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Surgery > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Is the pancreas intraparitoneal or retroperitoneal?

A

Retroperitoneal

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2
Q

The pancreas lies behind what membrane at what level?

A

Behind the posterior peritoneal membrane at the level of L2

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3
Q

Where is the head of the pancreas?

A

in the duodenal C loop

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4
Q

Where is the neck of the pancreas?

A

lies over the superior mesenteric vein

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5
Q

Where is the body of the pancreas?

A

left of the SMV

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6
Q

Where is the tail of the pancreas?

A

The tail is the distal-most portion and abuts the splenic hilum

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7
Q

Where is the CBD in relation to the pancreas?

A

CBD descends in the posterior surface of the pancreatic head

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8
Q

What duct does the CBD join and where?

A

the main pancreatic duct at the ampulla of Vater

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9
Q

What is the ampulla surrounded by?

A

The sphincter of Oddi

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10
Q

What is the Duct of Wirsung?

A

main pancreatic duct

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11
Q

What is the Duct of Santorini?

A

lesser duct that drains the superior portion of the head through the lesser papilla

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12
Q

What artery supplies the head of the pancreas?

A
  • Celiac trunk to the hepatic artery to the GDA (Gastroduodenal artery) to the superior pancreaticoduodenal artery
  • SMA (Superior mesenteric artery) to the inferior pancreaticoduodenal artery
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13
Q

What artery supplies the body and tail of the pancreas?

A

Celiac trunk to the splenic artery

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14
Q

Where does venous drainage from the pancreas empty?

A

portal vein

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15
Q

What percentage of the pancreas mass is exocrine?

A

80-90%

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16
Q

What do acinar cells do?

A

Secrete enzymes responsible for digestion

Secrete fluid and electrolytes and bicarbonate

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17
Q

What enzymes to acinar cells secrete?

A

Amylases
Lipases
proteases

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18
Q

What is the function of bicarb?

A

buffer

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19
Q

What is bicarbonates stimulus and when is it released?

A

secretin which is released due to low duodenal pH

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20
Q

What do the islets of Langerhans do?

A

secretes hormones that control glucose homeostasis

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21
Q

What do alpha cells secrete?

A

Glucagon

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22
Q

What do beta cells secrete?

A

Insulin and amylin

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23
Q

What do delta cells secrete?

A

Somatostatin

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24
Q

What do PP or F cells secrete?

A

Pancreatic polypeptide

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25
Q

What is the pathophys of pancreatitis?

A

An acute inflammatory process in which pancreatic enzymes autodigest the gland

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26
Q

Pancreatitis is a malfunction of what?

A

exocrine secretion

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27
Q

What process allows activation of pancreatic enzymes outside the pancreatic ducts and GI tract?

A

Acinar cell injury

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28
Q

What is the initiating event in acute pancreatitis?

A

anything that injures the acinar cell and impairs the secretion of zymogen granules, such as alcohol use, gallstones, and certain drugs

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29
Q

What is the overall mortality rate of patients with acute pancreatitis?

A

10-15%

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30
Q

Does biliary or alcoholic pancreatitis have a higher mortality rate?

A

Biliary>alcoholic

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31
Q

What percentage of biliary tract disease is caused by alcohol?

A

85%

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32
Q

What are other causes of pancreatitis?

A 
Post-ERCP 
Drugs 
Tumors
Trauma  
Hypertriglyceridemia  
Developmental abnormalities of the pancreas – pancreas divisum
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33
Q

What is on the ddx for acute pancreatitis?

A 
Acute cholecystitis
Ascending cholangitis
Perforated peptic ulcer
Mesenteric ischemia
Esophageal perforation
MI
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34
Q

How would acute cholecystitis present?

A

Gall stones, gallbladder wall thickening, pericholecystic fluid, nl amylase and lipase

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35
Q

How would ascending cholangitis present?

A

Jaundice, CBD dilation, nl amylase and lipase, Charcot’s triad, Reynold’s pentad
Perforated peptic ulcer
Free air

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36
Q

How would mesenteric ischemia present?

A

Thickened bowel wall, pneumatosis intestinalis

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37
Q

How would esophageal perforation present?

A

Air in mediastinum, pnuemothx, pleural effusion, nl amylase and lipase

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38
Q

How does an MI present?

A

Abnl cardiac nz’s and EKG, nl amylase and lipase

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39
Q

Where is pain located in acute pancreatitis?

A

Epigastric. May radiate to back, LUQ or RUQ

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40
Q

What are the characteristics of pain in acute pancreatitis?

