Pancreatic surgery

Question 1

ampullary carcinoma has a worse prognosis when

Answer 1

3 types of adeno

Question 2

distal third of the common bile duct courses through what part of the pancreas?

Answer 2

head of the pancreas

Question 3

endocrine histologic neoplasia

Answer 3

insulinoma (benign)
Non-functioning PNETs
Functioning PNETs
(insulinoma, gastrinoma, glucagonoma, VIPoma, Somatostatinoma, polypeptoma, serotninoma, rare)

Question 4

90% of the Exocrine Pancreatic cancers (which are 98% of pan cancers) are

Answer 4

adenomas

Question 5

Incidence of Pancreatic Cancer

Answer 5

10/100,000 year

Question 6

Survival of Pancreatic cancer (adenoma)

Answer 6

worst survivability

Question 7

80-90% of pancreatic cancers are what stage?

Answer 7

III or IV or already IIB (w/ mets)

Question 8

median age?

Answer 8

72

Question 9

highest risk factor and others?

Answer 9

smoking

Chronic alcoholic pancreatitis

Obesity

Question 10

Groups at risk

Answer 10

African american, Ashkenazi, Native Hawaiians, Maoris

Question 11

Genetic Syndromes associated with panc cancer?

Answer 11

Peutz/jeghers

Hereditary Pancreatitis

Atypical Multiple Mole and Melanoma

Breast-ovarian cancer

HNPCC
CF

Question 12

what percent of pan cancer is familiar?

Answer 12

10-15%

Question 13

Mutations of Pancreatic cancer

Answer 13

Oncogenes (K-RAS)

Suppressor Genes (p16, p53)

> 200 gene mutations

Question 14

early symptoms of pancreatic cancer

Answer 14

no symptoms

Question 15

general symptoms

Answer 15

weight loss
pain
jaundice
anoroexia
stool change
nausea
weakness

Question 16

Only diagnostic scan for pancreatic cancer staging pre-op? what about gold standard for tissue dx

Answer 16

CT

EndoscopicUS

Question 17

double duct sign

Answer 17

distal common bile duct and pancreatic duct are dilated on CT,
pathognomonic for periampullary neoplasm

Question 18

pancreatoduodenal complex (distal CBD, pancrease, duodenum) arise as outpouching right at the ____gut meets the ____gut

Answer 18

foregut meets the mid gut

Question 19

Venous drainage and lymphatic drainage follows_____

Answer 19

arteries

Question 20

Removing the body and tail of the pancreas requires a splenectomy because lymphatic drainage is through the

Answer 20

splenic vein

Question 21

Bulk of the islet cells is in the

Answer 21

tail

Question 22

Once you remove the tail what is a complication?

Answer 22

Insulin dependent Diabetes

Question 23

Body is topographically

Answer 23

medial border of SM to the medial border of the Aorta

Question 24

Body is topographically

Answer 24

medial border of SM to the medial border of the Aorta

Question 25

neck is anterior to the

Answer 25

SMV

Question 26

Head is to the right or lateral border of the

Answer 26

SMV

Question 27

Tail is lateral to the left edge of the

Answer 27

aorta

Question 28

inoperable hen

Answer 28

distant mets

Question 29

pancreas is retro/intraperitoneal?

Answer 29

retroperitoneal

Question 30

what is the connection between the SMA and SMV

Answer 30

gastroduodenal artery

Question 31

benefits of rconnecting pancreas to stomach?

Answer 31

no enterokinase, low pH reduces likelihood of activation of proteolytic enzymes, Alkaline pancreatic secretions protect against ulceration