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Pancreas > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Head blood supply

A

superior (off GDA) and inferior (off SMA) pancreaticoduodenal arteries (ant/post branches)

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2
Q

Body blood supply

A

great, inferior, and caudal pancreatic artery (off splenic artery)

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3
Q

Tail blood supply

A

splenic, gastroepiploic and dorsal pancreatic arteries

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4
Q

Located where

A

retroperitoneum

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5
Q

SMA and SMV

A

lie behind neck of pancreas

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6
Q

Venous drainage

A

into portal system

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7
Q

Portal vein

A

forms behind neck (SMV and splenic vein)

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8
Q

Ductal cells

A

have carbonic anhydrase and secrete HCO3- ; increase flow leads to increase bicarb and decrease chloride

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9
Q

Acinar cells

A

secrete chloride and digestive enzymes

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10
Q

Ventral pancreatic bud

A

connected to duct of wirsung; migrates posteriorly, to the right and clockwise and fuse with dorsal bud; forms uncinate and inferior portion of head

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11
Q

Dorsal pancreatic bud

A

body, tail, and superior aspect of pancreatic head; duct of santorini

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12
Q

Duct of santorini

A

small accessory pancreatic duct that drains directly into duodenum

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13
Q

Duct of wirsung

A

major pancreatic duct that merges with CBD before entering duodenum

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14
Q

Exocrine function

A

amylase, lipase, trypsinogen, chymotrypsinogen, carboxypeptidase; bicarb

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15
Q

Amylase

A

only pancreatic enzyme secreted in active form; hydrolyzes alpha 1-4 linkages of glucose chains

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16
Q

Enterokinase

A

released by duodenum; activates trypsinogen to trypsin; trypsin activates other pancreatic enzymes

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17
Q

Secretin

A

released from cells in duodenum; increase bicarb

18
Q

CCK

A

released from cells in duodenum; increase enzymes

19
Q

Acetylcholine

A

increase bicarb and enzymes

20
Q

somatostatin and glucagon

A

decrease exocrine function

21
Q

Endocrine function

A

glucagon (alpha cells); insulin (beta cells, center of islets); somatostatin (delta cells); pancreatic polypeptide (PP or F cells)

22
Q

Islet cells

A

also prodce VIP, serotonin, neuropeptide Y, gastrin releasing peptide; receive majority of blood supply

23
Q

Annular Pancreas

A

2nd portion of duodenum trapped in pancreatic band; can see double bubble on abdominal xray; assoc with down syndrome; forms from ventral pancreatic bud from failure of clockwise rotation; tx: duodenojejunostomy or duodenoduodenostomy and sphincteroplasty; pancreas not resected

24
Q

Pancreas divisum

A

failed fusion of pancreatic ducts; can result in pancreatitis from duct of santorini (accessory duct) stenosis; most are asymptomatic; some get pancreatitis; DX: ercp, minor papilla will show long and large duct of Santorini, major papilla will show short duct of Wirsung; tx: sphincteroplasty and stent placement if symptomatic, some may need pancreaticojejunostomy

25
Q

Heterotopic pancreas

A

most commonly found in duodenum; usually asymptomatic; surgical resection if symptomatic

26
Q

Pancreatic pseudocysts

A

nonepithelialized sac; expectant management up to 3 months, allows pseudocyst to mature; only need to treat pts with continued symptoms or pseudocysts that are growing; need MRCP / ERCP to check for duct involvemnt; if duct involved need cystogastrostomy; if duct not involved can do perc drainage

27
Q

Puestow procedure

A

chronic pancreatitis; pancreaticojejunostomy for ducts > 8mm; open along main pancreatic duct

28
Q

Pancreatic adenocarcinoma

A

tobacco #1 risk factor; lymphatic spread first; 70% in head; 50% invade portal vein, SMV, or retroperitoneum at time of dx; mets to peritoneum, omentum, liver, celiac, SMA nodes unresectable disease; pts with resectable disease do not need biopsy; if appears to have mets then biopsy