A

Dull, boring, and steady. Usually, the pain is sudden in onset and gradually intensifies in severity until reaching a constant ache. Severity varies

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41
Q

What are the associated sx with acute pancreatitis?

A

N/V. Hematemesis or melena if severe

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42
Q

What are the precipitating factors of pancreatitis?

A

Large fatty meal if GS pancreatitis. Alcohol ingestion if EtOH pancreatitis

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43
Q

What are the alleviating factors for acute pancreatitis?

A

Sitting or standing

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44
Q

What is the general survey of acute pancreatitis?

A

Varies: Uncomfortable to motionless. NAD to toxic (pale, diaphoretic, and listless)
Respiratory distress if severe
Jaundice if GS pancreatitis

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45
Q

What will vitals show for acute pancreatitis?

A

Normal to fever, tachycardia, hypotension and hypoxic if severe

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46
Q

What will abdominal exam show for acute pancreatitis?

A

Upper abdominal tenderness with distention +/- guarding and rebound
Severe – Grey Turner’s sign or Cullen’s sign

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47
Q

What is the Grey Turner’s sign?

A

Bruising of the flank

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48
Q

What is the cullen’s sign

A

Bruising around umbilicus

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49
Q

What will labs show for acute pancreatitis?

A

CBC w/diff – leukocytosis with left shift
Amylase elevation ~ 2.5 x normal
Lipase elevation 5 x normal
The level of elevation not related to severity of disease
Elevated bili and alk phos if GS pancreatitis
ABGs if patient is dyspneic

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50
Q

What is part of Ranson’s Criteria on admission?

A 
Age				>55 years
WBC 			>16,000/µL
Blood glucose level 		>200 mg/dL
Serum LDH level 		>350 IU/L
AST level 			>250 IU/L
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51
Q

What is part of Ranson’s Criteria during first 48 hrs?

A

Hematocrit fall >10%
BUN level increase >5 mg/dL
Serum calcium level 4 mEq/L
Fluid sequestration >600 mL

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52
Q

What does a ranson’s score of >/= 3 indicate?

A

Severe pancreatitis likely

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53
Q

What does a Ranson’s score of <3 indicate?

A

Severe pancreatitis unlikely

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54
Q

What mortality is associated with a Ranson’s score of 0-2

A

2%

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55
Q

What mortality is associated with a Ranson’s score of 3-4?

A

15%

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56
Q

What mortality is associated with a Ranson’s score of 5-6?

A

40%

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57
Q

What mortality is associated with a Ranson’s score of 7-8?

A

100%

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58
Q

When should a CRP be drawn for pancreatitis?

A

24-48 hrs after presentation

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59
Q

What levels of CRP indicates severe pancreatitis?

A

> 6 mg/dL at 24 hour and > 7 mg/dL at 48 hours strongly indicates severe pancreatitis

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60
Q

What BUN level indicates severe pancreatitis?

A

Elevated BUN at admission

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61
Q

What is Grade A severity on CT?

A

Normal pancreas

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62
Q

What is Grade B severity on CT?

A

Focal or diffuse gland enlargement

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63
Q

What is Grade C severity on CT?

A

Inflammation of pancreas or peipancreatic fat

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64
Q

What is Grade D severity on CT?

A

Single ill-defined collection or phlegmon

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65
Q

What is Grade E severity on CT?

A

Two or more ill-defined collections or the presence of gas in or nearby the pancreas

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66
Q

What would CXR show for acute pancreatitis?

A

R/O free air. Pleural effusions, hemidiaphragm elevation

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67
Q

What would abd films show for acute pancreatitis?

A

ileus, sentinel loop, cutoff sign

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68
Q

What would CT show for acute pancreatitis?

A

pancreatic edema, peripancreatic fluid, necrosis of the gland

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69
Q

What would US show for acute pancreatitis?

A

gallstones, CBD enlargement

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70
Q

What is the treatment for acute pancreatitis that will spontaneously resolve?

A

NPO
IVF
Analgesics
No ABX
If gallstone – cholecystectomy when pancreatitis resolves (same admission)
Resolution based on symptoms, not amylase and lipase levels
Feed as pain and tenderness resolve and WBC return to normal

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71
Q

What complications are associates with pancreatitis?

A

Shock, pulmonary failure, renal failure, GI bleed, MOS failure

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72
Q

When should a patient with acute pancreatitis be admitted to ICU?

A

CV issues

Respiratory issues

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73
Q

How are CV issues managed with acute pancreatitis?

