calcifications, cystic changes, and other pancreatic lesions with high resolution.
77
What is the purpose of Endoscopic Retrograde Cholangiopancreatography (ERCP) in chronic pancreatitis?
ERCP is the gold standard for diagnosis and staging, allowing for diagnostic and therapeutic interventions like stenting or drainage.
78
What is the main symptom in the early stage of chronic pancreatitis?
Recurrent acute attacks.
79
Are there any complications in the early stage of chronic pancreatitis?
No complications.
80
What is the pancreatic morphology in the early stage of chronic pancreatitis?
Morphologic changes are detectable with imaging procedures directed to the pancreatic parenchyma and ductal system.
81
What is pancreatic function like in the early stage of chronic pancreatitis?
Normal pancreatic endocrine and exocrine function.
82
What diagnostics are used in the early stage of chronic pancreatitis?
EUS, ERP/MRP, CT, Secretin.
83
What are the characteristics of pain in the moderate stage of chronic pancreatitis?
Increasing number of attacks with increased intensity.
84
What complications may occur in the moderate stage of chronic pancreatitis?
Pseudocysts, cholestasis, segmental portal hypertension.
85
What is the pancreatic morphology in the moderate stage of chronic pancreatitis?
Progredient morphologic changes detectable in several imaging procedures.
86
What is pancreatic function like in the moderate stage of chronic pancreatitis?
Impairment of pancreatic function in several degrees but rarely steatorrhea.
87
What diagnostics are used in the moderate stage of chronic pancreatitis?
Transabdominal US, ERP/MRP, EUS, CT, fasting blood glucose, oral glucose tolerance test.
88
What happens to pain levels in the advanced stage of chronic pancreatitis?
Pain decreases ('burnout' of the pancreas).
89
What complications may occur in the advanced stage of chronic pancreatitis?
Pseudocysts, cholestasis, segmental portal hypertension, and calculi.
90
What is pancreatic function like in the advanced stage of chronic pancreatitis?
Marked impairment with frequent steatorrhea and diabetes mellitus.
91
What diagnostics are used in the advanced stage of chronic pancreatitis?
Transabdominal US, ERP/MRP, CT, FE-1, fasting blood glucose, oral glucose tolerance test.
92
What is the most common symptom of chronic pancreatitis?
Abdominal pain.
93
How is abdominal pain in chronic pancreatitis described?
Constant and boring, often epigastric or mid-epigastric, radiating to the back, associated with anorexia, nausea, and vomiting.
94
In chronic pancreatitis, when does pain often disappear ('burnout' phase)?
In the late phases, often associated with diabetes and exocrine insufficiency.
95
What are common symptoms of malabsorption in chronic pancreatitis?
Bloating, flatulence, diarrhea, and steatorrhea.
96
What are some nutritional deficiencies seen in chronic pancreatitis due to malabsorption?
Deficiencies in micronutrients and fat-soluble vitamins A, D, and E.
97
When does pancreatogenic diabetes typically develop in chronic pancreatitis?
In the later stages, when 90% of the parenchyma is replaced by fibrosis.
98
What is pancreatogenic diabetes?
A global deficiency of all three glucoregulatory islet cell hormones: insulin, glucagon, and pancreatic polypeptide.
99
What is the purpose of pancreatic duct stenting in chronic pancreatitis?
To relieve obstruction and reduce pain symptoms.
100
Why are pancreatic duct stents only left in place for a limited time?
To avoid further inflammation.
