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General Surgery > Pancreas > Flashcards

Pancreas Flashcards

1
Q

The pancreas is formed from which 2 buds? Describe which bud forms which part of the pancreas

A
  1. Dorsal bud, forms the superior head, neck, body and tail
  2. Ventral bud forms the inferior head and uncinate process
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2
Q

The ventral bud is associated with ________ duct while the dorsal bud is associated with the __________ duct

A

Main pancreatic duct of Wirsung, the accessory pancreatic duct of Santorini

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3
Q

The _________ bud is intimately associated with the biliary tree and rotates _______ to join the other bud.

A

ventral, clockwise

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4
Q

Describe annular pancreas and name 4 associated congenital anomalies

A

Ring like tissue around the duodenum
1. Gut malrotation
2. Congenital heart defects
3. Intestinal atresia
4. Tracheoesophageal fistula

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5
Q

Describe pancreas divisum

A

Failure of fusion; each bud stays independent and drains its own secretions
Risk of pancreatitis as smaller duct handles a lot of secretions

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6
Q

The head of pancreas overlies which major vessel? The uncinate process wraps around which vein?

A

IVC at level of renal veins
Uncinate wraps around SMV

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7
Q

What marks the distinction between body and tail?

A

Confluence of IMV and splenic vein

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8
Q

Describe the blood supply

A

Head: sup and inf pancreaticoduodenal art from celiac and SMA respectively
Neck and body: Dorsal pancreatic art < splenic art
Tail: branches of splenic art

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9
Q

The exocrine portion of pancreas

A

Acinar cells>alveolus>lobule
Acinar cells secrete digestive enzymes: lipase, amylase, protease
Centroacinar cells secrete HCO3 rich fluid and electrolytes (500-800 mls)

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10
Q

Factors that stimulate and inhibit exocrine secretions

A

Stimulants: CCK, gastrin, secretin, ACh
Inhibitors: somatostatin, pancreatic polypeptide, glucagon

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11
Q

Cells of the endocrine pancreas

A

Islets of Langerhans
Alpha cells: glucagon
Beta cells: insulin
Delta cells: somatostatin
F cells: Pancreatic polypeptide

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12
Q

8 causes of acute pancreatitis

A
  1. Gallstones
  2. Alcohol
  3. Trauma, including post ERCP
  4. Metabolic: hypercalcemia, hypertriglyceridemia
  5. Drugs: sulfonaides, aspirine, thiazides, HAART, statins
  6. Infections/ inflammatory: autoimmune, ascariasis, clonorchis, viruses, scorpion
  7. Obstruction from divisum, tumors
  8. Idiopathic
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13
Q

Atlantic criteria for diagnosis

A
  1. Abdominal pain consistent, that is epigastric, radiating to back
  2. Serum lipase/ amylase >X3 UMNL
  3. Imaging: ultrasound/ CECT
    You need 2 to make a diagnosis
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14
Q

What is:
a) Cullen sign
b) Gray Turner’s sign

A

a) Periumbilical ecchymoses due to pancreatic hemoperitonum
b) Flank ecchymoses

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15
Q

Outline 2 local complications of pancreatitis

A
  1. Interstitial edema causing fluid collection. If < 4/52 it is a peripancreatic collection, afterwards it is a pseudocyst
  2. Necrotizing pancreatitis. Acute pancreatic collection if < 4 weeks, afterwards it is a walled off collection
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16
Q

4 indications for CT in acute pancreatitis

A
  1. Concern for necrosis
  2. Worsening clinical condition after first 5-7 days: increasing fever, leukocytosis, elevated CRP, hemodynamic instability
  3. Concern for bowel ischemia
  4. Concern for pseudoaneurysm or significant UGIB
17
Q

Outline different scoring systems and what they are used for

A
  1. Estimation of systemic complications: Modified Marshall, SOFA
  2. Score for severity: Ranson’s, BISAP
  3. To exclude severe pancreatitis: HAPS
18
Q

Treatment prongs for acute pancreatitis

A
  1. Fluid rehabilitation
  2. Analgesia
  3. Nutritional support; prefer early enteric
  4. Antibiotics in established infections (Carbapenems)
  5. Manage local complications: abscesses, bowel necrosis, abdominal compartment syndrome
19
Q

Indication for ERCP in acute pancreatitis

A
  1. Persistent cholestasis/ jaundice
  2. Presence of biliary obstruction, +/- cholangitis
20
Q

Regarding serum amylase and lipase, contrast and compare.

A
  1. Lipase more sensitive for pancreatitis
  2. Lipase has a longer half life giving a bigger window within which diagnosis can be done (5-7 days versus 8-14 days)
21
Q

Chronic pancreatitis causes

A
  1. Alcohol
  2. Metabolic: hypercalcemia
  3. Unrelieved obstruction: strictures, tumor
  4. Hereditary (autosomal dominant chronic pancreatitis)
  5. Autoimmune: Sjogren’s, type I DM
  6. Idiopathic
  7. Tropical pancreatitis
22
Q

Pancreatic exocrine tumors account for ______% while endocrine tumors account for _______%

A

95%, 5%

23
Q

Insulinoma

A
  1. Commonest functional PNET
  2. Occur anywhere on pancreas
  3. Whipple’s triad: hypoglycemia, symptoms of hypoglycemia and relief of symptoms with glucose
  4. 85-95% benign
24
Q

Gastrinoma

A
  1. Occurs in gastrinoma triangle, with 70% in duodenum
  2. Hypergastrinemia; Zollinger Elison syndrome
  3. 60-90% malignant
25
Q

VIPoma

A
  1. Common in body and tail
  2. Cause diarrhea, hypokalemia, achlorrhydia.
  3. 40-70% malignant
26
Q

Glucagonoma

A
  1. Rare
  2. Exclusively in the tail
  3. 4Ds: dermatitis, diabetes, DVT and depression.
  4. 75-80% malignant
27
Q

Somatostatinoma

A
  1. Rare
  2. Gastrinoma triangle (more common in duodenum)
  3. Diarrhea, steatorrhea, cholelithiasis
  4. 70-80% malignant
28
Q

Non-functional PNETs

A
  1. Symptoms due to local compression
  2. Commonest PNET (50-80%)
  3. Head of pancreas commonest
  4. 70-90% malignant
29
Q

Cystic neoplasm vs pseudocyst

A

Pseudocyst: Thin wall, no loculations,/ solid components
Cystic neoplasm: Thick walls, irregular walls, septated, have solid components

30
Q

3 types of cystic neoplasms

A
  1. Serous: Benign. Grandmothers. Flower like central scar with lobules around scar
  2. Mucinous: Premalignant. Mothers. Thick septae with calcified walls
  3. Intraductal papillary: communicate with main duct/ side branch. Premalignant. Older males and females.

General Surgery (2 decks)

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