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Appendix > Pancreas SCORE > Flashcards

Pancreas SCORE Flashcards

1
Q

Pseudocysts have what cytology?

A

low CEA

high amylase

serous fluid

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2
Q

Serous cystic neoplasms have what cytology?

A

low CEA

low amylase

serous fluid

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3
Q

IPMN and MCN have what fluid cytology?

A

IPMN: high CEA, high amylase, mucinous fluid

MCN; high CEA, low amylase, mucinous fluid

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4
Q

What do we do with asymptomatic pseudocysts?

A

don’t require treatment

50% of pts will develop psueodocysts after an episode of severe acute pancreatitis

70% will resolve spontaneously

**you operate when pts have intractable abdominal pain, oral intolerance, and can’t exclude cystic neoplasm

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5
Q

What % of cases of chronic pancreatitis in US are due to etoh?

A

50%

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6
Q

Management of main-duct IPMN vs branched type IPMN:

A

main duct–> surgical resection; 60% malignant potential

branched type–> plan based on tumor size

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7
Q

Mortality of surgical intervention in acute pancreatitis within 2 weeks is?

A

75%

decreases to 8% after 28 days

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8
Q

What are two duodenum-preserving pancreatic head resection procedures?

A

Begger

Frey

(these procedures are not appropriate when pancreatic cancer is considered)

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9
Q

Do we resect mucinous cystic neoplasms of pancreas?

A

YES

considered pre-malignant

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10
Q

What are pancreatic MCNs?

A

mucinous cystic neoplasms

made of mucin producing epithelial cells

walls of cyst contain a distinctive ovarian-type stroma

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11
Q

For a Puestow procedure, what is the minimal length of your anastomosis?

A

6cm

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12
Q

Gold standard to diagnose pancreas divisum?

A

MRCP

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13
Q

What’s the risk of post-ERCP pancreatitis?

A

5%

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14
Q

What enzymes produced by pancreas in active form, that helps digest starch (sugars)?

A

amylase secreted in active form from pancreas and saliva

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15
Q

When do we performa a longitudinal pancreaticojejunostomy?

A

dilated pancreatic duct >6 mm w/out pancreatic head enlargement

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16
Q

When do we perform a Frey procedure?

A

enlarged pancreatic head

dilated pancreatic duct

(involves pancreatic duct drainage and a focal pancreatic head resection)

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17
Q

Pts w/ Lynch syndrome have an increased risk of pancreatic cancer; Lynch syndrome is caused by what??

A

germline mutation in mismatch repair

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18
Q

Most common symptom assc/ w pancreas divisum?

A

no symptoms

95% of pts remain asymptomatic

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19
Q

Serous cystadenomas of pancreas tend be located anywhere in pancreas, and their fluid cytology shows:

A

clear fluid

low CEA
neg mucin
low amylase

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20
Q

Most frequent complication of pancreaticoduodenectomy?

A

pancreatic fistula

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21
Q

For all patients undergoing surgical debridement of pancreatic necrosis; what’s the incidence of developing DM?

A

25%

risk is assc/ w % of gland lost, with more gland lost, more chance of developing DM

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22
Q

30 days following a necrosectomy, a pt’s JP drain has been putting out 60 /cc a day, what do you do next?

A

most pancreatic fistulas will close in 4-6 weeks

if they fail to close, ERCP and stent placement help close > 85% of fistulas

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23
Q

When is the Beger procedure used?

A

used for pancreatitis w/ large pancreatic head and small pancreatic ducts

it’s a duodenal preserving pancreatic head resection

transect the pancreatic neck, core out pancreatic head

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24
Q

Puestow procedure?

A

longitudinal pancreaticojejunostomy

used for pancreatic ducts 6 mm >, without enlarged pancreatic head

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25
Q

Frey procedure?

A

lateral pancreaticojejunostomy with local pancreatic head resection

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26
Q

When do we use Frey procedure?

A

dilated pancreatic duct from obstruction due to enlarged pancreatic head

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27
Q

Duodenal sparing pancreatic head resection?

A

Beger procedure

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28
Q

When is Beger used?

A

enlarged pancreatic head with normal caliber pancreatic duct

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29
Q

Most common cause for pancreatic insufficiency is chronic pancreatitis, 2nd most common cause is?

A

cystic fibrosis

30
Q

When we have food in the duodenum, pancreatic ductal cells secrete HCO3 to neutralize acidity of food, HCO3 release is mediated by?

A

secretin

HCO3 is pumped outside the ductal cell into the lumen, and Cl is exchanged inside the cell

31
Q

Pancreas divisom is failure of the ventral and dorsal pancreatic ducts to fuse, rarely does it present with symptoms, how is it treated?

