Pancreas Flashcards
Pancreatic cyst, pigmented histiocytes, low viscosity, high amylase, low CEA, KRAS neg; dx and distribution
Pseudocyst, evenly
Pancreatic cyst, acid Schiff+, low viscosity, low amylase, low CEA, KRAS neg; dx and distribution
Serous Cystadenoma, evenly
Pancreatic cyst, mucinous, increased viscosity, low amylase, high CEA, KRAS positive; dx and distribution
Mucinous Cyst Neoplasm, Tail
Pancreatic cyst, mucinous, high viscosity, high amylase, high CEA, KRAS pos; dx and distribution
IPMN, Head
Palpable abdominal mass, 6cm pancreatic head, , weight loss, fevers, elevated LDH, normal CA 19-9; dx and tx
Primary pancreatic lymphoma, CHOP or R-CHOP
Indication for IMV ligation during pancreatectomy
If it enters the splenic vein to the right of the lesion
Pancreatic duct ≥ 7 mm (normal diameter 3.5 mm) without enlarged pancreatic head; surgical tx and describe
Longitudinal pancreatojejunostomy (Puestow procedure)
Pancreatic head/ampullary mass; surgical tx and description
Pancreaticoduodenectomy (Whipple procedure)
Enlarged pancreatic head with normal caliber pancreatic duct; surgical tx and description
Duodenal sparing pancreatic head resection (Beger procedure)
Dilated pancreatic duct due to obstruction from enlarged pancreatic head; surgical tx and description
Lateral pancreatojejunostomy with local pancreatic head resection (Frey procedure)
Approach to infected pancreatic necrosis
Step Up
Step Up approach
1 - FNA for gram stain/culture + Carbapenem
2 - Perc drainage with upsizing PRN
3 - VARD (video assist retroperitoneal debride)
4 - Necrosectomy (endo vs lap vs open)
Persistent pancreatic pseudocyst not amenable to endo or perc tx
Lap or open cystojejunostomy
Infiltrate vascular, lymphatic and perineural space and account for more than 75% of non-endocrine pancreatic cancers
Ductal adenocarcinoma
Sudden hematemesis or bloody drain output s/p pancreatic debridement; next step
CT angio
Most common functional neuroendocrine tumor and distribution
Insulinoma, even
Symptomatic annular pancreas, tx
Surgical bypass (duo-duo, duo-je, gastro-je)
Diameter of pancreatic duct along pancreas
4-3-2 rule, 4mm head, 3mm body, 2mm tail
Location of splenic artery and vein in respect to pancreas
Superiorly and posteriorly to the body/tail
Superior modality for staging pancreatic ampullary malignancy
EUS
Ranson Criteria components
Admission:
Age >55, WBC>16, Glucose>200, LDH>350, AST>250
48hrs:
Hct >10%, BUN incr >5, Base deficit >4, Fluid req >6L, PaO2 <60, Ca <8
Pancreatic fistula; tx
NPO, nasojejunal feeding, correct electrolytes, skincare and close in 4-6wks
Definition of high output pancreatic fistula
> 200mL/day
Pancreas divisum with recurrent pain or pancreatitis, tx
Sphincterotomy and tenting of minor papilla
Concerned for autoimmune pancreatitis; next step
Bx to rule out pancreatic adenocarcinoma
Most common PNET, where do they arise
Non-functional from islets of Langerhans
Unresectable pancreatic cancer definition
Mets, extension into hepatoduodenal lig, involvement of major arterial structures or neural structures
Ligated in the gastrosplenic ligament during pancreatectomy
Short gastrics from the splenic artery
Homogenous well-circumscribed fluid collection with hyperdense capsule 4wks after pancreatitis
Pancreatic pseudocyst
Gallstone pancreatitis with high suspicion for choledocholithiasis; next step
ERCP prior to cholecystectomy
Best imaging for dx of acute pancreatitis
MRCP
Subtypes of acute pancreatitis based on Atlanta Classification
Interstitial edematous pancreatitis and Necrotizing pancreatitis
Severity of acute pancreatitis based upon Atlanta Classification
Mild - no organ failure
Moderate - <48hrs organ failure
Severe - >48hrs organ failure
Young with unexplained recurrent acute pancreatitis; dx and tx
Pancreatic divisum, ERCP
