Pancreas Flashcards
What time of gland is the pancreas?
- Endocrine
2. Exocine
What do you call the duct from ventral anlage of the pancreas?
main pancreatic duct or duct of wirsung
Duct of Wirsung refers to
Main pancreatic duct
via ampulla of vater
The duct of santorini refers to
Accessory duct of the pancreas
What do you call the duct from the dorsal anlage?
Duct of Santorini
What is the most common congenital anomaly of the pancreas?
Pancreas divisum
functional obstruction of the main pancreatic duct
The most commonly affected part of the duodenum by the annular pancreas
2nd part of the duodenum
Associated with trisomy 21
[Acute pancreatitis]
____ sign refers to blood extending to the flank tissue resulting to flank ecchymosis
Grey Turner Sign
[Acute pancreatitis]
____ sign refers to blood dissecting up to the falciform ligament and create periumbilical ecchymosis
Cullen Sign
[Acute pancreatitis]
____ sign refers to ecchymosis of the inguinal ligament
Fox Sign
[Acute pancreatitis]
____ sign refers to the bluish discoloration of the scrotum
Bryan sign
What is the diagnostic gold standard to diagnose acute pancreatitis?
Abdominal CT scan
What is the pathognomonic abdominal CT scan finding of pancreatic infection?
Abnormal Extraluminal Gas Bubbles
When will you initiate enteral feeding in patients with severe pancreatitis?
<48 hours
Nasojejunal tube is preferred
What are the Ranson Prognostic Signs at admission?
GALAW
- Glucose >200 mg/dL
- Age >55 years old
- LDH >350 u/mL
- AST >250 u/nL
- WBC >16,000
What are the Ranson prognostic signs in the initial 48 hours?
CHOB BF
- Ca <8mg/dL
- Hct fall >10 points
- O2 <60mmHg
- BUN elevation >5mg/dL
- Base deficit >4mEq/L
- Fluid deficit >6L
A Ranson score of 3-5 is associated with how many percent mortality?
10-20%
What are the indications for surgical intervention in Acute pancreatitis?
- Diagnostic uncertainty
- Intraabdominal catastrophe unrelated to necrotizing pancreatitis
- Infected necrosis documented by FNA or extraluminal gas on CT
- Severe sterile necrosis
- Symptomatic organized pancreatic necrosis
What is the most effective surgical intervention if the target lesion in acute pancreatitis have a significant fluid component?
Catheter drainage
This surgical intervention for acute pancreatitis allows for the removal of necrosis via video-assisted retroperitoneal debridement
Minimally invasive necrosectomy
What is the reference standard of treatment in patients with infected necrotizing pancreatitis?
Open necrosectomy
What is the most common etiology of chronic pancreatitis?
Alcohol
What is the most common symptom of chronic pancreatitis?
abdominal pain
[Chronic Pancreatitis Surgical Intervention: Drainage Eponym]
caudal pancreaticojejunostomy
Duval-Zollinger
[Chronic Pancreatitis Surgical Intervention: Drainage Eponym]
longitudinal Roux en Y pancreaticojejunostomy
Puestow-Gillesby
[Chronic Pancreatitis Surgical Intervention: Drainage Eponym]
modified puesto-gillesby that does not include caudal pancreatectomy
Partington-Rochelle
[Chronic Pancreatitis Surgical Intervention: Resectional Eponym]
distal pancreatectomy; preserves the rim of the pancreas
Fry and Child
[Chronic Pancreatitis Surgical Intervention: Resectional Eponym]
Pancreaticoduodenectomy
Kaush-Whipple
[Chronic Pancreatitis Surgical Intervention: Resectional Eponym]
Total Pancreatectomy
Priestly
[Chronic Pancreatitis Surgical Intervention: Hybrid Eponym]
Duodenum-preserving pancreatic head resection
Beger
[Chronic Pancreatitis Surgical Intervention: Hybrid Eponym]
Local resection of the pancreatic head with longitudinal pancreaticojejunostomy
Frey and Smith
[Chronic Pancreatitis Surgical Intervention: Hybrid Eponym]
excavation of the central portion of the head without formal division if the pancreatic neck
Berne
Pseudocyst persisting about ___ weeks are unlikely to resole spontaneously
4-6 weeks
What the most common location of pancreatic CA?
pancreatic head
What do you call an enlarged palpable GB that is non-tender without fever that is a reliable diagnostic criteria for malignant choledochal obstruction
Courvoiser GB
What is the only definitive and potentially curative treatment of periampullary CA
Whipple surgery
[Palliative Options for Periampullary CA]
Gastric outlet obstruction with good performance status?
- Gastrojejunostomy +/- jejunostomy tube
2. consider enteral stent
[Palliative Options for Periampullary CA]
gastric outlet obstruction with poor performance status
- Enteral stent
2. PEG tube
What is the Whipple’s Triad that is associated with insulinoma?
- Symptomatic fasting hypoglycemia
- Serum glucose <50mg/dL
- Relief of symptoms with glucose administration
What do you call the area where gastrinoma typically occurs
Passaro’s Triangle
What are the borders of Passaro’s Triangle?
- Head of the pancreas
- Duodenum
- Lymphatic bed posterior and superior to the duodenum
Which part of the pancreas will you typically see the VIPoma?
Tail
What is the most sensitive imaging modality for VIPoma?
EUS
Presence of necrolytic migratory erythema is associated with what pancreatic disease
Glucagonoma
What is the second most common pancreatic islet cell tumor?
Non functioning islet-cell tumor