A

ERCP and sphincteroplasty

32
Q

Wirsung and Santorini ducts drain via what papilla?

A

duct of Wirsong drains via major papilla; drains head and uncinate process

duct of Santorini drains via minor papilla; drains body and tail

33
Q

Mucinous cystic neoplasms are commonly found where?

A

body and tail of pancreas

due to malignancy risk; laparoscopic spleen preserving pancreatectomy can be performed

there is no risk to rest of pancreas once removed, so no need for surveillance

34
Q

In terms of cystic neoplastic lesion of pancreas, which one has a starburst calcification pattern?

A

serous cystic neoplasms

35
Q

In terms of cystic neoplastic lesion of pancreas, which one has a eggshell calcification pattern?

A

MCNs

36
Q

Why are mucinous cystic neoplasms usually amenable to spleen preserving distal pancreatectomy?

A

b/c they are usually found in tail of pancreas

37
Q

Normal pancreatic duct drainage vs what happens in pancreas divisum:

A

normally; 70% of pancreas drained by ventral duct via major papilla

PD; major pancreatic drainage is via dorsal duct which drains into minor papilla

38
Q

What % of pts with acute pancreatitis that develop peri-pancreatic fluid collections will develop pseudocysts?

A

5-15%

39
Q

What enzyme secreted by pancreas in active form?

A

lipase

40
Q

How long does it take for pancreatic pseudocysts to develop?

A

4-8 weeks

41
Q

Tell me things about insulinomas;

A

benign
usually less than 2 cm

can be found anywhere in pancreas

42
Q

What is the most common neuroendocrine tumor?

A

insulinomas

43
Q

Ranson criteria and morality;

A

each category gets 1 point

0-2–> 2 % mortality

3-4–> 15%

5-6–>40%

+7 –> 100%

44
Q

Which enzyme cleared first in pancreatitis?

A

amylase

usually cleared in less than 48 hrs

45
Q

Whipple’s triad in insulinomas?

A

hypoglycemia

neuro-glycopenic symptoms ; weak, confused, palpatations

relief of sxs with glucose

46
Q

What are the most common functional pancreatic neuroendocrine tumors?

A

insulinomas

47
Q

Diagnostic study for insulinomas?

A

72 hr fast period in a hospital monitored setting

pts have a high ratio of insulin;glucose

48
Q

Whipple’s triad of insulinma?

A

hypoglycemia when fasting

blood glucose less than 50

relief after glucose given

49
Q

Insulinomas, benign or malignant?

A

BENIGN

50
Q

Diabetes associated with necrolytic migratory erythema?

A

glucagonoma

51
Q

What rash is seen with glucagonoma>

A

necrolytic migratory erythema

52
Q

Where are glucagonomas normally located?

A

head + tail

tend to be large with mets when diagnosed

53
Q

Tx for glucagonomas?

A

surgical removal with debulking if necessary

54
Q

How do we diagnose glucagonomas?

A

serum glucagon >500

55
Q

With this PNET; pts are at an increased risk of DVT?

A

glucagonoma

56
Q

Watery diarrhea, achlorhydria, hypokalemia?

A

VIPOMA

57
Q

What is WDAH syndrome seen with VIPOMAS?

A

watery diarrhea
achlorhydria
hypokalemia

58
Q

Most VIPOMAs found where?

A

Tail

59
Q

Pts with VIPOMAs, why do they have hypokalemia?

A

massive amts of watery diarrhea (>5L/day)

60
Q

This causes ZE syndrome;

A

gastrinomas

61
Q

Gastrinomas cause what syndrome?

A

ZE syndrome

62
Q

How do we diagnose gastrinoams?

A

gastrin level > 1000

63
Q

Borders of gastrinoma triangle;

A

cystic duct/CBD

2nd/3rd part of duodenum

neck/body pancreas

64
Q

How do we find gastrinomas?

A

ocreotide scanning with EUS

65
Q

With gastrinomas, what do we have to make sure?

A

MEN1

66
Q

How do pts with somatistainomas present?

A

gallstones

DM

steatorrhea

67
Q

How do we confirm diagnosis of somatistainomas?

A

> 10

most have mets at time of presentation

resection and GB removal appropriate in many times

68
Q

Serous cystic neoplasms of pancreas, stain positive for what?

A

periodic acid schiff stain

69
Q

Periodic acid schiff staining seen in what Ca>

A

serous cystic neoplasms

70
Q

Fish mouth ampulla seen in?

A

main duct IPMN

71
Q

Single best predictor of 30 day mortality in cirrhotic pts?

A

MELD (Bilirubin, INR, Cr)

72
Q

MOst common PNET in a MEN syndrome?

A

gastrinoma

Appendix (39 decks)

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