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ABSITE Flashcards > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Pancreas ducts

A 
Santorini = small duct
Wirsung = major duct
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2
Q

Pancreas divisum

A

failure of fusion
5% of population
Prone to pancreatitis
Santorini is major duct

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3
Q

Annular pancreas sign

A

double bubble on XRay

tx: obstruction w/duodenojejunostomy. Do not resect pancreas.

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4
Q

Celiac plexus block

A

50% EtOH on both sides of aorta near celiac

effective pain relief for non-resectable CA

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5
Q

Pancreatic pseudocysts tx

A

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

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6
Q

Complications of untreated pseudocyst

A

bleeding, infection, rupture, obstruction of CBD or duodenum

recurrence - 10%, much higher with EXTERNAL drainage

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7
Q

Tx of persistent pseudocyst

A

INTERNAL drainage - cyst-gastrostomy, =-duodeostomy, -jejunostomy

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8
Q

Insulinoma

A 
#1 islet cell tumor overall. Insulin to glucose ratio > 0.4. Incr C peptide (as with parathyroid hormone, C terminal of hormone is inactive).
90% benign
Rx = enucleation
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9
Q

Gastrinoma

A 
#1 islet cell tumor in MEN (MEN I). 60% malignant, 50% are multiple.
90% are in gastrinoma triangle: 1. cystic/CBD junction 2. pancreas neck 3. 3rd part of duodenum
Gastrin level > 1000, do secretin stimluation test (normal pts will decr gastrin)
Severe ulcer disease, diarrhea (due to lipase destruction by acid, malabsorption, and incr secretion)
NGT and H2 blockers help diarrhea
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10
Q

Somatostainoma

A

gallstones, steatorrhea, pancreatitis, diabetes

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11
Q

Glucogonoma

A

diabetes, glossitis, stomatitis, migratory necrolytic erythema, streptozocin and octreotide help

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12
Q

VIP-oma

A

WDHA syndrome = Watery Diarrhea Hypokalemia Achlohydria

Diarrhea does not improve with NGT or H2 blockers

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13
Q

Fluid collection in pancreas, what is it?

A

Necrotizing pancreatitis
- >4 week -> WON
- <4 week: acute pancreatic fluid collection
Non-necrotizing pancreatitis
- >4 week -> pseudocyst
- <4 week: acute pancreatic fluid collection

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14
Q

Next step for pseudocyst management after 6 weeks?

A

Image the duct FIRST with MRCP or ERCP

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15
Q

Tx of pseudocysts

A
  • transpapillary endoscopic stenting
  • endoscopic transluminal drainage
  • open cyst-gastrostomy
  • lap cyst-gastrostomy
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16
Q

Unresectable pancreatic tumor criteria

A

Tumor abutting the celiac artery/trunk, hepatic artery, or SMA by more than 180 degrees

Encasement/occlusion of the SMV/portal vein

17
Q

Borderline resectability of pancreatic tumors

A

Tumors that cause venous distortion of the SMV/portal vein axis
Encasement of GDA up to the hepatic artery
Less than 180 degree abutment of the SMA

18
Q

Mucinous cystic pancreatic neoplasm

  1. age
  2. sex
  3. location
  4. contour
  5. wall
  6. calcification present?
  7. pancreatic duct communication
  8. malignant potential
  9. imaging characteristics
  10. cyst fluid analysis: amylase/CEA/KRAS
  11. Treatment
  12. recurrence
  13. associated malignancy
A
  1. 4th-5th decade of life
  2. female
  3. > 95% body, tail
  4. round, oval, macrocystic 2-6 cm
  5. yes, central thickening
  6. yes, central
  7. no
  8. moderate 12-20%
  9. solid areas, peripheral calcifications
  10. low to none/>192 ng/mL/present
  11. resection
  12. no
  13. no
19
Q

Main duct/mixed type IPMN

  1. age
  2. sex
  3. location
  4. contour
  5. wall
  6. calcification present?
  7. pancreatic duct communication
  8. malignant potential
  9. imaging characteristics
  10. cyst fluid analysis: amylase/CEA/KRAS
  11. Treatment
  12. recurrence
  13. associated malignancy
A
  1. 6-7th decade of life
  2. male > female
  3. head (70%), body, tail
  4. main duct dilatation
  5. absent
  6. uncommon
  7. NA
  8. high
  9. > 10 mm nodules
  10. high/>192 ng/mL/present
  11. resection
  12. yes, up to 10% - lifelong surveillance required
  13. yes - other GI cancers, skin, breast, prostate
20
Q

Branch duct IPMN

  1. age
  2. sex
  3. location
  4. contour
  5. wall
  6. calcification present?
  7. pancreatic duct communication
  8. malignant potential
  9. imaging characteristics
  10. cyst fluid analysis: amylase/CEA/KRAS
  11. Treatment
  12. recurrence
  13. associated malignancy
A
  1. 6-7th decade of life
  2. male > female
  3. head (60%), body, tail
  4. grape cluster
  5. yes
  6. uncommon
  7. yes
  8. low to moderate
  9. > 3 cm, main duct >6 mm, irregular wall, mural nodules
  10. high/>192 ng/mL/present
  11. resection for high risk stigmata and worrisome features; surveillance with MRI/EUS every 6 months otherwise
  12. yes, up to 10% - lifelong surveillance required
  13. yes - other GI cancers, skin, breast, prostate
21
Q

Tx of low grade, small PNET tumors

A

Enucleation

ABSITE Flashcards (19 decks)

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