Pancreas-Exam 2

Question 1

What is the left limb of the pancreas supplied by? (blood vessel)

Answer 1

Splenic a.

Question 2

What is the body/right limb of the pancreas supplied by?

Answer 2

Caudal pancreaticoduodenal a. (branch of cranial mesenteric a.)

Question 3

What duct drains the R lobe and enters the duodenum at the major duodenal papilla w/ bile duct?

Answer 3

Pancreatic duct- drains R lobe

Question 4

What is the difference in the duct system in cats vs. dogs?

Answer 4

Cats don’t have an accessory duct

Question 5

What drains in to the minor DP in dogs?

Answer 5

Accessory pancreatic duct- drains L lobe

Question 6

What do the following pancreatic cells produce?

A, B, D, F/P

Answer 6

A: glucagon
B: insulin
D: somatostatin
F/P: pancreatic polypeptide

Question 7

T/F: Pancreatitis is a sx disease?

Answer 7

FALSE- common but not sx

Question 8

What biopsy method is used for the pancreas?

Answer 8

Guillotine technique

Question 9

What is indicated for a pancreatic tumor removal?

Answer 9

Partial pancreatectomy

Question 10

What are the best tools for dissecting lobules?

Answer 10

Hemoclips or bipolar cautery

Question 11

If the remaining ducts are patent in the pancreas-what percentage can be removed?

Answer 11

80%

Question 12

What is the most common complication associated with partial pancreatectomy?

Answer 12

Pancreatitis

Question 13

What happens if pancreatic drainage is completely obstructed?

Answer 13

Exocrine pancreatic insufficiency

Question 14

What is the tx of exocrine pancreatic insufficiency?

Answer 14

Pancreatic enzyme supplementation & low fat/highly digestible food

Question 15

What occurs when over 80-90% of the pancreas is removed?

Answer 15

Endocrine pancreatic insufficiency

Question 16

What is the tx for endocrine pancreatic insufficiency?

Answer 16

Insulin

Question 17

What can occur if you accidentally ligate vessels that are around the R lobe of the pancreas?

Answer 17

Devitalization of duodenum

Question 18

What is the instrument of choice for pancreatic sx?

Answer 18

Ligasure

Question 19

Why are pancreatic pseudocysts not true cysts?

Answer 19

Lack epithelial wall

Question 20

T/F: Pancreatic pseudocysts are often incidental findings

Answer 20

TRE

Question 21

What is the test of choice for pancreatic pseudocyst?

Answer 21

US- most sensitive

Question 22

T/F: You cannot differentiate pseudocyst from abscess on US

Answer 22

TRUE

Question 23

What is the first line tx for pancreatic pseudocyst?

Answer 23

Percutaneous aspiration- especially if aclinical

Question 24

What is the tx of choice for cure of pseudocysts?

Answer 24

Omentilization

Question 25

What is typically secondary to acute bouts of pancreatitis?

Answer 25

Pancreatic abscess

Question 26

T/F: Most pancreatic abscesses are sterile

Answer 26

TRUE

Question 27

What ab data supports pancreatic abscesses?

Answer 27

Hyperbilirubinemia/elevated LEZ due to EHBO- inflammation of pancreas causing duodenal papilla of CBD to swell shut

Question 28

What is the best method of sx management for pancreatic abscesses?

Answer 28

Omentalization

Question 29

What is a rare but highly malignant tumor in dogs that arises from APUD cells

Answer 29

Gastrinoma | APUD: amine precursor uptake decarboxylase cells

Question 30

What is the zollinger-ellison syndrome?

Answer 30

Syndrome of gastric acid, hypersecretion, gastrointestinal ulceration & non-B cell pancreatic tumors

Question 31

What is a diagnostic factor for gastrinoma?

Answer 31

High serum gastrin levles

Question 32

What is a malignant and locally invasive tumor in the pancreas?

Answer 32

Exocrine pancreatic adenocarcinoma

Question 33

What is the prognosis of a patient with exocrine pancreatic adenocarcinoma?

Answer 33

Poor

Question 34

What is insulinoma?

Answer 34

B-cells of islets of Langerhans--> secrete insulin despite hypoglycemia

Question 35

What % of insulinoma is malignant?

Answer 35

90%

Question 36

What are the components of the whipples triad?

Answer 36

CS associated w/ hypoglycemia Fasting blood glucose concentration of 40 mg/dL or ower Relief of neurological signs w/ feeding or glucose administration

Question 37

What is a def dx for insulinoma?

Answer 37

Fasting insulin glucose ratio | Insulin HIGH despide hypoglycemia

Question 38

What are the normal fasting serum levels?

Answer 38

5-26 mg/dL | Affected animals > 70 mg/dL

Question 39

What are some medical management methods for insulinoma

Answer 39

Small frquent meals (high protein, complex carbs) Glucocorticoid therapy Oral hyperglycemic agents- DIazoxide

Question 40

What is the gold standard sx tx for insulinoma?

Answer 40

Partial pancreatectomy

Question 41

What are the MST for the following insulinoma situations: No sx Sx Sx + medical therapy

Answer 41

No sx: 196 days Sx: 785 days Sx + medical management: 1316 days

Question 42

What is the main medication used in patients with insulinoma when combined with sx?

Answer 42

Pred

Question 43

What is the difference of MST for the following stages I II III

Answer 43

I: 785 days II: 547 days III: 217 days