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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
What is the most common site of communication in pancreatico-enteric fistulas?
The transverse colon, splenic flexure, or descending colon.
26
What symptoms are associated with a pancreatico-enteric fistula involving the colon?
GI or colonic bleeding and sepsis.
27
When might a pancreatico-enteric fistula close spontaneously?
If it communicates with the stomach or duodenum.
28
What are the general medical treatments for chronic pancreatitis?
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).
29
What are the interventional procedures for chronic pancreatitis pain?
Neuroablation (celiac plexus block, splanchnicectomy), decompression (endoscopic stenting, Puestow procedure), and resection (Whipple, Frey procedure).
30
What endoscopic treatments are available for chronic pancreatitis?
Stricture dilatation, stone extraction, stent placement, shock wave lithotripsy, internal drainage (cystogastrostomy, cystoduodenostomy, or cystojejunostomy).
31
What is the purpose of Duval-Zollinger’s procedure in chronic pancreatitis treatment?
It is a caudal pancreaticojejunostomy that creates a connection between the pancreas and jejunum for drainage.
32
What is the Puestow-Gillesby procedure?
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.
33
What is the Partington-Rochelle procedure?
It is a modification of the Puestow-Gillesby procedure, a longitudinal pancreaticojejunostomy that does not involve a caudal pancreatectomy.
34
What are drainage surgeries for chronic pancreatitis?
Drainage surgeries connect the pancreas to the jejunum to allow pancreatic juice drainage. Examples include Duval-Zollinger, Puestow-Gillesby, and Partington-Rochelle procedures.
35
What is the Fry and Child procedure?
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
What is the Kausch-Whipple procedure?
It is a pancreaticoduodenectomy often used in chronic pancreatitis or pancreatic malignancy; includes duodenojejunostomy, pancreaticojejunostomy, and choledochojejunostomy.
37
What is the difference between standard and pylorus-sparing Whipple procedures?
The standard Whipple involves distal gastrectomy, while the pylorus-sparing version preserves the pylorus for a less invasive approach.
38
What is the hybrid Beger procedure?
It is a duodenum-preserving pancreatic head resection (DPHR) that preserves the duodenum while reducing pancreatic head pressure.
39
What is the Frey and Smith procedure?
It involves local resection of the pancreatic head with longitudinal pancreaticojejunostomy (LR-LPJ) to decompress the entire pancreatic ductal system.
40
What is the Hamburg modification?
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
What is the Berne modification?
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
What is the purpose of the Whipple procedure in chronic pancreatitis?
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
How does the Partington-Rochelle procedure differ from other drainage surgeries?
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
Why is the Puestow-Gillesby procedure used?
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
What are the three connections made in the Whipple procedure?
Duodenojejunostomy, pancreaticojejunostomy, and choledochojejunostomy.
46
What is the goal of endoscopic internal drainage in chronic pancreatitis?
To drain pancreatic fluid collections or pseudocysts by connecting them to the gastrointestinal tract, such as with cystogastrostomy or cystoduodenostomy.
47
What is the primary medical goal of treating chronic pancreatitis?
To relieve pain, manage enzyme insufficiency, and prevent complications through lifestyle changes, enzyme replacement, and, when necessary, interventional procedures.
48
What is the dual role of the pancreas?
"The pancreas is both an exocrine and endocrine gland."
49
Which type of pancreatic neoplasm is more unfavorable, exocrine or endocrine?
"Endocrine neoplasm is more unfavorable due to hormonal imbalance."
50
What is the most common endocrine pancreatic tumor?
"Insulinoma."
51
What is Whipple’s Triad for insulinoma?
"Symptomatic fasting hypoglycemia
52
How is insulinoma diagnosed?
"Low blood sugar
53
What is the treatment for insulinoma located close to the main pancreatic duct?
"Distal pancreatectomy or pancreaticoduodenectomy if >2 cm and near main duct."
54
What are the key features of gastrinoma?
"Hyperacid secretion and peptic ulcer."
55
What syndrome is associated with gastrinoma?
"Zollinger-Ellison Syndrome (ZES)."
56
What is the diagnostic marker for gastrinoma?
"Serum gastrin >1000 pg/mL
57
What is Passaro’s triangle?
"An anatomic region typical for gastrinoma location
58
What syndrome is associated with VIPoma?
"Watery diarrhea
59
What is the diagnostic marker for VIPoma?
"Serum vasoactive intestinal peptide (VIP) levels."
60
What are the characteristics of glucagonoma?
"Diabetes with dermatitis
61
What is the usual location of glucagonoma?
"Body and tail of the pancreas."
62
What is the diagnostic marker for somatostatinoma?
"Serum somatostatin >10 ng/mL."
63
What is the most common histology of pancreatic cancer?
"Adenocarcinoma."
64
What is the prognosis of pancreatic cancer?
"Worst prognosis among malignancies
65
What is the most commonly mutated gene in pancreatic cancer?
"K-ras oncogene
66
What is the imaging choice for pancreatic cancer?
"Dynamic contrast-enhanced CT scan."
67
What is the main curative treatment for pancreatic cancer?
"Pancreaticoduodenectomy (Whipple procedure)."
68
What are the three bypasses in the Whipple procedure?
"Gastrojejunostomy
69
What is a palliative option for biliary obstruction in unresectable pancreatic cancer?
"Endoscopic biliary metal stent
70
What type of pancreatic lesion presents as a fluid-containing structure?
"Cystic neoplasms of the pancreas."
71
What is the prognosis of cystic neoplasms compared to pancreatic adenocarcinoma?
"Prognosis is significantly better than pancreatic adenocarcinoma."
72
What imaging modality is preferred for surveillance of cystic pancreatic lesions?
"MRI."
73
What is a characteristic feature of cystadenoma?
"Benign
74
How is cystadenoma diagnosed?
"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
What is the treatment for cystadenoma?
"Surgical removal; drainage alone is insufficient."
76
What is mucinous cystadenoma (MCN) and cystadenocarcinoma?
"Pancreatic cystic tumors that can be benign or malignant
77
What diagnostic markers are associated with mucinous cystadenoma?
"CT scan showing thick walls
78
What is the treatment for mucinous cystadenoma or cystadenocarcinoma?
"Distal pancreatectomy
79
What is Intraductal Papillary Mucinous Neoplasm (IPMN)?
"A neoplasm within the pancreatic ducts
80
How is IPMN diagnosed?
"ERCP shows mucin from the Ampulla of Vater (fish eye lesion)
81
What is the treatment for IPMN?
"Surgical resection based on the length of duct involvement."
82
What are key characteristics of pancreatic lymphoma?
"Large mass located in the head and body of the pancreas."
83
How is pancreatic lymphoma diagnosed?
"EUS-guided biopsy."
84
What is the treatment for pancreatic lymphoma?
"Endoscopic stenting to relieve jaundice

SURGERY (3RD YEAR) (5 decks)

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