29
Q

Whipple

A

pancreaticoduodenectomy; delayed gastric emptying #1 complication

30
Q

Intraductal Papillary Mucinous Neoplasm

A

6th-7th decade of life; side branch, main duct, mixed type; tx: partial pancreatectomy for main duct, symptomatic, large branch type > 3c, or invasive component; cyst fluid: mucin stain positive; high amylase; high CEA

31
Q

Mucin cystic neoplasm

A

cyst fluid: mucin stain positive, low amylase, high CEA

32
Q

Serous cystic neoplasm

A

cyst fluid: mucin stain negative, low amylase, low CEA

33
Q

Pseudocyst

A

cyst fluid: mucin stain negative; high amylase; low CEA

34
Q

Pancreatic trauma

A

Grade I:
hematoma - minor contusion without ductal injury
laceration - superficial lac w/o ductal injury
Grade II:
hematoma - major contusion w/o ductal injury
laceration - major lac w/o ductal injury
Grade III:
laceration - distal transection or parenchymal injury with ductal injury
Grade IV:
laceration - proximal transection or parenchymal injury involving the ampulla
Grade V:
laceration - massive disruption of pancreatic head

35
Q

Nonfunctional Endocrine Tumors

A

1/3 pancreatic endocrine tumors; 90% malignant; sxs: pain, weight loss, jaundice; indolent course; tx: resection unless mets; 5FU and streptozocin may be effective; 50% 5 year survival after resection

36
Q

Insulinoma

A
  • most common islet cell tumor and functional neoplasm of pancreas
  • 90% benign; evenly distributed; 10% assoc with MEN I
  • sxs: whipples triad
    1. fasting hypoglycemia
    2. sxs of hypoglycemia (palpitations, tachycardia, sweating, blurry vision, fatigue, seizures)
    3. relief with glucose
  • Dx –> insulin:glucose ratio > 0.4 after fast; increase c-peptide and proinsulin
  • Tx: enucleate < 2cm; formal resection > 2cm; mets streptozocin, octreotide, 5FU
37
Q

Gastrinoma

A
  • most common islet cell tumor (fxt’l tumor) in MEN-I
  • 50% malignant / 50% multiple
  • 75% sporadic / 25% MEN-I
  • majority in gastrinoma triangle (CBD, neck of pancreas, 3rd portion of duodenum)
  • Sx: refractory ulcer disease, abd pain, diarrhea
  • Dx: gastrin > 200, > 1,000 diagnositc; secretin stim test (gastrin > 200, normal pts decrease gastrin); octreotide scan (somatostatin receptor scintigraphy) best study to localize tumor
  • Tx: enucleation < 2cm; formal resection > 2cm; excise suspicious nodes; can’t find tumor perform duodenostomy, look inside duodenum; duodenal tumor resect with primary closure (whipple maybe); debulking can improve
38
Q

Somatostatinoma

A
  • very rare; most malignant / most in head
  • Sx: DM, gallstones, steatorrhea, hypochlorhydria
  • Dx: fasting somatostatin level > 100
  • tx: perofrm chole with resection; debulk hepatic mets
39
Q

Glucagonoma

A
  • most malignant; distal panc
  • Sx: DM, stomatitis, dermatitis (necrolytic migratory erythema), weight loss)
  • Dx: high fasting glucagon level; biopsy skin lesion
  • Tx: resection (usually distal panc); octreotide useful in controlling symptoms (hyperglycemia, dermatitis); zinc, amino acids or fatty acids for skin rash
40
Q

VIPOMA

A
  • verner-morrison syndrome
  • most malignant; most distal; 10% extrapancreatic (RP, thorax)
  • Sxs: watery diarrhea, hypokalemia, achlorhydria (WDHA); decrease K+ from diarrhea (lethargy, muscle weakness, nausea); metabolic acidosis d/t loss of bicarb in diarrhea
  • Dx: exclude other causes of diarrhea; increase VIP level
  • Tx: pre op electrolyte correction; distal panc; octreotide as adjunct
41
Q

Functional Endocrine Pancreatic Tumors

A 
Insulinoma
Gastrinoma
Somatostatinoma
Glucagonoma
VIPoma

Pancreas (1 decks)

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