PANCREAS Flashcards
2 pancreatic ducts
Wirsung duct
Santorini duct
Major duct
Wirsung duct
Blood supply (head of the pancreas)
- Celiac trunk –> gastroduodenal –> Anterior superior pancreaticoduodenal artery
Posterior superior pancreaticoduodenal artery
- Superior mesenteric artery –> Anterior inferior pancreaticoduodenal artery
Posterior inferior pancreaticoduodenal artery
- Splenic artery –> Dorsal pancreatic artery
Endocrine function of the pancreas
Islets of Langerhans:
alpha-cells: glucagon
beta-cells: insulin
delta cells: somatostatin
PP cells: pancreatic polypeptide
Exocrine function of the pancreas
Digestive enzymes: amylase, lipase, trypsin, chymotrypsin, carboxypeptidase
Kocher maneuver
Used to mobilize the duodenum and pancreas and evaluate the
entire pancreas
Incise the lateral attachments of the duodenum and then lift the pancreas to examine the posterior surface
Admission Ranson Criteria
“GA LAW (Georgia law)”:
Glucose >200 Age >55 LDH >350 AST >250 WBC >16,000
Ranson’s criteria at less than 48 hours be remembered
“C HOBBS (Calvin and Hobbes)”:
Calcium <8 mg/dL Hct drop of >10% O2 <60 (PaO2) Base deficit >4 Bun >5 increase Sequestration >6 L
Chronic inflammation of the pancreas region causing destruction of the parenchyma, fibrosis, and calcification, resulting in loss of endocrine and
exocrine tissue
Chronic Pancreatitis
Chronic inflammatory changes that are caused by the compression or occlusion of the proximal ductal system by tumor, gallstone, posttraumatic scar, or inadequate duct caliber (as in pancreas divisum)
Chronic Pancreatitis
TIGAR-O Classification
Toxic and metabolic Idiopathic Genetic Predisposition Autoimmune Recurrent and Severe acute pancreatitis Obstructive
Represents a special case of obstructive pancreatitis and the MC congenital anomaly involving the pancreas
Pancreas divisum
Characterized by diffuse fibrosis and a loss of acinar elements with a predominant mononuclear cell infiltration throughout the gland
Chronic Inflammatory Pancreatitis
Common feature of all forms of chronic pancreatitis
perilobular fibrosis
The MC symptom of chronic pancreatitis
pain
For patients with focal inflammatory changes localized to the body and tail, or in whom no significant ductal dilatation exists
Distal Pancreatectomy
Proximal pancreatectomy or pancreaticoduodenectomy, with or without pylorus preservation
Proximal Pancreatectomy
Origin of cells of the endocrine pancreas, or islet cells
neural crest cells
Multiple Endocrine Neoplasm (MEN) I – 3 Ps
pituitary tumors
parathyroid hyperplasia
pancreatic neoplasms
The MC functional pancreatic endocrine neoplasms
Insulinomas
Associated with beta-cell hypertrophy, islet hyperplasia and ↑ beta-cell mass
Noninsulinoma Hyperinsulinemia Hypoglycemia Syndrome
Endocrine tumor that secretes gastrin –> acid hypersecretion and peptic ulceration
causes Zollinger-Ellison syndrome (ZES)
Gastrinoma
Whipple’s triad
- symptomatic fasting hypoglycemia
- documented serum glucose level <50 mg/dL
- relief of symptoms with the administration of glucose
Location of primary gastrinoma i in 70% to 90% of patients
Passaro’s triangle