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Written Boards > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Describe chronic panc procedures

A
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2
Q

What does pancreatic mass bx with diffuse lymphocytic invasion indicate

A

Autoimmune panc

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3
Q

How did the Halsted 1898 operation differ from WHipple in 1935

A

just the 2nd portion of the duo

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4
Q

Original periop mortality? for periampullary ca
after tert centers
and now

A

20-40
5
2

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5
Q

4 risk for pancreatic cancer

A

Smoking, obesity, DM2, and 1st degree relatives

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6
Q

5 y survival for PDAC

A

7%

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7
Q

how many are surgical candidates for PDAC? how many of those make 5 years

A

20%; 20%

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8
Q

2 risk factors for distal cholangio

A

liver flukes
PSC

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9
Q

Only good thing about ampullary ACA

A

early obstruction

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10
Q

Duodenal adeno is what % of SB CA; associated syndrome

A

56; FAP

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11
Q

tumor marker for panc

A

cA 19-9

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12
Q

What is the imaging modality of choice for PDAC? How does it appear?

CholangioCA?

A

Hypodensity surrounded by normal appearing tissue

OFten not seen —>CBD thickening seen

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13
Q

What ‘sign’ can be seen radiologically for periampullary ca

A

double duct — PD and CBD

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14
Q

T staging for periampullary CA

A

0-2
2-4
>4
local vessels

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15
Q

Periampullary ca stage 2b - 3 diff

A

N2

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16
Q

What defines abuttment

A

loss of fat plane on imaging

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17
Q

Whipple 6 big steps

A

1 - Met eval, full kocher to L renal v, expose Portal and SMV, LN harvest
2- Lesser sac,

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18
Q

3 post operative tenets for whipple

A

Early feeding, early drain removal(3days), zero fluid balance

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19
Q

3 major complications following whipple early post op

A

DGE, POPF, PPH

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20
Q

Post op whipple hemorrhage causes eary v late

A

technical error

inflammation from panc leak —-> GDA PSA

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21
Q

POPF grading scale

A
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22
Q

5 year survival rate for all panc adenoca

A

7%

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23
Q

3 methods of non op biliary obstruction managmennt

A

endo stent> perc stent> perc drain

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24
Q

difference in biliary stents

A

plastic temp

metal long term 12m, covered stents have better patency against overgrowth but can migrate

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25
Q

non op options for GOO do to panc adenoca, what type of patient
success rate?

A

stent if less than 6 months predicted
96%

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26
Q

3 operative palliative procedures for panc adenoca

A

roux choledocho
GJJ
Celiac neurolysis

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27
Q

Describe celiac neurolysis procedure

A

50% ethanol injection either side of aorta

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28
Q

Side effects folfirinox v gemcit

A
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29
Q

Why does all panc adeno get systemic therapy at some point

A

It is considered systemic disease at dg

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30
Q

Borderline cutoffs: artery, vein and extrapancreatic

A

Artery: <180 abuttment sma and celiac, short encasement CHA

Vein:>180 SMV/PV; < 190 with contour irreg or thrombosis

Extra: Suspicious mets(10-20% will have radiographically occult disease

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31
Q

2 arguments against the conko 001 adjuvant trial

A

Heavy bias
only 50% received it

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32
Q

5 Neo adjuvant for PDAC pros and 3 cons

A

Pros:
-all pts treated
-aggressive tumors identified by response
incs rads efficacy
-dec fistula
dec pos margins

Cons:
- Needs endo bx
- possible endo stent
- possible loss of “window” (2%)

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33
Q

how long is neo chemo for pdac

A

2 months

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34
Q

Schedule for resectable pdac including neo

what is included in restaging

A

neo 2 m, RS, surgery, RS, adj 4 months

CTDP
CA19-9
ECOG

35
Q

ECOG scale

A
36
Q

Describe a serous cystadenoma

Appearance on CT

FNA results

A

benign, true epithelial lining with glyogen rich cuboidal cells

starburst, honeycomb

low cea, low mucin, atypia on FNA

37
Q

Tx for serous cystadenoma

A

AS: obs
Sympt/growing: resect

38
Q

What radiologic characteristic of some serous cystad may cause dg confusion

What additional test do we perform

A

multicystic

FNA

39
Q

describe rads findings for mucinous cystic neoplasm

typical pt demographic

Cell type found

A

singular, thick walled, large

female 9:1

ovarian type stroma

40
Q

ovarian type stroma is dg for what panc mass

A

mucinous cystic neo

41
Q

what is often radiographically confused with mucinous cystadenoma

What 2 labs can diff on fna

A

pseudocyst

amy up in pseudo
CEA above 200 is pathognomonic for mucinous cystic ne

42
Q

Tx for mucinous cystic neo

A

resection

43
Q

This panc pathology mimics PDAC radiographically and clinically

A

Autoimmune panc

44
Q

IgG4 s serology used to dg what

A

autoimmune panc

45
Q

Describe the histopathology findings for AIP

A

periductal lymphoplasmocytic infiltration with obliterative phlebitis

Lymph infilt w/ storiform fibrosis and Igg4 cells

46
Q

Tx for AIP

What to monitor for after starting tx

A

steroids

watch IgG4 and CA19-9 (occult malign monitoring)

