Pancreas

Question 1

Pancreas ducts:
Santorini- small or major?
Wirsung- small or major?
Pancreas divisum is what? % population? prone to what?S

Answer 1

Santorini is small duct, wirsung is major duct. Pancreas divisum= failure of fusion (5% of population, prone to pancreatitis), santorini is then major duct

Question 2

Annular pancreas: imaging shows…. rx….

Answer 2

double bubble on XRay; rx obstruction w/ duodenojejunostomy. Do not resect pancreas

Question 3

Pancreatic cancer: Overall ___% dead in one year

Answer 3

90

Question 4

Ca 19-9 (serum marker) is generally high in _______. 90% have mutated ______.

Answer 4

pancreatic cancer; have mutated K-Ras

Question 5

Celiac plexus block is effective pain relief for ___________. What and where is it? _______.

Answer 5

non-resectable pancreatic cancer; (50% EtOH on both sides of aorta near celiac)

Question 6

Pancreatic pseudocysts: management?

__% resolve on otheir own?

Answer 6

expectant management if asymptomatic and not enlarging up until ~12 wks after episode of acute pancreatitis. 85% of pseudocysts resolve on their own.

Question 7

Drainage of pancreatic pseudocysts: __________.
Complications of untreated: _________.
Recurrence %? Much higher with ______.

Answer 7

Internal drainage by cyst-gastrostomy, -duodenostomy, or -jejunostomy. Complications of untreated; bleed, infection, rupture, obstruction of CBD or duodenem. Recurrence 10%. Much higher with external drainage.

Question 8

1 islet cell tumor overall

Answer 8

insulinoma

Question 9

Insulinoma: Insulin to glucose ratio _____. Increase/decrease C peptide? ____.
C terminal of hormone is active/inactive? _____.

Answer 9

> 0.4; incr C peptide (as with parathyroid hormone, C terminal of hormone is inactive).

Question 10

Insulinoma: ___% benign
Rx: ______________

Answer 10

90% benign; Rx enucleation

Question 11

1 islet cell tumor in MEN (MEN I)

Answer 11

Gastrinoma

Question 12

Gastrinoma Location:

___% here: _______. 1- _________. 2- __________. 3 - ____________

Answer 12

90% in gastrinoma triangle: 1- cystic/CBD junction. 2- pancreas neck. 3- 3rd part of duodenum

Question 13

Gastrinoma: ___% malignant, ___% are multiple

Answer 13

60% malignant; 50% are multiple

Question 14

Gastrinoma Tests:

Gastrin level: _________; do this test: _________ (normal patients will have __________)

Answer 14

gastrin level >1000; do secretin stimulation test (normal pts will decr gastrin)

Question 15

Gastrinoma symptoms:
__________, _________, _________
These things help symptoms: __________

Answer 15

severe ulcer disease, diarrhea (due to lipase destruction by acid, malabsorption, and incr secretion), NGT and H2 blockers help diarrhea

Question 16

__________: Gallstones, steatorrhea, pancreatitis, diabetes

Answer 16

Somatostatinoma

Question 17

___________: diabetes, glossitis, stomatitis, migratory necrolytic erythema…. these things help _________ and ______

Answer 17

Glucogonoma; streptozocin and octreotide help

Question 18

__________: WDHA syndrome = watery diarrhea hypokalemia achlohydria
Diarrhea improve with NGT or H2 blockers?

Answer 18

VIP-oma; Diarrhea does not improve with NGT or H2 blockers