Pancreatic Review

Question 1

Describe the Berger Procedure

Answer 1

• partial pancreatic head resection, to level of portal vein
• pancreatic head remnant is cored out, thin rim of pancreatic tissue left on duodenum
• remaining pancreas is anastomosed using a Roux-en-Y jejunal loop

Question 2

Indication for Berger procedure

Answer 2

• normal distal pancreatic ducts, main inflammation localized to head of pancreas

Question 3

What procedure would you use for isolated pancreatic head dilation causing pancreatitis?

Answer 3

• Berger or Bern procedure

Question 4

Describe Bern procedure

Answer 4

• resection of pancreatic head, with attached duodenum
• creation of pancreaticojejunostomy
• creation of hepaticojejunostomy
• creation of gastricjejunostomy

Question 5

Indication of Bern procedure

Answer 5

• chronic pancreatitis with isolated pancreatic head ductal dilation

Question 6

Describe the Frey procedure

Answer 6

• coring out of pancreatic head
• longitudinal dissection of pancreatic duct towards the tail
• reconstruction with a longitudinal pancreaticojejunostomy

Question 7

Indication for Frey procedure

Answer 7

• chronic pancreatitis with minimal head involvement
• has to be associated with distal pancreatic duct dilation of at least 7 mm (any less and you cannot perform procedure safely)

Question 8

Describe the Puestow procedure

Answer 8

• longitudinal pancreaticojejunostomy

Question 9

Indication for Puestow procedure

Answer 9

• dilation of head and distal pancreatic ducts

- dilation of distal pancreatic ducts must be greater than 7 mm

Question 10

large volume diarrhea a/w flushing and pancreatic tail mass…

Answer 10

• VIPoma

Question 11

What electrolyte changes are associated with VIPoma

Answer 11

• hypokalemia

- hypochlorhydria

Question 12

• fasting glucose <50
• symptoms of hypoglycemia (i.e. confusion)
• resolution of sx after IV glucose

what is triad called and what is it associated with

Answer 12

• Whipple’s triad

- pancreatic insulinoma

Question 13

Sxs of abdominal pain, diarrhea, and recurrent peptic ulcers a/w pancreatic mass…what is the mass?

Answer 13

• gastrinoma

Question 14

• pancreatic mass
• diabetes
• necrotizing migratory erythema
• pro-thrombotic

Answer 14

• glucagonoma

Question 15

• pancreatic mass
• cholelithiasis
• steatorrhea
• diabetes

Answer 15

• somatostinoma

Question 16

Another name for type 1 auto-immune pancreatitis…there are two other names for it…

Answer 16

1. Lymphoplasmacytic sclerosing pancreatitis

2. AIP w/o granulocyte epithelial lesions

Question 17

Another name for type 2 auto-immune pancreatitis…give two

Answer 17

1. Idiopathic duct-centric pancreatitis

2. AIP w/ granulocyte epithelial lesions

Question 18

Obstructive jaundice, with elevated IgG4 levels, and sclerosing cholangitis/sclerosing sialadenitis

Answer 18

type 1 AIP or lymphoplasmacytic sclerosing pancreatitis

Question 19

Band-like strictures, beading, or prune-tree appearance to pancreas

Answer 19

• think about primary sclerosing pancreatitis

Question 20

when do you intervene on a pseudocyst after a bout of pancreatitis?

Answer 20

• if its larger than 6 cm

- if it persists beyond 6 weeks

Question 21

when can you do a local ampullary excision for a peri-ampullary mass?

Answer 21

if its carcinoma in situ

• any invasive tumor should get a whipple

Question 22

pancreatic mass, extensive lymphadenopathy, elevated LDH, and normal CA 19-9…what is it?

Answer 22

pancreatic lymphoma

• the normal CA 19-9 was the give away