Pancreas@ Flashcards
At what timeframe do acute panc collections become WON or pseudocyst?
4 weeks
What stimulates panc secretion?
inc permeability of apical Cl/HCO3 channels through cAMP & Calcium
T/F: VIP and secretin stim panc secretion by inc cAMP
True
Which substances inc panc secretion by increasing Ca?
Gastrin releasing peptide (GRP), subst P
MC presentation of MCN?
Unilocular, body or tail, middle aged F
This panc lesion typically multilocular with central stellate calcifications?
Serous cystadenoma
Ovarian stroma on path in what?
MCN
T/F: All IPMNs have some type of duct communication?
True
What is the most potent sti of secretin release by duodenal S cells?
Duod pH < 4.5
Which type of FA can stim secretin release?
LCFA (oleate)
What is T2 AI panc?
idiopathic, duct centric pancreatitis
Which type of AI panc responds better to steroids?
Type 2
T/F: Relapses with T2 AI panc are common?
False, they are rare
Which type of AI panc has elevated IgG4?
Type 1
Path of type 2 AI panc bx?
Periductal inflammation and granulocyte epithelial lesions
Which defect causes AD calcific hered pancreatitis?
PRSS1 gain of fcn mut
T/F: CFTR is transmitted in AD fashion?
False, AR
Which defect causes “tropical panc”?
SPINK1
T/F: If suspected infected panc necrosis, abx and conservative mgmt should be tried first.
True
What is MC NET with MEN1?
Gastrinoma
MEN2a risks
Thyroid, adrenal, PT adenomas (PAT)
What is pancreatic panniculitis AW?
Panc acinar cell carcinoma
What is minimum dose of panc enzymes to tx steatorrhea
30,000 IU
T/F: PPI can be used as a primary tx to tx steatorrhea in CP.
False, can be used as adjunct but not primary tx
What is Shwachman-Diamond syndrome?
AR dz that can cause panc insufficiency in kids (2nd MC after CF), BM fx w neutropenia –> infxns, short stature
What MAL are SDS pts at risk for?
MDS and AML
Age groups for T2 and T1 AIP?
T1 ~ 60 yo
T2 ~ 40 yo
Which AIP is AW IgG4 dz?
Type 1
Granulocyte epithelial lesion
Type 2 AIP
T/F: Type 2 AIP not AW extrapanc dz?
True
What is T2 AIP recurrence rate after steroids?
< 10%
What activates panc enzymes and defect in it is associated with tropical pancreatitis?
Trypsin
T/F: Pt swith chronic panc and exocrine insuff are at inc risk of SIBO
True
Pt with disabling pain in chronic panc, dilated duct, no further alc use - what is best tx to improve QOL over next 5 yrs?
Peustow
List groups of pts that need panc CA screening.
- 2 FDRs
- Lynch with 1 FDR
- BRCA2
- FAMM syndrome
- Peutz-Jeghers syndrome
Pts with panc AC are absolute CI to surgical resection if invasion of what vessel?
SMA
MCC of hereditary panc is what?
Gain of fcn of cationic trypsinogen gene (PRSS1)
MEN1 can lead to what?
HyperPTH, ZES, hypercalcemia, NET (HeNZ)
Type 1 vs type 2 AIP histo.
Type 1 - Lymphoplasmacytic sclerosing pancreatitis
Type 2 - Duct centric pancreatitis
Rate of relapse after steroids for T1 AIP?
20-60%
Which factors inc risk of post ERCP panc?
Young age Female Normal LFTs/imaging Multiple cannulation attempts or forceful cannulation Repeated panc injections Precut sphincterotomy Panc sphincterotomy Low case volume endoscopist
Which med can decrease opioid need in chronic panc?
Pregabalin
If AIP leads to obstructive jaundice, consider which type?
Type 2
T/F: T1 AIP is AW IBD.
False, type 2
Typical IgG4 dz pt presentation affects which organs
Bile duct, panc, salivary glands
IgG4 AI panc usually has what panc and panc duct findings?
Narrowed, not enlarged or dilated duct with diffusely enlarged panc
What are characteristic findings of glucagonoma?
Rash (necrolytic migratory erythema), high glucose
Dystrophic nails, alopecia, angular chelitis
How to dx glucagonoma?
High serum glucagon (>500), CT/MR with findings, consider PET or gad scan
How to tx glucagonoma?
Surg if possible, SS analogues can help
T/F: PPX anticoag should be done in pts with glucagonoma due to high risk of DVT/PE.
True