A 
Monitor CV status
Foley catheter
Central venous catheter
PA catheter
Treat with 
Aggressive fluid resuscitation 
May need pharmacologic assistance
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74
Q

How is respiratory status monitored?

A

Pulse ox

ABG

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75
Q

What is impairment of oxygenation caused by with acute pancreatitis?

A

Sympathetic pleural effusions
ARDs
Fluid overload

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76
Q

How are respiratory issues managed?

A

O2

May need intubation with aggressive vent settings

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77
Q

How should fluids be managed with acute pancreatitis?

A

NPO and require aggressive intravenous hydration

Initial several liter fluid bolus followed by 250-500 cc/h continuous infusion

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78
Q

What is the abx protocol for acute pancreatitis?

A

As prophylaxis against infection in severe acute pancreatitis is not recommended
Should be used in any case of pancreatitis complicated by infected pancreatic necrosis

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79
Q

What GI measures should be taken with a patient with AP?

A

NGT and antiemetics for nausea and emesis prn

Prophylaxis for gastritis and PUD

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80
Q

What is the nutrition protocol for AP?

A

Early initiation of enteral nutritional supplementation maintenance of a positive nitrogen balance nasojejunal feeding – past the LOT
TPN second choice

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81
Q

What surgery is indicated when the etiology is gallstones?

A

Cholecystectomy

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82
Q

What it the protocol for cholecystectomy for mild pancreatitis?

A

+/- ERCP for sphincterotomy and stone extraction pre-op

Cholecystectomy prior to d/c

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83
Q

What is the protocol for cholecystectomy for severe pancreatitis?

A

ERCP for sphincterotomy and stone extraction if stone impacted at ampulla of Vater
Cholecystectomy after recovery

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84
Q

What percentage of mortality is associated with infected pancreatic necrosis?

A

40%

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85
Q

At what point of acute pancreatitis does infected pancreatic necrosis occur?

A

2-3 weeks

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86
Q

What does worsening organ disfunction signify?

A

infected pancreatic necrosis

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87
Q

What will be on CT that signifies infected pancreatic necrosis?

A

Air on CT

88
Q

What test is done if there is no air on CT but there is high suspicion of infected necrosis?

A

CT guided needle aspiration for C&S

89
Q

What is done for an infected pancrease?

A

Necrostomy
Drainage
ABX

90
Q

What is a necrosectomy?

A

aggressive surgical debridement to remove dead tissue and to clear the infection – usually requires multiple trips to the OR

91
Q

What is a pancreatic abscess?

A

A collection of pus adjacent to the pancreas without necrosis

92
Q

How is a pancreatic abscess treated?

A 
External drainage (Operative or Percutaneous)
ABX
93
Q

What is the most common complication of acute pancreatitis?

A

Peripancreatic fluid collections

94
Q

What causes peripancreatic fluid collections?

A

disruption of pancreatic duct

95
Q

What is a persistent peripancreatic fluid collection called?

A

Pseudocyst

96
Q

How are peripancreatic fluid collections treated?

A

Usually respond spontaneously

97
Q

What is a pancreatic pseudocyst?

A

Collection of peripancreatic fluid that is walled into a cyst like structure

98
Q

What is it called when the pseudocyst contacts the pancreatic duct and shares fluid?

A

Communicating

99
Q

How long does it take for the wall of the pseudocyst to mature and therefore be treated surgically?

A

4-6 weeks

100
Q

What are symptoms of pseudocyst?

A

May cause abdominal pain, N/V, early satiety, jaundice

101
Q

What imaging is used for a pseudocyst?

A

CT

102
Q

How are non-communicating pseudocysts drained?

A

externally

103
Q

How are communicating pseudocysts drained?

A

Internally

104
Q

What is the process of chronic pancreatitis?

A

Chronic, irreversible inflammation that leads to fibrosis with calcification

105
Q

What are the sx for chronic pancreatitis?

A

Chronic abdominal pain and normal or mildly elevated pancreatic enzyme levels

106
Q

How much of the pancreas must be replaced with scar tissue before exocrine insufficiencies occur?

A

90%

107
Q

What occurs with endocrine and exocrine insufficiencies?

A

DM

Statorrhea

108
Q

What is the most common cause of chronic pancreatitis?

A

Excessive alcohol consumption, 60% of all cases

109
Q

What are other causes of chronic pancreatitis?

A 
Obstruction of pancreatic juice
Cystic fibrosis
Hyperlipidemia 
Hypercalcemia
medications
110
Q

What is the location of pain in chronic pancreatitis?

