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SURGERY > PANCREAS > Flashcards

PANCREAS Flashcards

1
Q

2 pancreatic ducts

A

Wirsung duct

Santorini duct

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2
Q

Major duct

A

Wirsung duct

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3
Q

Blood supply (head of the pancreas)

A
  1. Celiac trunk –> gastroduodenal –> Anterior superior pancreaticoduodenal artery

Posterior superior pancreaticoduodenal artery

  1. Superior mesenteric artery –> Anterior inferior pancreaticoduodenal artery

Posterior inferior pancreaticoduodenal artery

  1. Splenic artery –> Dorsal pancreatic artery
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4
Q

Endocrine function of the pancreas

A

Islets of Langerhans:

alpha-cells: glucagon
beta-cells: insulin
delta cells: somatostatin
PP cells: pancreatic polypeptide

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5
Q

Exocrine function of the pancreas

A

Digestive enzymes: amylase, lipase, trypsin, chymotrypsin, carboxypeptidase

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6
Q

Kocher maneuver

A

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

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7
Q

Admission Ranson Criteria

A

“GA LAW (Georgia law)”:

Glucose >200
Age >55
LDH >350
AST >250
WBC >16,000
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8
Q

Ranson’s criteria at less than 48 hours be remembered

A

“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
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9
Q

Chronic inflammation of the pancreas region causing destruction of the parenchyma, fibrosis, and calcification, resulting in loss of endocrine and
exocrine tissue

A

Chronic Pancreatitis

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10
Q

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)

A

Chronic Pancreatitis

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11
Q

TIGAR-O Classification

A 
Toxic and metabolic
Idiopathic
Genetic Predisposition
Autoimmune
Recurrent and Severe acute pancreatitis
Obstructive
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12
Q

Represents a special case of obstructive pancreatitis and the MC congenital anomaly involving the pancreas

A

Pancreas divisum

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13
Q

Characterized by diffuse fibrosis and a loss of acinar elements with a predominant mononuclear cell infiltration throughout the gland

A

Chronic Inflammatory Pancreatitis

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14
Q

Common feature of all forms of chronic pancreatitis

A

perilobular fibrosis

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15
Q

The MC symptom of chronic pancreatitis

A

pain

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16
Q

For patients with focal inflammatory changes localized to the body and tail, or in whom no significant ductal dilatation exists

A

Distal Pancreatectomy

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17
Q

Proximal pancreatectomy or pancreaticoduodenectomy, with or without pylorus preservation

A

Proximal Pancreatectomy

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18
Q

Origin of cells of the endocrine pancreas, or islet cells

A

neural crest cells

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19
Q

Multiple Endocrine Neoplasm (MEN) I – 3 Ps

A

pituitary tumors
parathyroid hyperplasia
pancreatic neoplasms

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20
Q

The MC functional pancreatic endocrine neoplasms

A

Insulinomas

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21
Q

Associated with beta-cell hypertrophy, islet hyperplasia and ↑ beta-cell mass

A

Noninsulinoma Hyperinsulinemia Hypoglycemia Syndrome

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22
Q

Endocrine tumor that secretes gastrin –> acid hypersecretion and peptic ulceration

causes Zollinger-Ellison syndrome (ZES)

A

Gastrinoma

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23
Q

Whipple’s triad

A
  1. symptomatic fasting hypoglycemia
  2. documented serum glucose level <50 mg/dL
  3. relief of symptoms with the administration of glucose
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24
Q

Location of primary gastrinoma i in 70% to 90% of patients

A

Passaro’s triangle

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25
Q

Also called WDHA syndrome due to the presence of WATERY DIARRHEA, HYPOKALEMIA, and ACHLORHYDIA

A

Vasoactive Intestinal Peptide-Secreting Tumor

26
Q

DIABETES in association with DERMATITIS

A

Glucagonoma

27
Q

Serum glucagon level in glucagonoma

A

> 500 pg/mL

28
Q

Presents with:

GALLSTONES due to bile stasis
DIABETES due to inhibition of insulin secretion
STEATORRHEA due to inhibition of pancreatic exocrine secretion and bile secretion

A

Somatostinoma

29
Q

MC site of somatostinoma

A

ampulla and periampullary area

30
Q

Serum somatostatin level in somatostinoma

A

> 10 ng/mL

31
Q

The most commonly mutated gene in pancreatic cancer, with ~ 90% of tumors having a mutation

A

K-ras oncogene

32
Q

The MC cystic lesion of the pancreas

No epithelial lining and is a nonneoplastic complication of pancreatitis or pancreatic duct injury

