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SURGERY (3RD YEAR) > PANCREAS 1.1 > Flashcards

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.

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2
Q

What are the functions of the pancreas?

A

The pancreas functions as both an endocrine and exocrine organ.

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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.

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4
Q

What embryological structures form the pancreas?

A

The pancreas forms from the fusion of a ventral bud and a larger dorsal bud.

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5
Q

Which parts make up the pancreas?

A

The pancreas consists of the head, uncinate process, neck, body, and tail.

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6
Q

Where does the head of the pancreas lie?

A

The head is disc-shaped within the concavity of the C-shaped duodenum.

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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.

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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.

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9
Q

What is pancreatic divisum?

A

A congenital anomaly where the pancreatic ducts fail to fuse, potentially leading to pancreatitis.

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10
Q

What is the treatment for symptomatic pancreatic divisum?

A

Operative or endoscopic sphincteroplasty of the minor papilla and accessory duct.

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11
Q

What is annular pancreas?

A

A developmental anomaly where pancreatic tissue encircles the duodenum, potentially causing obstruction.

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12
Q

What is the surgical treatment for annular pancreas?

A

Duodenal bypass procedures such as gastrojejunostomy or duodenojejunostomy.

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13
Q

What arteries supply blood to the pancreas?

A

The pancreas is supplied by branches from the celiac and superior mesenteric arteries.

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14
Q

What veins drain blood from the pancreas?

A

The pancreaticoduodenal veins drain into the superior mesenteric vein and hepatic portal vein.

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15
Q

What nerves innervate the pancreas?

A

Parasympathetic innervation from the vagus nerve and sympathetic innervation from splanchnic nerves.

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16
Q

What are the primary symptoms of pancreatic malignancy?

A

Jaundice, severe abdominal pain, and obstruction.

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17
Q

What is a palliative procedure for pancreatic cancer pain?

A

Injecting alcohol near the celiac plexus to alleviate pain.

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18
Q

What are the two main functions of the pancreas?

A

Endocrine (hormone secretion) and exocrine (digestive enzyme release).

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19
Q

What percentage of the pancreas is exocrine tissue?

A

85% of the pancreas is made up of exocrine tissue.

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20
Q

What hormone does the beta cell secrete, and what is its function?

A

Insulin, which decreases gluconeogenesis and increases glucose uptake.

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21
Q

What is the function of glucagon?

A

Increases hepatic glycogenolysis and gluconeogenesis.

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22
Q

What is the role of somatostatin in the pancreas?

A

It inhibits gastrointestinal secretion and endocrine peptide release.

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23
Q

What cell type secretes pancreatic polypeptide, and what is its function?

A

PP cells secrete pancreatic polypeptide, which inhibits pancreatic exocrine secretion.

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24
Q

What is the role of amylin (IAPP)?

A

Counter-regulates insulin secretion and function.

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25
Q

What is acute pancreatitis?

A

Acute pancreatitis is an inflammatory disorder of the pancreas characterized by edema, necrosis, and potential complications.

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26
Q

What are the two main common causes of acute pancreatitis?

A

The two most common causes are alcohol and gallstones.

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27
Q

What does the ‘common channel theory’ state regarding gallstone-related pancreatitis?

A

It states that obstruction by a stone causes bile to flow back to the pancreas, leading to damage by bile salts.

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28
Q

What effect does alcohol have on the pancreas to cause pancreatitis?

A

Alcohol causes spasm of the sphincter of Oddi, decreases blood flow to the pancreas, and is a metabolic toxin to acinar cells.

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29
Q

What is the main pathophysiological mechanism in acute pancreatitis?

A

Acute pancreatitis is caused by acinar cell injury, which may result from gallstone obstruction, alcohol irritation, or blocked pancreatic juice flow.

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30
Q

What initiates the acinar cell injury in pancreatitis?

A

Activation of digestive zymogens within the acinar cells initiates cell injury, leading to inflammation and potential systemic effects.

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31
Q

What are some clinical presentations of acute pancreatitis?

A

Common presentations include epigastric pain radiating to the back, nausea, vomiting, and signs of systemic inflammation.

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32
Q

What are Grey Turner, Cullen, Fox, and Bryant signs?

A

These are signs of retroperitoneal hemorrhage, seen as ecchymosis in different body regions.

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33
Q

What does the Grey Turner sign indicate and where does it appear?

A

Grey Turner sign is flank ecchymosis, indicating retroperitoneal hemorrhage.

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34
Q

What does the Cullen sign indicate and where does it appear?

A

Cullen sign is periumbilical ecchymosis, indicating retroperitoneal hemorrhage.

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35
Q

What does the Fox sign indicate?

A

Fox sign is ecchymosis along the inguinal ligament.

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36
Q

What does the Bryant sign indicate?

A

Bryant sign is bluish discoloration of the scrotum, often associated with retroperitoneal bleeding.

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37
Q

What should be monitored in patients with suspected pancreatitis?

A

Vital signs, oxygenation, hemodynamics, and kidney and metabolic function should be monitored.