A

Epigastric. May radiate to back

111
Q

What are the characteristics of pain with chronic pancreatitis?

A

Dull

112
Q

What symptoms are associated with chronic pancreatitis?

A

Steatorrhea and weight loss, DM

113
Q

What is the duration of pain with chronic pancreatitis?

A

Initially intermittent lasting hours to days

Becomes constant and unrelenting

114
Q

What are the precipitating factors of chronic pancreatitis?

A

Supine position

Food and EtOH

115
Q

What are the alleviating factors of pancreatitis?

A

Leaning forward

116
Q

What is seen in general survey for chronic pancreatitis?

A

Uncomfortable
Advanced disease - decreased subcutaneous fat, temporal wasting, sunken supraclavicular fossa, and other physical signs of malnutrition

117
Q

What will vitals show with chronic pancreatitis?

A

Normal

118
Q

What will be found on abdominal exam with chronic pancreatitis?

A

Upper abdominal tenderness

Fullness or mass in epigastrium

119
Q

What will labs show for chronic pancreatitis?

A

Serum amylase and lipase levels may be slightly elevated or not elevated at all
Pancreatic function tests
Glucose

120
Q

What will show on abd radiography for chronic pancreatitis?

A

Pancreatic calcifications, often considered pathognomonic of chronic pancreatitis, are observed in approximately 30% of cases

121
Q

What provides the most accurate visualization of the pancreatic ductal system?

A

ERCP/MRCP

122
Q

What imaging should be done for chronic pancreatitis and will diagnose most cases?

A

CT of abdomen

123
Q

How is pain treated with chronic pancreatitis?

A

Rarely treated

124
Q

What digestive therapy is given with chronic pancreatitis?

A

Pancreatic enzyme replacement

Insulin

125
Q

How is abdominal pain alleviated with chronic pancreatitis?

A

Analgesics

Celiac plexus blockade

126
Q

How is an obstructed pancreatic duct treated?

A

Endoscopic decompression

127
Q

What is the Puestow procedure?

A

Pancreaticojejunostomy or pancreatic duct drainage

attach jejunum to pancreatic duct

128
Q

What are the surgical treatments to relieve pain in chronic pancreatits?

A

Pancreaticojejnostomy (puestow)
Pancreatic resection
Sphincteroplasty

129
Q

What percentage of pancreatic cancers will die?

A

98%

130
Q

What is the median survival for unresectable pancreatic cancer

A

6 mo

131
Q

What percentage diagnosed with pancreatic cancer are candidates for resection?

A

20%

132
Q

What are risk factors for pancreatic cancer?

A 
Black males in US
Tobacco
obesity
red meats
DM
Hereditary
Chronic pancreatitis
133
Q

What is the most common type of pancreatic cancer?

A

Adenocarcinoma (90%)

134
Q

Where do adenocarcinomas of the pancreas originate?

A

From ductal epithelium

135
Q

What are the types of pancreatic cancers?

A 
Adenocarcinoma  
Islet cell tumors
Lymphomas
Mucinous cystic neoplasms
Metastatic lesions
136
Q

What proportion of pancreatic cancers are in the head or neck?

A

3/4

137
Q

What percentage of pancreatic cancers are in the body?

A

15-20%

138
Q

What percentage of cancers are in the tail?

A

5-10%

139
Q

How many pts have pain with pancreatic cancers at the head of the pancreas?

A

1/3 – no pain, 1/3 – mild pain, 1/3 severe pain

140
Q

When does the patient experience pain with pancreatic cancer in the head of the pancreas?

A

Nighttime

141
Q

What is the quality of pain with a patient with pancreatic cancer in the head of the pancreas?

A

Unrelenting, mid-epigastric, radiates to the mid- or lower back (what can radiating to the back signify)

142
Q

What is a large indicator of pancreatic cancer?

A

Painless jaundice*****

143
Q

What are associated sx with pancreatic cancer?

A 
Significant weight loss
Anorexia
Malaise 
Fatigue
Nausea
144
Q

What is the duration of pain with pancreatic cancer?

A

Slow and progressive

145
Q

What is the general survey for adenocarcinoma of the pancreas?

A

Thin/muscle wasting

Jaundiced

146
Q

What does abdominal exam show for adenocarcinoma of the pancreas?

A 
Courvoisier’s sign
Ascites, palpable abdominal mass, hepatomegaly, splenomegaly
Sister Mary Joseph nodule
Blumer’s shelf
Virchow’s node
147
Q

What is Courvoiseier’s sign?