A

Pseudocysts

33
Q

Essentially considered benign tumors without malignant potential

A

Cystadenoma

34
Q

encompass a spectrum ranging
from benign but potentially malignant to carcinoma with a very aggressive behavior

commonly seen in perimenopausal women

about 2/3 are located in the body or tail of the pancreas

A

Mucinous Cystadenoma and Cystadenocarcinoma

35
Q

Surgical Treatment for Chronic Pancreatitis

A

Puestow—LONGITUDINAL pancreaticojejunostomy (pancreatic duct must be dilated)
Duval—DISTAL pancreaticojejunostomy
Near-total pancreatectomy

36
Q

Frey Procedure

A

Longitudinal pancreaticojejunostomy with core resection of the pancreatic head

37
Q

Acute pancreatitis from a gallstone in or

passing through the ampulla of Vater (the exact mechanism is unknown)

A

Gallstone Pancreatitis

38
Q

Encapsulated collection of pancreatic

fluid

A

Pancreatic Pseudocyst

39
Q

Surgical option for pseudocyst ADHERENT to the STOMACH

A

Cystogastrostomy (drain into the stomach)

40
Q

Surgical option for pseudocyst ADHERENT to the DUODENUM

A

Cystoduodenostomy (drain into the duodenum)

41
Q

Surgical option for pseudocyst NOT ADHERENT to the stomach or duodenum

A

Roux-en-Y cystojejunostomy (drain into

the Roux limb of the jejunum)

42
Q

Surgical option for pseudocyst in the TAIL of the pancreas

A

Resection of the pancreatic tail with the pseudocyst

43
Q

MC cause of death due to pancreatic pseudocyst

A

massive hemorrhage into the pseudocyst

44
Q

Adenocarcinoma of the pancreas arising

from duct cells

A

Pancreatic carcinoma

45
Q

Pancreatic carcinoma

A

66% - pancreatic HEAD

33% - BODY and TAIL

46
Q

Why are most pancreatic cancers in the tail nonresectable?

A

These tumors grow without symptoms until it is too late and they have already spread— head of the pancreas tumors draw attention earlier because of biliary obstruction

47
Q

Signs/ symptoms of tumors based on location

A

HEAD (pancreas)
PAINLESS JAUNDICE from obstruction of CBD; weight loss; abdominal pain; back pain; weakness; pruritus from bile salts in skin; anorexia; Courvoisier’s sign; acholic stools; dark urine; diabetes

BODY OR TAIL
weight loss and pain (90%); migratory thrombophlebitis (10%); jaundice (<10%); nausea and vomiting; fatigue

48
Q

The MC symptoms of cancer of the pancreatic HEAD

A

Weight loss (90%)
Pain (75%)
Jaundice (70%)

49
Q

“Courvoisier’s sign”

A

palpable
nontender
distended gallbladder

50
Q

Metastatic lymph nodes described classically for

gastric cancer which can be found with metastatic pancreatic cancer

A

Virchow’s node

Sister Mary Joseph’s nodule

51
Q

Tumor markers associated with pancreatic cancer

A

CA - 19

carbohydrate antigen

52
Q

Treatment based on location

A

head of the pancreas - Whipple procedure
(pancreaticoduodenectomy)

tail - Distal resection

53
Q

Whipple procedure

pancreaticoduodenectomy

A 
Cholecystectomy
Truncal vagotomy
Antrectomy
Pancreaticoduodenectomy—removal of
head of pancreas and duodenum
Choledochojejunostomy—anastomosis of
CBD to jejunum
Pancreaticojejunostomy—anastomosis of
distal pancreas remnant to jejunum
Gastrojejunostomy—anastomosis of
stomach to jejunum
54
Q

“pylorus preserving Whipple”

A

No antrectomy; anastomose duodenum

to jejunum

55
Q

possible post-Whipple complications

A

delayed gastric emptying (if antrectomy is performed)
anastomotic leak (from the bile duct or pancreatic anastomosis)
causing pancreatic/biliary fistula
wound infection
postgastrectomy syndromes
sepsis
pancreatitis

56
Q

Pancreas encircling the duodenum; if obstruction is present, bypass, do NOT resect

A

annular pancreas

57
Q

Failure of the two pancreatic ducts to fuse; the normally small duct (Small Santorini) of Santorini acts as the main duct

A

Pancreatic Duct

58
Q

Longitudinal filleting of the pancreas/ pancreatic duct with a side-to-side anastomosis with the small bowel

A

Puestow procedure

59
Q

Pancreatic tumor is associated with gallstone

formation

A

Somatostatinoma

60
Q

Triad found with pancreatic somatostatinoma

tumor

A

Gallstones
Diabetes
Steatorrhea

61
Q

2 classic findings with pancreatic glucagonoma tumors

A

Diabetes

Dermatitis/rash (necrotizing migratory erythema)

62
Q

The only therapy shown to prevent the progression of

chronic pancreatitis

A

Pancreatic duct decompression

SURGERY (27 decks)

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