47
Q

how does acinar cell ca differ from pdac radiologically

A

hyperenhancing borders rather than discrete

48
Q

What fna finding separates acinar cell ca

tx?

A

lipaase

resection

49
Q

What is Schmid’s triad

A

eosinophilia, polyarthralgia and eerythema nodosum found in acinar cell ca

50
Q

Elevated LDH found on FNA with lobulated panc mass

what is needed for treatment

what is tx

A

lymphoma

tissue

CHOP

51
Q

CHOP regimen and side effects

A
52
Q

MC origin of met disease in panc, apearance on CT

A

RCC

hypervasce

53
Q

who revolutionized vascular transplant techniques and when

A

Alexs Carrell of France in 1300

54
Q

4 selection criteria for panc transplant

A

under 55
not obese
brittle diabetics with end stage dyfunction
Failed medical tx

55
Q

preferred procurement host

preferred specimen on gross

A

bmi less than 30
under 50

soft
pink

56
Q

Ransons criteria

A
57
Q

Atlanta Criteria

A
58
Q

Main goal of initial resus in severe panc

A

hydrate till they piss

10-20 ml/kg/h of LAR for 24-48h

plus goal directed

58
Q

what is the initial insult starting acute panc

then what 2 additional things happen

A

edema/microangiopathic change

dec blood flow

cell death and exocrine release

58
Q

abx tenets for AP

A

hold unless obvious infection

59
Q

decision algorithm for chol mild gs panc vs severe

A

chole same stay vs 6 weeks for severe

60
Q

what is the mortality % for sev panc with more than 48h of SIRS

A

25

61
Q

What percent of panc resections does IPMN account for

A

25

62
Q

Cytology for IPMN

A

inc CEA and amylase

63
Q

oncogenes for ipmn
fam hx for ipmn

A

KRAS/GNAS
Panc CA hx

64
Q

3 high risk stigmata for ipmn

A

jaundice
10mm pd
mural nodule>5mm

65
Q

7 worrisome features for ipmn

A

mural nodule <5mm, PD 5-9mm, >3cm, thick wall, LN involv, inc CA19-9, grows >5mm in 2y, abrupt caliber change in PD

66
Q

Observation of ipmn by size classification

A

<1cm: 6m then q2y
1-2cm: 6 6 1 1 2
2-3cm: EUS 3-6m, then MRI q1y
>3cm : push surgery, EUS q 3-6m

67
Q

How many people with IPMN resections are symptomatic

what is a major associated comorbidity

A

50

DM

68
Q

cancer and dyplasia rates for bd v md ipmns

A

BD: 15 and 9
MD 44 and 33

69
Q

What CA19 9 level is concerning for IPMN, what is the ppv at this pointq

A

100

92%

70
Q

What is the imaging modality and what might be even better for ipmn

A

MDCT panc protocol

MRI/MRCP

71
Q

epithelial types for BD and MD Ipmn

A

gastric

intestinal

72
Q

Post resection 5 y survival invasive v non for ipmn

A

47
93

73
Q

margins for ipmn?

A

controversial

74
Q

most common functional pnet
s/s
tx

A

insulinoma
hypoglycemia
enucleation

75
Q

vipoma triad

A

diarrhea acholorydria hypokalemia

76
Q

pnet for necroltyic migratory erythema

management

A

glucagonoma

lanreotide then surgery(aggressive)

77
Q

What s/s show up for SSoma

A

cholelithiasis
dm2
steatorrhea

78
Q

what testing is done for insulinoma dg and what 3 criteria are met

A

72h fast
gluc<45
insulin>5inc proinsuilin and c pep

79
Q

imaging modality of choice for pnet

what did it used to be

A

PET DOTATATE 68 GA DOTA peptide

SS scan

80
Q

2 metastatc pnet treatments and their receptor types

when can mets be operated on

A

everolimus(mtor)
sunitinib(rtki)

iso liver

81
Q

pnet size cutoff for aggressive surgical resection

A

2-3cm

82
Q

Describe Appleby procedure

A

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