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SURGERY (3RD YEAR) > PANCREAS 1.2 > Flashcards

PANCREAS 1.2 Flashcards

1
Q

What is a common intrapancreatic complication of chronic pancreatitis?

A

Pseudocysts.

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2
Q

What complications can arise from pseudocysts?

A

Duodenal or gastric obstruction, thrombosis of splenic vein, abscess, perforation, and erosion into visceral artery.

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3
Q

What are some possible outcomes of an inflammatory mass in the head of the pancreas?

A

Bile duct stenosis, portal vein thrombosis, and duodenal obstruction.

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4
Q

What can duct strictures and/or stones cause in chronic pancreatitis?

A

Ductal hypertension and dilatation.

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5
Q

What type of cancer is a complication of chronic pancreatitis?

A

Pancreatic carcinoma.

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6
Q

What are some extrapancreatic complications of chronic pancreatitis?

A

Pancreatic duct leak with ascites or fistula, pseudocyst extension beyond lesser sac into mediastinum, retroperitoneum, lateral pericolic spaces, pelvis, or adjacent viscera.

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7
Q

What is a pancreatic pseudocyst?

A

A chronic collection of pancreatic fluid surrounded by non-epithelialized walls of granulation tissue and fibrosis.

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8
Q

What percentage of acute and chronic pancreatitis cases develop a pseudocyst?

A

10% in acute pancreatitis and 20-38% in chronic pancreatitis.

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9
Q

When is surgery indicated for a pancreatic pseudocyst?

A

If the pseudocyst is >6 cm and persists for >6 weeks for cystic wall maturation.

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10
Q

What is the most important cause of pancreatic pseudocyst formation?

A

Pancreatitis (75%), followed by trauma (25%).

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11
Q

What complication can arise if a pseudocyst ruptures during the acute phase and surgery is performed?

A

The patient may become toxic due to the risk of rupture.

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12
Q

What is a common diagnostic tool for detecting pseudocysts?

A

CT scan, as it reveals well-circumscribed, usually round or oval peripancreatic fluid collections with a well-defined enhancing wall.

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13
Q

What indicates a pancreatic abscess?

A

Presence of gross purulence (pus) with bacterial or fungal organisms.

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14
Q

What is peripancreatic fluid collection?

A

A collection of enzyme-rich pancreatic juice that occurs early in acute pancreatitis or from a pancreatic duct leak, lacking a well-organized wall.

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15
Q

What is early pancreatic (sterile) necrosis?

A

A focal or diffuse area of nonviable pancreatic parenchyma, typically >30% of the gland with liquefied debris and fluid.

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16
Q

What is an acute pseudocyst?

A

A collection of pancreatic juice enclosed within a perimeter of granulation tissue, usually occurring within 3-4 weeks of acute pancreatitis.

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17
Q

What is a chronic pseudocyst?

A

A collection of pancreatic fluid surrounded by a wall of normal granulation and fibrous tissue, usually persisting for >6 weeks.

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18
Q

What is the treatment goal for a pancreatic pseudocyst?

A

For the cystic wall to resolve within 6 weeks at <6 cm; if >6 weeks and >6 cm, surgery may be considered.

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19
Q

What is the purpose of internal drainage in pseudocyst treatment?

A

To create a connection between the pseudocyst and the stomach for cystic fluid drainage.

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20
Q

What is pancreatic ascites?

A

Leakage of pancreatic fluid into the peritoneal cavity without forming a pseudocyst.

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21
Q

What are typical clinical manifestations of pancreatic ascites?

A

Progressive abdominal swelling, low serum albumin, and a history of chronic pancreatitis.

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22
Q

What can ERCP reveal in pancreatic ascites?

A

The location of the pancreatic duct leak and the underlying ductal anatomy.

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23
Q

What is the treatment for a central pancreatic duct leak?

A

A Roux-en-Y pancreaticojejunostomy performed at the site of duct leakage.

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24
Q

What is a pancreatico-enteric fistula?

A

An abnormal connection between the pancreas and an adjacent hollow organ, often due to a ruptured pancreatic pseudocyst.

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25
Q

What is the most common site of communication in pancreatico-enteric fistulas?

A

The transverse colon, splenic flexure, or descending colon.

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26
Q

What symptoms are associated with a pancreatico-enteric fistula involving the colon?

A

GI or colonic bleeding and sepsis.

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27
Q

When might a pancreatico-enteric fistula close spontaneously?

