Pancreas Flashcards
The most common congenital anomaly of the pancreas.
Pancreas divisum
Duct of wirsung arises from what bud
Small ventral bud
Uncinate process arises from what bud
Small ventral bud
Duct of santorini arises from what bud
Dorsal bud
Pancreatic body and tail and superior portion of the head arise from what bud
Dorsal bud
Treatment of pancreatic divisum.
sphincterotomy and cholecystectomy
Treatment of annular pancreas.
duodenojejunostomy
Failure of the ventral bud to rotate
Annular pancreas
Blood supply to the head of pancreas
SMA and Gastroduodenal artery
Blood supply to body of pancreas
Splenic artery
Superior venous drainage of pancreas drains into? Inferior drains into?
PV; IMV
Body and tail - splenic vein
Pancreas secretes how much pancreatic fluid daily
500-1500 mL
Flank ecchymosis [Grey-Turner’s sign] and periumbilical ecchymosis [Cullen’s sign] are seen in
Acute pancreatitis
Retroperitoneal bleeding
Confirmatory diagnosis for acute pancreatitis
Contrast abdominal CT
Contrast-enhanced abdominal CT finding: Peripancreatic fat stranding, fluid collections, and non-enhancing pancreatic parenchyma with gas
Acute pancreatitis
A way to predict morbidity and mortality in patients admitted with acute pancreatitis
Ranson’s criteria
And APACHE II
Prophylactic antibiotic for necrotizing pancreatitis
Imipenem
CT scan reveal a dilated, calcified pancreatic duct with areas of stenosis (ie, “chain of lakes” appearance).
Chronic pancreatitis
The gold standard for the diagnosis of chronic pancreatitis
ERCP
irregular main duct, ductal dilation, and duct strictures.
Surgical procedure of choice for chronic pancreatitis with duct of normal diamete
Pancreaticoduodenectomy (Whipple)
Surgical procedure of choice for chronic pancreatitis dilated duct
Longitudinal pancreaticojejunostomy (Puestow)
Surgical procedure of choice for chronic pancreatitis with distal disease
Distal pancreatectomy
Surgical procedure of choice for chronic pancreatitis with small duct with diffuse disease
Total pancreatectomy with autotransplantation of islet cells
Peripancreatic fluid collections with a nonepithelialized capsule.
Pseudocyst
Complication of chronic pancreatitis
Persistent abdominal pain and early satiety
Imaging of choice for pancreatic pseudocyst
MRI
Pancreatic pseudocysts are most commonly associated with
alcoholic pancreatitis
Characterized by mucin production, dilation of the pancreatic duct, and communication with the main pancreatic duct.
Intraductal papillary mucinous neoplasms (IPMNs)
Head of pancreas
Cystic neoplasm of pancreas that are commonly found in middle-aged females and in the body or tail of the pancreas and characterized by an ovarian-like stroma and a lack of ductal communication.
Mucinouscystic neoplasms (MCNs)
Distal pancreatectomy
Classic presentation of pancreatic ductal adenocarcinoma
Painless jaundice
Palpable gallbladder: what sign?
Courvosier’s sign
Palpable periumbilical metastatic disease
Sister Mary Joseph’s node
Migratory thrombophlebitis
Trousseau’s sign
Palpable metastases on rectal examination
Blumer’s shelf
Elevated marker in pancreatic ductal adenocarcinoma
CA 19-9 and CEA
ERCP finding of double duct sign with two strictures
Pancreatic ductal adenocarcinoma
CBD and pancreatic duct dilatation
Chemoradiotherapeutic regimens for pancreatic cancer
gemcitabine, 5-fluorouracil
ERCP finding of double duct sign with one stricture
Ampullary cancer
Tumors of what part of the pancreas are usually not detected at an early stage and are usually unresectable at time of diagnosis?
body and tail
5 year survival rate of pancreatic cancer
10-20%
Whipple’s triad is seen in
Insulinoma
Migratory necrolytic erythema, anemia, DM, protein malnutrition, hypercoagulability and stomatitis are symptoms of
Glucagonoma
Watery diarrhea, hypokalemia, achlorrhydia and hypercalcemia are SSx of
VIPoma or Verner-Morrison syndrome
WDHA syndrome
Preoperative medication for insulinoma to prevent hypoglycemia
Diazoxide
Treatment for small insulinoma (
Enucleation
Boundaries of the gastrinoma triangle
(1) Cystic duct
(2) Junction of the second and third portions of the duodenum
(3) Junction of the neck and body of the pancreas
A 50-year-old male with a history of chronic pancreatitis presents with bleeding gastric varices. What is the most likely cause? Curative treatment?
Most likely diagnosis is splenic vein thrombosis. As patient is bleeding, treat with splenectomy.
What is the most common location of an insulinoma? Gastrinoma? Glucagonoma? Somatostatinoma?
Insulinoma: Evenly distributed throughout the pancreas.
Gastrinoma: Gastrinoma triangle.
Glucagonoma: Pancreatic tail.
Somatostatinoma: head
A 65-year-old man presents with painless jaundice, and you suspect PDAC. What is the most sensitive radiographic modality to diagnosis PDAC?
Endoscopic ultrasound