A

enlarged palpable gallbladder in patients with obstructive jaundice caused by tumors of biliary tree or pancreatic head tumors. This kind of biliary obstruction envolves slowly, then envolves dilated gallbladder with thin wall.

148
Q

What is a Sister Mary Joseph nodule?

A

palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen

149
Q

What is a blumers shelf?

A

inding felt in rectal examination that indicates that a tumor has metastasized to the Pouch of Douglas.

150
Q

What is a virchows node?

A

lymph node in the left supraclavicular fossa (the area above the left clavicle)

151
Q

What will labs show for adenocarcinoma of the pancrease?

A

Elevation of total and direct bilirubin, alk phos and g-GGT
Mild elevation of transaminases (low hundreds)
Preoperative CA19-9 levels may be of prognostic value with high levels indicating poorer outcome and less chance of being resectable
CEA elevated in 40 – 45%

152
Q

What does ultrasound (screening) show for pancreatic cancer?

A

Dilated ductal system

Can only detect 60 – 70% pancreatic lesions

153
Q

What is the mainstay of diagnostic modality?

A

CT

154
Q

What shows on CT for pancreatic cancer?

A

Small tumors can be missed
Can help direct FNA
90% accuracy to determine respectability

155
Q

What is better than CT at detecting small tumors in the pancreas?

A

esophageal US

156
Q

What can be done with an esophageal ultrasound with pancreatic cancer?

A

FNA

157
Q

What is a disadvantage of esophageal US in pancreatic cancer?

A

Can’t detect distant metastases

158
Q

What are advantages of ERCP with pancreatic CA?

A

Can do brush cytology and forcep biopsy

Therapeutic palliation

159
Q

What are disadvantages of ERCP with pancreatic cancer?

A

More invasive

Can’t detect distant metastases

160
Q

What diagnostic method for pancreatic CA prevents 20% of attempted resection?

A

Preoperative staging laparoscopy

161
Q

What procedure is used for tumors at the head of the pancreas?

A

Pancreaticoduodenectomy (Whipple procedure)

162
Q

What is the “dreaded”complication of whipple procedure?

A

Pancreatic leak

163
Q

What procedure is used for tumor at the body or tail of the pancreas?

A

Distal pancreatectomy

164
Q

What follows a distal pancreatectomy?

A

Adjuvant chemotherapy +/- RT

165
Q

What is a Whipple procedure?

A

Tumor resected, cut bowel after stomach, attach stomach to sm bowel and pancreas stub to sm bowel

166
Q

What is given for palliative care for pancreatic cancer?

A 
CT and/or RT 
Narcotic analgesics
Tricyclic antidepressants 
Antiemetics
Celiac axis neurolysis
RT
167
Q

What is done to relieve jaundice with pancreatic cancer?

A

Endoscopic or percutaneous stent placement

Operative biliary decompression at time of operation for resectability assessment

168
Q

What is done to relieve duodenal obstruction with pancreatic CA?

A

Gastrojejunostomy

169
Q

What can be done to relieve duodenal obstruction in pancreatic cancer if pt is a poor candidate for surgery?

A

Endoscopic stenting of duodenal obstruction

170
Q

What size is a serous cystadenoma?

A

10 cm

171
Q

What a serous systadenoma?

A

Usually large (avg 10cm) and well-circumscribed
Multiloculated w/ clear and serous fluid
Benign

172
Q

Where are serous cystadenomas usually found?

A

Frequently at body or tail

173
Q

What demographic are serous cystadenomas usually found?

A

Women > men, > 50yo

174
Q

How is a serous cystadenoma usually found?

A

Abdominal mass or pain or incidental

175
Q

Why are serous cystadenomas removed?

A

for symptoms or to differentiate from other tumors

176
Q

What are mucinous cystadenoma or cystadenocarcinoma?

A

Potentially lethal
Large (avg 10cm) soft and irregular
Unilocular with thick mucous

177
Q

Why are mucinous cystadenoma or cystadenocarcinoma potentially lethal?

A

Most contain at least focal areas of atypia or frank carcinomatous transformations

178
Q

Who are mucinous cystadenoma or cystadenocarcinomas usually seen in?

A

Women&raquo_space; men

179
Q

How are mucinous cystadenoma or cystadenocarcinomas usually found?

A

Abdominal pain or mass

180
Q

How are mucinous cystadenoma or cystadenocarcinomas treated?

A

Aggressive surgical excision

181
Q

What are tests that can diagnose pancreatic endocrine tumors (6)?

