Pancreas

Question 1

Pseudocyst fluid analysis

Answer 1

High amylase, low CEA

Question 2

Serous cystadenoma fluid analysis

Answer 2

Low amylase, low CEA

Question 3

Mucinous cystic neoplasm fluid analysis

Answer 3

Low amylase, high CEA

Question 4

IPMN fluid analysis

Answer 4

high amylase, high CEA

Question 5

Mucinous cystic neoplasms

Answer 5

Body and tail, high mucin and CEA but low amylase; high malignant potential means resection with spleen preserving distal panc

Question 6

Serous cystic neoplasms

Answer 6

Even distribution, Multiple small cysts separated by internal separations with central starburst calcifications; no mucin, CEA or amylase

Question 7

IPMN

Answer 7

Mostly head, high mucin, CEA and amylase, Poorly demarcated, lobulated, polycystic mass with dilation of main or branch ducts

Question 8

Annular pancreas

Answer 8

MC with Down’s, atresias (esophageal and duodenal), and imperforate anus, classic “double bubble” sign on x-ray, surgical bypass with duodenoduodenostomy, gastrojejunostomy, or duodenojejunostomy not resection

Question 9

Primary pancreatic lymphoma

Answer 9

Large poorly enhancing homogenous mass with peripancreatic lymphadenopathy; elevated serum lactate dehydrogenase (LDH), elevated beta-2 microglobulin level, and a normal serum CA 19–9; B symptoms; chemo with R-CHOP

Question 10

Unresectable for Whipple

Answer 10

Pancreatic cancer is considered unresectable with any metastases, extension into the hepatoduodenal ligament, involvement of major arterial structures, or involvement of nodal or neural structures around the celiac or superior mesenteric arteries. Isolated involvement of the superior mesenteric vein or portal vein can be resected in selected patients.

Question 11

Autoimmune pancreatitis

Answer 11

diffusely enlarged hypodense pancreas or a focal mass that may be mistaken for pancreatic malignancy; Elevated IgG4 level; biopsy is indicated to rule out malignancy

Question 12

Pancreatic ductal adenocarcinoma

Answer 12

infiltrate vascular, lymphatic, and perineural spaces; mets to LN and liver

Question 13

Post-op pancreatic fistula

Answer 13

NPO, TPN, octreotide, MRCP for anatomy of leak

Question 14

Whipple outcomes

Answer 14

There is no significant difference between pylorus-preserving pancreaticoduodenectomy and the classic Whipple operation in terms of either relative ease of performance or short- or long-term outcome (including survival).

Question 15

Steps of Whipple

Answer 15

Determine if candidate
Open lesser sac and dissect inferior pancreas/SMV
Kocher and Cattell-Braash
Portal dissection and chole
Tunnel
Divide stomach
Divide pancreas
Divide jejunum
Reconstruct