Pancreas Flashcards
The percentage of patients who will have an occurence of a repalced right heaptic artery?
15-20%
The most common complication of chronic pancreatitis is _________
Pseudocysts
- A chronic collection of pancreatic fluid surrounded by a non epithelialized wall of granulation tissue and fibrosis
- 10% of patients with acute pancreatitis
- 20-38% of patients with chronic pancreatitis
Insulinomas are associated with the multiple endocrine neoplasia (MEN)1 Syndrome
Are sporadic in nature
- 90% of insulinomas are sporadic
- 10% are associated with MEN 1
- multifocal
- higher rate of recurrence
A pancreatic cystic neoplasms is <3cm, has atypical cells present, and has a solid component requires _______
Resection
According to Ranson criteria, a 67 yer old female patient suspected of acute pancreatitis presenting to the OR with sudden onset of severe abdominal pain, a serum aspartate tansaminases (AST) >250 U/dL, a white blood cell >16000/mm3, and a blood glucose >200mg/ dL would receive a disease classification of _______
Predicted severe
Most common presenting symptom in patients with a somatostatinoma
Cholelithiasis
- Somatostatin inhibits pancreatic and biliary secretions, patients with a somatostatinoma present with gallstones due to bile stasis, diabeted due to inhibition of insulin secretion and steatorrhea due to inhibition of pancreatic exocrine secretion and bile secretion
- Most somatostatinoma originate in the proximal pancreas or the pancreatoduodenal groove, with the ampulla and periampullary area (60%)
- Abdominal pain (25%), jaundice (25%), cholelithiasis (19%)
- somatostatin above 10 ng/mL
The etiology associated with chronic calcific pancreatitis
- alcohol abuse
- hyperparathyroidism
- hyperlipidemia
In PAtients undergoing ERCP for diagnosis and staging of chronic pancreatitis, the population most at risk of developing procedure-induced pancreatitis is
- Sphincter of oddi dysfunction
- previous history of post-ERCP pancreatitis
ERCP is considered the gold standard for the diagnosis and staging of chronic pacnreatitis
Treatment of a 1 cm gastrinoma in the wall of the duodenum is best accomplished by
Full thickness resection
- 50% of gastrinomas metastasize to LN or the liver and are therefore considered malignant
- All lymphnodes in the PASARO triangle are excised for pathologic analysis
- Gastrinoma in the pancrease and does not involve the main pancereatic duct = ENUCLEATED
- Highly selective vagotomy can be performed if unresectable disease is identified or if the gastrinomas with no metastases
- Postop
- fasting serum gastrin
- secretin stimulation tests
- octreotide scans and CT scans
- Inoperable disease
- chemotherapy with streptozocin, doxorubicin, 5 FU
The ERCP finding that is virtually diagnostic of intraductal papillary mucinous neoplasms (IPMN)
fIsh eye lesion
- occurs within the head if the pancreas and arise within the pancreatic ducts
- The ductal epithelium forms a papilalry projection into the duct and mucin production causes intraluminal cystic dilation
Pain from chronic pancreatitis is caused by
- Ductal hypertension
- due to strictures or stones
- exacerbated by eating
- readily relieved by pancreatic duct decompression
- Parenchymal disease
- chronic pain without exacerbation
- retroperitoneal inflamamtion
- Obstructive pancreatography
A aptient undergoing the Frey procedure to relieve pain from obstructive pancreatography is found to have 85% oarenchymal fibrosis. The percentage of pain relief the patient is likely to experience is
100%
- 80% fibrosis = 100% pain relief
- 10% fibrosis = 60%
The only therapy shown to prevent the progression of chronic pancreatitis
Pancreatitic duct decompression
The part of the pancrea resected in order to ensure successful resolution of pain long term for patients with chronic pancreatitis
Pancreatic duct decompression
- surgery shpuld be considered only when the medical therapy of symptoms has failed
The part of pancreas resected in order to ensure successful resolution of pain long-term for patients with chronic pancreatitis
The head