A

CT or MRI
Visceral angiography
EUS
Octreotide scan
Transhepatic portal venous hormone sampling
Surgical exploration with intraoperative US

182
Q

What is the most common pancreatic endocrine tumor?

A

Insulinoma

183
Q

What percentage of pancreatic endocrine tumors are malignant?

A

10%

184
Q

Are pancreatic endocrine tumors solitary?

A

Most are solitary

185
Q

What size are pancreatic endocrine tumors?

A

<2cm

186
Q

How are pancreatic endocrine tumors often diagnosed?

A

with psychiatric conditions

187
Q

What is the Whipple triad?

A
  • Symptoms of hypoglycemia during fasting
  • Documentation of hypoglycemia with serum glucose < 50 mg/dL
  • Relief of hypoglycemic symptoms with exogenous glucose
188
Q

What does the whipple triad indicate?

A

Insulinoma

189
Q

How is insulinoma diagnosed?

A

monitored fast checking serum insulin:glucose ratio q 4 – 6 hr

190
Q

What is the biochemical diagnosis for insulinoma?

A

Blood glucose < 40 mg/dl
Concominent serum insulin ≥ 10 uU/L
C-peptide levels > 2.5 mg/dL
Serum proinsulin levels > 25% normal (nl < 2 ng/mL)
Absence of sulfonylurea in plasma and/or urine

191
Q

What is the treatment for insulinoma?

A

Excision

192
Q

What is the treatment for insulinoma for metastatic disease?

A

Debulk

193
Q

What is the treatment for insulinoma for non-surgical candidates?

A

Octreotide and diazoxide

194
Q

How is gastrinoma diagnised?

A
  • Fasting gastrin level > 1000 pg/mL while gastric pH < 2
  • If gastrin level > 200 pg/mL but < 1000 pg/mL, must have basal acid output ≥ 15 mEq/hr and a + secretin stimulation test
195
Q

What is the treatment for gastrinoma?

A

PPI, CT (mets and non-surgical candidates), excision

196
Q

What are the symptoms of a gastrinoma?

A

Intractable abdominal pain (PUD)
Severe esophagitis
Severe diarrhea

197
Q

Where are most gastrinomas found?

A

60 – 90% found within the gastrinoma triangle

198
Q

What are the symptoms of a glucagonoma?

A

Weight loss, diarrhea, stomatitis, necrolytic migratory erythema, DVT, psychiatric disorders, cachexia, anemia

199
Q

How is glucagonoma diagnosed?

A

Elevated fasting serum glucagon levels (500 – 1000 pg/dL)

200
Q

Where are most glucagonomas found?

A

Most at body or tail

201
Q

What phase are glucagonomas when they present?

A

Usually large at presentation

Most have metastasized

202
Q

What is the treatment for glucagonoma?

A

Treatment is resection/debulking and octreotide (unresectable). CT

203
Q

What is WDHA?

A

watery diarrhea, hypokalemia and achlorhydria

204
Q

What is WDHA associated with?

A

VIPoma (Verner-Morrison syndrome)

205
Q

What are the symptoms of VIPoma (Verner-Morrison syndrome)?

A

Symptoms – watery diarrhea, weakness, lethargy and nausea

206
Q

How is VIPoma (Verner-Morrison syndrome) diagnosed?

A

serum VIP level (>75 – 100 pg/dL). Also - hypokalemia, achlorhydria, metabolic acidosis and and imaging

207
Q

What is the treatment for VIPoma (Verner-Morrison syndrome)?

A

Treatment surgical excision or octreotide (if unresectable). CT

208
Q

What is a VIPoma?

A

Secretes vasoactive intestinal peptide

209
Q

What is achlorhydria?

A

No gastric acid in stomach

210
Q

What is a somatostatinoma?

A

Release somatostatin which inhibits pancreatic and GI secretions

211
Q

Where are somatostatinomas found?

A

Pancreas, ampulla, duodenum, jejunum, cystic duct or rectum

212
Q

What are the sx of somatostatinomas?

A

Steatorrhea, diabetes, hypochlorhydria and cholelethiasis

213
Q

How are somatostatinomas diagnosed?

A

fasting serum somatostatin levels (>160 pg/mL) and imaging

214
Q

Where are most somatostatinomas found in the pancreas?

A

Most in head of the pancreas

215
Q

How are somatostatinomas treated?

A

Surgery
debulking indicated
CT

216
Q

How common is cure for somatostatinoma?

A

cure rare b/c mets

Surgery (10 decks)

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