Pancreas Flashcards
What are the two most common causes of pancreatitis?
alcohol and gallstones
What is the terminology for fluid collections surrounding pancreatitis?
non-necrotizing:
- acute peri-pancreatic fluid collection
- pseudocyst if > 4 weeks
necrotizing:
- acute necrotic collection if < 4 weeks
- walled off necrosis if > 4 weeks
When are antibiotics indicated for pancreatitis? What antibiotic is used?
- for necrotizing pancreatitis with signs of infection (fever, leukocytosis, FNA with positive cultures)
- use imipenem
What is the step up approach to pancreatitis?
- a strategy for the management of infected necrotizing pancreatitis
- begins with supportive care, resuscitation, and nutrition
- evolves to include perc drainage and antibiotics
- then add drain upsizing
- and finally add minimally invasive RP necrosectomy
How does chronic pancreatitis look on CT?
a fibrotic, atrophic, calcified gland
Describe the Puestow procedure.
longitudinal pancreaticojejunostomy
Describe the Beger procedure:
resection of the pancreatic head up to the wall of the duodenum with pancreaticojejunostomy
Describe the Frey procedure:
lateral longitudinal pancreaticojejunostomy with coring out of the pancreas head
Describe the following procedures:
- Puestow
- Beger
- Frey
- Puestow: longitudinal PJ
- Beger: resection of pancreatic head with PJ
- Frey: core out the pancreatic head with longitudinal PJ
What is the correct operation for a patient with chronic pancreatitis and a dilated pancreatic duct?
Peustow procedure as long as the head is normal
What is the correct operation for a patient with chronic pancreatitis and head-dominant disease?
Frey procedure with or without duct dilatation
What is the correct operation for a patient with chronic pancreatitis and tail-dominant disease?
distal pancreatectomy
What is the correct operation of a patient with chronic pancreatitis and minimal change of the gland?
denervation with bilateral thoracoscopic splanchnicectomy
How are pancreatic pseudocysts managed?
- most resolve spontaneously with three months of expectant management
- consider intervention if >6cm or symptomatic
- get an MRCP or ERCP prior to intervention because they are often associated with PD abnormality
What are the indications for intervention in someone with a pancreatic pseudocyst?
size > 6cm or symptomatic disease
What FNA finding is consistent with a mucinous cyst?
CEA > 192
High amylase from a pancreatic cyst is suggestive of what diagnosis? What about CEA?
- high amylase suggest pseudocyst or IPMN
- high CEA (> 192) suggests a mucinous cyst
How are serous cyst adenomas of the pancreas diagnosed and managed?
- low CEA and low amylase on FNA
- well-circumscribed with central stellate scar on imaging
- resect only if symptomatic or growing
How are mutinous cysts managed?
- high CEA and low amylase on FNA
- thick walled with internal septations on imaging
- have malignant potential so all should be resected in fit patients
Which has a higher risk of malignancy, main or branch duct IPMNs?
main duct IPMNs
When should IMPNs be resected?
- all MD-IPMNs should be resected
- BD-IPMNs with any of the following: size > 3cm, thickened wall, non-enhancing mural nodules, lymphadenopathy, MPD > 1cm, abrupt cut off of MPD with distal atrophy, young patients with lesion > 2cm
What are the indications for BD-IMPNs?
- size greater than 3cm
- size greater than 2cm in young patients
- thick walls
- mural nodules, usually non-enhancing
- MPD > 1cm or MPD cutoff with distal atrophy
Where are pNETs most commonly found?
in the head of the pancreas
What is the most common type of functional pNET?
insulinoma