A

If it communicates with the stomach or duodenum.

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28
Q

What are the general medical treatments for chronic pancreatitis?

A

Lifestyle changes (no alcohol or smoking), diet modification (small, low-fat meals), NSAIDs and narcotics for analgesia, enzyme replacement (30,000 IU lipase per meal), and antisecretory agents (somatostatin, octreotide).

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29
Q

What are the interventional procedures for chronic pancreatitis pain?

A

Neuroablation (celiac plexus block, splanchnicectomy), decompression (endoscopic stenting, Puestow procedure), and resection (Whipple, Frey procedure).

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30
Q

What endoscopic treatments are available for chronic pancreatitis?

A

Stricture dilatation, stone extraction, stent placement, shock wave lithotripsy, internal drainage (cystogastrostomy, cystoduodenostomy, or cystojejunostomy).

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31
Q

What is the purpose of Duval-Zollinger’s procedure in chronic pancreatitis treatment?

A

It is a caudal pancreaticojejunostomy that creates a connection between the pancreas and jejunum for drainage.

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32
Q

What is the Puestow-Gillesby procedure?

A

It is a longitudinal Roux-en-Y pancreaticojejunostomy that involves removing part of the tail of the pancreas, opening the pancreatic duct, and connecting it to the jejunum to drain pancreatic juice.

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33
Q

What is the Partington-Rochelle procedure?

A

It is a modification of the Puestow-Gillesby procedure, a longitudinal pancreaticojejunostomy that does not involve a caudal pancreatectomy.

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34
Q

What are drainage surgeries for chronic pancreatitis?

A

Drainage surgeries connect the pancreas to the jejunum to allow pancreatic juice drainage. Examples include Duval-Zollinger, Puestow-Gillesby, and Partington-Rochelle procedures.

35
Q

What is the Fry and Child procedure?

A

It is a 95% distal pancreatectomy that preserves the rim of the pancreas in the pancreaticoduodenal groove, along with associated blood vessels and the distal common bile duct.

36
Q

What is the Kausch-Whipple procedure?

A

It is a pancreaticoduodenectomy often used in chronic pancreatitis or pancreatic malignancy; includes duodenojejunostomy, pancreaticojejunostomy, and choledochojejunostomy.

37
Q

What is the difference between standard and pylorus-sparing Whipple procedures?

A

The standard Whipple involves distal gastrectomy, while the pylorus-sparing version preserves the pylorus for a less invasive approach.

38
Q

What is the hybrid Beger procedure?

A

It is a duodenum-preserving pancreatic head resection (DPHR) that preserves the duodenum while reducing pancreatic head pressure.

39
Q

What is the Frey and Smith procedure?

A

It involves local resection of the pancreatic head with longitudinal pancreaticojejunostomy (LR-LPJ) to decompress the entire pancreatic ductal system.

40
Q

What is the Hamburg modification?

A

It is a modification of the Frey and Smith LR-LPJ procedure with a wider excavation of the pancreatic head, followed by a single side-to-side pancreaticojejunostomy.

41
Q

What is the Berne modification?

A

It is a modification of the Beger procedure with excavation of the central portion of the pancreatic head without formal division of the pancreatic neck.

42
Q

What is the purpose of the Whipple procedure in chronic pancreatitis?

A

It removes the inflamed head of the pancreas and reconnects the pancreatic, bile, and digestive tracts to relieve symptoms and improve quality of life.

43
Q

How does the Partington-Rochelle procedure differ from other drainage surgeries?

A

It modifies the Puestow-Gillesby procedure by only excising necrotic tissue without making an opening in the pancreas, connecting healthy pancreas to normal bowel.

44
Q

Why is the Puestow-Gillesby procedure used?

A

It allows pancreatic juice to drain from the pancreatic duct by creating a connection to the jejunum after resecting the tail and opening the duct longitudinally.

45
Q

What are the three connections made in the Whipple procedure?

A

Duodenojejunostomy, pancreaticojejunostomy, and choledochojejunostomy.

46
Q

What is the goal of endoscopic internal drainage in chronic pancreatitis?

A

To drain pancreatic fluid collections or pseudocysts by connecting them to the gastrointestinal tract, such as with cystogastrostomy or cystoduodenostomy.

47
Q

What is the primary medical goal of treating chronic pancreatitis?

A

To relieve pain, manage enzyme insufficiency, and prevent complications through lifestyle changes, enzyme replacement, and, when necessary, interventional procedures.