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38
Q

What is the SOFA score used for in acute pancreatitis?

A

The SOFA score assesses sepsis risk and disease severity in patients with acute pancreatitis.

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39
Q

What is the ‘cut-off sign’ on an abdominal X-ray?

A

An abrupt termination of air in the left transverse colon, associated with inflamed pancreas.

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40
Q

Why is a CT scan preferred for diagnosing severe pancreatitis?

A

CT scan can reliably detect pancreatic necrosis, hemorrhage, and other severe changes that ultrasound may miss.

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41
Q

What ultrasound findings suggest mild pancreatitis?

A

Mild pancreatitis may show no abnormalities or mild peripancreatic fluid collections on ultrasound.

42
Q

What is the purpose of Ranson’s criteria in pancreatitis?

A

Ranson’s criteria are used to assess mortality risk in acute pancreatitis.

43
Q

What is the gold standard imaging modality for diagnosing pancreatitis?

A

Abdominal CT scan is the gold standard for diagnosing acute pancreatitis.

44
Q

What is the general management approach for acute pancreatitis?

A

Management includes fluid resuscitation, monitoring, analgesia, and nutritional support.

45
Q

When are prophylactic antibiotics indicated in acute pancreatitis?

A

Antibiotics are reserved for documented cases of infected pancreatic necrosis.

46
Q

What is the purpose of ERCP in acute pancreatitis?

A

ERCP is used for patients with biliary pancreatitis complicated by cholangitis or bile duct obstruction.

47
Q

When is laparotomy indicated in acute pancreatitis?

A

Laparotomy is indicated for acute abdomen, failed drainage, or compartment syndrome.

48
Q

What is the importance of nutritional support in acute pancreatitis?

A

Proper nutrition supports recovery, with enteral nutrition preferred over parenteral in severe cases.

49
Q

How does alcohol affect the acinar cells in acute pancreatitis?

A

Alcohol acts as a metabolic toxin and causes ischemic injury to acinar cells.

50
Q

What does the SOFA scoring system include?

A

SOFA scoring assesses
PaO2/FiO2,
platelet count,
bilirubin,
hypotension,
GCS, and
creatinine.

51
Q

What are some complications associated with acute pancreatitis?

A

Complications include pancreatic necrosis, sepsis, shock, organ failure, and pseudocyst formation.

52
Q

What can be seen on a CT scan in mild pancreatitis?

A

Mild pancreatitis may show interstitial edema of the pancreas.

53
Q

What can be seen on a CT scan in severe pancreatitis?

A

Severe pancreatitis may show pancreatic necrosis with air pockets and fluid collections.

54
Q

What is the ‘step-up approach’ in pancreatitis management?

A

It involves gradual intervention, starting with non-surgical methods before progressing to surgery if needed.

55
Q

What is necrosectomy?

A

Necrosectomy is the debridement of necrotic pancreatic tissue, used in severe pancreatitis cases with necrosis.

56
Q

When might pancreatic pseudocysts form in acute pancreatitis?

A

Pseudocysts can form as a complication due to fluid collections following inflammation or necrosis.

57
Q

When does a pancreatic abscess typically occur after the initial pancreatitis attack?

A

Occurs 2-6 weeks after the initial attack.

58
Q

What is the treatment for a pancreatic abscess?

A

Treated by external drainage, either percutaneous or open.

59
Q

What are the indications for surgical intervention in acute pancreatitis?

A

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
Q

How long is the wait period before surgery for symptomatic organized pancreatic necrosis?

A

Typically a wait period of 4-6 weeks is advised to allow inflammation to decrease.

61
Q

What is catheter drainage in treating pancreatic necrosis?

A

A least invasive technique where a catheter is placed percutaneously through the retroperitoneum or transabdominally, often successful without surgery.

62
Q

What is the purpose of video-assisted retroperitoneal debridement (VARD)?

A

It allows the removal of large pieces of necrosis with the use of large-bore surgical drains for continuous lavage.

63
Q

What is one advantage of endoscopic transluminal necrosectomy?

A

Requires no abdominal incision, has no risk for incisional hernia, and does not create an external pancreatic fistula.

64
Q

What is the main disadvantage of endoscopic transluminal necrosectomy?

A

Multiple repeated procedures may be needed to remove sufficient necrosis.

65
Q

What is the role of open necrosectomy in treating necrotizing pancreatitis?

A

It is the reference standard for treatment and involves open or closed packing or continuous closed postoperative lavage.

66
Q

What is chronic pancreatitis?

A

An incurable, progressive inflammatory condition that leads to irreversible destruction of pancreatic tissue.

67
Q

What is the most common cause of chronic calcific pancreatitis?

A

Alcohol use is the most common cause.

68
Q

What type of mutation is associated with hereditary chronic pancreatitis?

A

Autosomal dominant mutations in PRSS1 & SPINK1 genes.

69
Q

What nutritional factor is linked to tropical chronic pancreatitis?

A

Cassava root, which contains toxic glycosides that form hydrocyanic acid, leading to free radical injury to the pancreas.

