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Pancreas Flashcards

1
Q

Ranson’s criteria

A
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2
Q

4 clinical stages of pancreatic cancer

A
  1. Resectable
  2. Borderline resectable
  3. Locally advanced (unresectable)
  4. Metastatic
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3
Q

Resectable characteristics

A
  1. Less than 50% involvement of portal vein /SMV
  2. No involvement of hepatic artery or SMA
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4
Q

Borderline resectable characteristics

A
  1. > 180 involvement of portal vein/SMV with ability to reconstruct
  2. < 180 involvement of SMA or celiac and only up to short segment encasement of Hepatic artery (amenable to recontruction)
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5
Q

Advantages of neoadjuvant chemo in pancreatic cancer

A

median survivaal 34 vs 24 months

lower rate of LN mets

Higher rate of

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6
Q

First jejunal branch of SMV travels where in relation to SMA

A

Behind usually.

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7
Q

Pancreatic cysts

A
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8
Q

MCN (% of cysts, % malignant, location, gender, age)

A

30% of pancreatic cysts

20% malignant

distal pancreas

women

45-50 years old

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9
Q

differentiating factors between SCA, MCN, IPMN

A

Microcystic SCA - honeycomb

Macrocystic SCA compared to MCN - SCA has central calcifications vs MCN has peripheral calcifications

IPMN vs SCA or MCN - IPMN connects with duct, while others do not.

MRCP good study to differentiate in addition to EUS with fluid analysis

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10
Q

3 main genes for chronic pancreatitis

A
  1. PRSS1
  2. CFTR
  3. Spink1
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11
Q

beger vs berne

A

beger has 2 anastomosis - berne is like a frey without the longintudinal component.

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12
Q

Percent pain relief after pancreatic resection for chronic pancreatitis

A

85%

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13
Q

modified Atlanta classifcation for complicated acute pancreatitis

A
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14
Q

abnormal amount of fat excreted consistent with steathorrhea

A

7g daily on fecal fat study

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15
Q

Functional pancreatic NETs

A
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16
Q

Serum markers secreted by all pancreatic NETs including nonfunctional ones

A

chromogranin A, PP, neuron specific enolase

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17
Q

Grading of pancreatic neuroendocrine tumors based on mitotic count and Ki-67 index

A
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18
Q

Familial syndromes associated with PanNETs

A

similar to pheo

MEN

VHL

Neurofibromatosis

tuberous sclerosis

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19
Q

CT characterisitcs of PanNET

A

hyperintense (only 3 things hyperintense in pancreas - NET, splenule, metastatic RCC)

20
Q

Imaging work up for PanNETs

A
  1. thin sliced pancreas protocol contrasted CT
  2. Dodatate scan for all but insulinoma
  3. EUS for lesions supsected of being < 1 cm
21
Q

Imamura test

A

Calcium injection into various arteries supplying the pancreas (GDA, splenic, IPDA) and subsequent measurement of insulin from hepatic vein to try to localize the tumor.

22
Q

Biochemical work up for insulinoma

A

insulin, proinsulin, C peptide (proinsulin and C peptide low if exogenous insulin)

Observed fasting glucose level.

23
Q

Biochemical work up if suspicious of VIPoma

A

WDHA syndrome

Watery diarrhea, hypokalemia, achlorrydia (acidosis)

Send VIP level

Send gastrin level

24
Q

Pre op treatment for most PanNETs and the important exception

A

Octreotide except for insulinoma, need diazoxide.

25
5 year survival for PanNETs with liver mets
50% (maybe some survival advantage for surgical debulkin \> 90%)
26
Percent of gastrinomas associated with MEN
20%
27
Biochemical work up for Gastrinoma
1. Fasting serum gastrin (after holding PPI for 1 week (H2 blockers started and helf for 2 days))- \>1000 diagnostic 2. Gastric pH (\> 3 excludes gastrinoma, \< 2 expected) 3. If gastrin 200-1000 then secretin stimulation test (gastrin rises in gastrinoma)
28
indications for pancreatic or duodenal resection in gastrinoma associated with MEN1
\< 2cm as these associated with liver METs, otherwise, control medically as likely to have more gastrinomas. Can enucleate if not bulky or involving the ampulla or duct in MEN1 - sporadic need formal resection as more likely to be malignant. If not doing a whipple, need to do duodenotomy and palpate for tumors Resect parathyroid first since this can worsen gastrinoma symptoms.
29
Typical symptoms of all PanNETs
1. Insulinoma - whipple triad - hypoglycemia, MS changes relieved with sugar 2. Glucagonoma - Hyperglycemia, dermatitis, DVT 3. VIPoma - watery diarrhea, hypokalemia 4. Gastrinoma - diarrhea, ulcers 5. Somatostatinoma -
30
Complication of administering octroetide to insulinoma that not somatostatin receptor positive
profound hypoglycemia
31
Treatment of \< 1 cm non-functional NET of pancreas
Observation is fine in this scenario, but resection for larger lesions or growing lesions absent other contra-indications.
32
Surveillance for pancreatic NETs
1. H&P and chromogranin every 6 months for 1-2 years, then annually for 10 years 2. Annual CT C/A/P for 10 years. No screening dotatae scan necessary
33
HIgh risk stigmata for IPMN
1. Obstructive jaunidice 2. MPD \> 1 cm 3. Mural nodule \> 5 mm
34
Worrisome features of IPMN
1. MPD between 5 and 9 mm 2. Mural nodule \< 5 mm 3. Enhancing cyst wall 4. CA19-9 elevated 5. Change in size of cyst \> 5 mm in 2 years 6. Cyst \> 3 cm 7. Lymphadenopathy 8. Pancreatitis
35
Elements on EUS for IPMN
1. Characterize mural nodule (doppler flow, just mucin?) is it \> 5mm 2. Assess for main duct involvement 3. Cytology If nodule confirmed, main duct involved, or cytology positive, then proceed with resection. If not, then proceed to size based surveillance.
36
Size based surveillance for BD IPMN
1. \> 3 cm - Alternating MRI and EUS every 6 months - if young, should consider surgery 2. 2-3 cm - EUS in 6 months, then interval to 1 year alternating with MRI (consider surgery if patient is young and will need life long surveillance) 3. 1-2 cm - CT/MRI q6 months for 1 year, yearly for 2 years, then every 2 years 4. \< 1 cm - CT/MRI in 6 months, then every 2 years.
37
38
Diameter of pancreatic duct to perform Puestow or Frey
7 mm
39
Best serum test to evaluate for chronic pancreatitis
Post prandial pancreatic polypeptide
40
Risk of pancreatic adenocarcinoma in MD-IPMN
30-50%
41
IgG4 is sensitive or specific for autoimmune pancreatitis
specific, thus a normal IgG4 does not rule out AIP
42
Pancreatic lymphoma will have elevated ...
LDH, beta 2 microglobulin
43
5 year survival of resected IPMN vs pancreatic adenocarcinoma
43-60% vs 15%
44
Secreted from duodenal mucosa and activates pancreatic enzymes (except lipase)
Enterokinase
45
Pancreatic enzyme secreted into the pancreatic duct in its active form
lipase
46
RP hemorrhage in with brusing periumbilical, flank, and groin, respectively
Cullen, Grey-turner, Fox
47
CCK and secretin are secreted by...
duodenum

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