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Absite Behind the Knife > Pancreas > Flashcards

Pancreas Flashcards

1
Q

MC cause acute panc

A

alcohol gallstones

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2
Q

Gallstone Panc tx

A

Clear duct - ERCP, IC

Cholecystectomy in same admission

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3
Q

Atlanta classification

A

Non-nec: < 4 wks (acute peri-panc fluid collection), > 4 wks (pancreatic pseudocyst)

Nec: < 4 wks (acute nec collection, > 4 wks (walled off necrosis)

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4
Q

Nec panc tx with abx or not

A

No, only if have subsequent infection

F, Inc WBC, CT guided FNA

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5
Q

What abx for infected nec panc

A

Imipenem

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6
Q

Step up approach

A

1) Admit to ICU: Fluids, nutrition, support
2) Abx and percutaneous drain
3) Upsize drain
4) Video assisted retroperitoneal drainage

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7
Q

MC cause chronic panc

A

Alcohol
Biliary tract disease
Autoimmune
Idiopathic

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8
Q

S/S of chronic panc

A

Persistent abd pain
Weightloss
Malabsorption/steatorrhea/DM
>= 1 bout of acute panc

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9
Q

Dx: CT

A

Fibrosis, atrophy, calcification of gland

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10
Q

Chronic pain inc risk of cancer?

A

Yes

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11
Q

Tx

A

Non op mgmt
Abstain from alcohol
Panc enzyme replacement

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12
Q

Surgical mgmt of chronic pain

A

Decompress duct: Puestow

Resection of dz tissue: Beggar, Fray

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13
Q

Puestow

A

Longitudinal pancreaticojejunostomy
Large duct pancreatitis > 6 mm duct
W/ Normal panc head

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14
Q

Beggar

A

Resection of pancreatic head, pancreaticojejunostomy

Panc head dominant pancreatitis

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15
Q

Fray

A

Lat longitudinal pancreaticojejunostomy, core out head of panc

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16
Q

Distal panc

A

For mostly distal strictured disease

17
Q

Minimal change panc

A

Resection/drainage won’t help
Need denervation
Bilateral thoracoscopic splantenectomy

18
Q

Panc pseudocyst

A

Non nec > 4 wks
More common in chronic panc patients
Manage expectantly for 6 wks -> mature or resolve
If enlarging, symptomatic or > 6 cm then intervene

19
Q

Panc pseudocyst surgical intervention

A

1st: Pre-op ERCP or MRCP to assess duct
2nd: Transpapillary endoscopic stenting, Endoscopic transluminal drainage, Open cystgastromstomy, Lap cystgastrostomy

20
Q

PNETs

A

Most found incidentally on CT, then need panc triple phase CT or MRI
EUS -> FNA -> Analyze for CEA and amylase levels

21
Q

Mucinous cyst

A

CEA > 190

22
Q

Pseudocyst

A

Amylase high -> ductal communication

23
Q

Serocystadenoma

A

Low CEA
Benign
Well circumscribed, central stellate scar
Do not need resection

24
Q

Mucinous cystic neoplasm

A 
Malignant potential
Thick walled
Cyst with internal septations
CEA > 190, mucin in aspirate
Tx: Must resect
25
Q

IPMN

A

3 groups
Main duct
Branch duct
Mixed type

26
Q

Main duct IPMN

A

Higher risk of malignancy
Fishmouth papilla on endoscopy
Must resect
Tx mixed type the same

27
Q

Branch duct IPMN

A

Lower risk of malignancy
Decision to resect: Fitness of patient, Cyst > 3 cm, Thickened wall, non-enhancing mural nodules, lymphadenopathy, main duct > 10 cm

28
Q

Daughter
Mother
Grandaughter

A

Daughter: Solid pseudopapillary
Mother: Mucinous
Grandmother: Serous

29
Q

MC PNET

A

Non functional tumor

30
Q

MC functional PNET

A

Insulinoma

31
Q

Non function PNET

A

Malignant
Discovered late due to asymptomatic
Usually large, in head of panc and having some mass effect when found

32
Q

Insulinoma

A

Benign
Throughout panc - even distribution
Whipple’s triad

33
Q

Whipple’s triad

A

Neuroglycopenic symptoms
High insulin
Resolution of symptoms with administration of glucose

34
Q

Dx of insulinoma

A 
S/S
Insulin > 18
Glucose < 55
C-peptide > 6
B hydroxy biutyrate < 2.7
Inc plasma glucose by 25 with glucagon
Negative urine test for oral hypoglycemic
35
Q

Tx:

A

Localize: Triphasic panc CT or MRI, EUS, or if cannot localize -> Intrarterial Ca injection and hepatic vein sampling.
Somatostatin scintography is not helpful
Solitary/Benign -> enucleate
Distal -> Distal panc/splenectomy

36
Q

Gastrinom

A

Mostly malignant

In gastrinoma triangle

Absite Behind the Knife (11 decks)

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