70
Q

What is the cause of chronic obstructive pancreatitis?

A

It can be due to tumors, strictures, gallstones, or congenital issues like pancreas divisum causing duct obstruction.

71
Q

What type of immune cells predominate in chronic inflammatory pancreatitis?

A

Mononuclear cells predominate in the fibrosis and loss of acinar cells.

72
Q

What is characteristic of chronic autoimmune pancreatitis?

A

It is a non-obstructive, diffuse infiltrative disease with mononuclear cell infiltration and increased autoantibodies.

73
Q

Which autoimmune conditions are associated with chronic autoimmune pancreatitis?

A

Sjogren’s syndrome, rheumatoid arthritis, Type I diabetes, primary sclerosing cholangitis, and cirrhosis.

74
Q

Is surgical treatment recommended for chronic autoimmune pancreatitis?

A

No, these patients are typically not candidates for surgery; steroid therapy is used instead.

75
Q

What radiologic feature on an abdominal ultrasound is commonly seen in chronic pancreatitis?

A

Heterogeneity of the pancreatic parenchyma with dilated ductal systems and cyst formation.

76
Q

What is the role of CT scan in diagnosing chronic pancreatitis?

A

CT provides visualization of duct dilation, calcifications, cystic changes, and other pancreatic lesions with high resolution.

77
Q

What is the purpose of Endoscopic Retrograde Cholangiopancreatography (ERCP) in chronic pancreatitis?

A

ERCP is the gold standard for diagnosis and staging, allowing for diagnostic and therapeutic interventions like stenting or drainage.

78
Q

What is the main symptom in the early stage of chronic pancreatitis?

A

Recurrent acute attacks.

79
Q

Are there any complications in the early stage of chronic pancreatitis?

A

No complications.

80
Q

What is the pancreatic morphology in the early stage of chronic pancreatitis?

A

Morphologic changes are detectable with imaging procedures directed to the pancreatic parenchyma and ductal system.

81
Q

What is pancreatic function like in the early stage of chronic pancreatitis?

A

Normal pancreatic endocrine and exocrine function.

82
Q

What diagnostics are used in the early stage of chronic pancreatitis?

A

EUS, ERP/MRP, CT, Secretin.

83
Q

What are the characteristics of pain in the moderate stage of chronic pancreatitis?

A

Increasing number of attacks with increased intensity.

84
Q

What complications may occur in the moderate stage of chronic pancreatitis?

A

Pseudocysts, cholestasis, segmental portal hypertension.

85
Q

What is the pancreatic morphology in the moderate stage of chronic pancreatitis?

A

Progredient morphologic changes detectable in several imaging procedures.

86
Q

What is pancreatic function like in the moderate stage of chronic pancreatitis?

A

Impairment of pancreatic function in several degrees but rarely steatorrhea.

87
Q

What diagnostics are used in the moderate stage of chronic pancreatitis?

A

Transabdominal US, ERP/MRP, EUS, CT, fasting blood glucose, oral glucose tolerance test.

88
Q

What happens to pain levels in the advanced stage of chronic pancreatitis?

A

Pain decreases (‘burnout’ of the pancreas).

89
Q

What complications may occur in the advanced stage of chronic pancreatitis?

A

Pseudocysts, cholestasis, segmental portal hypertension, and calculi.

90
Q

What is pancreatic function like in the advanced stage of chronic pancreatitis?

A

Marked impairment with frequent steatorrhea and diabetes mellitus.

91
Q

What diagnostics are used in the advanced stage of chronic pancreatitis?

A

Transabdominal US, ERP/MRP, CT, FE-1, fasting blood glucose, oral glucose tolerance test.

92
Q

What is the most common symptom of chronic pancreatitis?

A

Abdominal pain.

93
Q

How is abdominal pain in chronic pancreatitis described?

A

Constant and boring, often epigastric or mid-epigastric, radiating to the back, associated with anorexia, nausea, and vomiting.

94
Q

In chronic pancreatitis, when does pain often disappear (‘burnout’ phase)?

A

In the late phases, often associated with diabetes and exocrine insufficiency.

95
Q

What are common symptoms of malabsorption in chronic pancreatitis?

A

Bloating, flatulence, diarrhea, and steatorrhea.

96
Q

What are some nutritional deficiencies seen in chronic pancreatitis due to malabsorption?

A

Deficiencies in micronutrients and fat-soluble vitamins A, D, and E.

97
Q

When does pancreatogenic diabetes typically develop in chronic pancreatitis?

A

In the later stages, when 90% of the parenchyma is replaced by fibrosis.

98
Q

What is pancreatogenic diabetes?

A

A global deficiency of all three glucoregulatory islet cell hormones: insulin, glucagon, and pancreatic polypeptide.

99
Q

What is the purpose of pancreatic duct stenting in chronic pancreatitis?

A

To relieve obstruction and reduce pain symptoms.

100
Q

Why are pancreatic duct stents only left in place for a limited time?

A

To avoid further inflammation.

SURGERY (3RD YEAR) (5 decks)

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