48
Q

What is the dual role of the pancreas?

A

“The pancreas is both an exocrine and endocrine gland.”

49
Q

Which type of pancreatic neoplasm is more unfavorable, exocrine or endocrine?

A

“Endocrine neoplasm is more unfavorable due to hormonal imbalance.”

50
Q

What is the most common endocrine pancreatic tumor?

A

“Insulinoma.”

51
Q

What is Whipple’s Triad for insulinoma?

A

“Symptomatic fasting hypoglycemia

52
Q

How is insulinoma diagnosed?

A

“Low blood sugar

53
Q

What is the treatment for insulinoma located close to the main pancreatic duct?

A

“Distal pancreatectomy or pancreaticoduodenectomy if >2 cm and near main duct.”

54
Q

What are the key features of gastrinoma?

A

“Hyperacid secretion and peptic ulcer.”

55
Q

What syndrome is associated with gastrinoma?

A

“Zollinger-Ellison Syndrome (ZES).”

56
Q

What is the diagnostic marker for gastrinoma?

A

“Serum gastrin >1000 pg/mL

57
Q

What is Passaro’s triangle?

A

“An anatomic region typical for gastrinoma location

58
Q

What syndrome is associated with VIPoma?

A

“Watery diarrhea

59
Q

What is the diagnostic marker for VIPoma?

A

“Serum vasoactive intestinal peptide (VIP) levels.”

60
Q

What are the characteristics of glucagonoma?

A

“Diabetes with dermatitis

61
Q

What is the usual location of glucagonoma?

A

“Body and tail of the pancreas.”

62
Q

What is the diagnostic marker for somatostatinoma?

A

“Serum somatostatin >10 ng/mL.”

63
Q

What is the most common histology of pancreatic cancer?

A

“Adenocarcinoma.”

64
Q

What is the prognosis of pancreatic cancer?

A

“Worst prognosis among malignancies

65
Q

What is the most commonly mutated gene in pancreatic cancer?

A

“K-ras oncogene

66
Q

What is the imaging choice for pancreatic cancer?

A

“Dynamic contrast-enhanced CT scan.”

67
Q

What is the main curative treatment for pancreatic cancer?

A

“Pancreaticoduodenectomy (Whipple procedure).”

68
Q

What are the three bypasses in the Whipple procedure?

A

“Gastrojejunostomy

69
Q

What is a palliative option for biliary obstruction in unresectable pancreatic cancer?

A

“Endoscopic biliary metal stent

70
Q

What type of pancreatic lesion presents as a fluid-containing structure?

A

“Cystic neoplasms of the pancreas.”

71
Q

What is the prognosis of cystic neoplasms compared to pancreatic adenocarcinoma?

A

“Prognosis is significantly better than pancreatic adenocarcinoma.”

72
Q

What imaging modality is preferred for surveillance of cystic pancreatic lesions?

A

“MRI.”

73
Q

What is a characteristic feature of cystadenoma?

A

“Benign

74
Q

How is cystadenoma diagnosed?

A

“CT scan shows a well-circumscribed cystic mass with small septations and central scar with calcifications; ERCP may show dilation of the main duct.”

75
Q

What is the treatment for cystadenoma?

A

“Surgical removal; drainage alone is insufficient.”

76
Q

What is mucinous cystadenoma (MCN) and cystadenocarcinoma?

A

“Pancreatic cystic tumors that can be benign or malignant

77
Q

What diagnostic markers are associated with mucinous cystadenoma?

A

“CT scan showing thick walls

78
Q

What is the treatment for mucinous cystadenoma or cystadenocarcinoma?

A

“Distal pancreatectomy

79
Q

What is Intraductal Papillary Mucinous Neoplasm (IPMN)?

A

“A neoplasm within the pancreatic ducts

80
Q

How is IPMN diagnosed?

A

“ERCP shows mucin from the Ampulla of Vater (fish eye lesion)

81
Q

What is the treatment for IPMN?

A

“Surgical resection based on the length of duct involvement.”

82
Q

What are key characteristics of pancreatic lymphoma?

A

“Large mass located in the head and body of the pancreas.”

83
Q

How is pancreatic lymphoma diagnosed?

A

“EUS-guided biopsy.”

84
Q

What is the treatment for pancreatic lymphoma?

A

“Endoscopic stenting to relieve jaundice

SURGERY (3RD YEAR) (5 decks)

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