Pncrs ABST SLYR Flashcards
Major pancreatic duct that forms in the pancreatic head and descends inferiorly
and joins the intrapancreatic portion of the common bile duct to form the
common pancreaticobiliary channel proximal to the ampulla of Vater.
Duct of Wirsung
Accessory pancreatic duct that drains the anterior portion of the pancreatic head
Duct of Santorini
What is the blood supply to the head of the pancreas?
Anterior and posterosuperior pancreaticoduodenal arteries
Anterior and posterosuperior pancreaticoduodenal arteries are direct branches of what artery?
Gastroduodenal artery
The gastroduodenal artery is a branch of
common hepatic artery
The common hepatic artery is a branch of
coeliac artery
Which enzyme is responsible for pancreatic necrosis in presence of bile?
Phospholipase A
What defines a high-output pancreatic fistula?
Output in excess of 200 mL/d
What accounts for >90% of acute pancreatitis?
Gallstones and alcohol
Hyperlipidemia that cause acute pancreatitis?
Types I, IV and V
How does hypercalcemia cause pancreatitis?
Hypercalcemia most commnly found with hyperparathyroidism could lead to intraductal precipitation of calcium.
How is acute pancreatitis diagnosed?
2 of the following 3 features
- abdominal pain characteristic of acute pancreatitis
- serum amylase or lipase level at least 3 times the upper limit of normal
- characteristic findings of acute pancreatits on CT
PLC
Which enzyme is implicated in etiology of pancreatitis?
Trypsin
Which serum enzyme rises within 2 hours of the onset of pancreatitis and
peaks within 48 hours?
Amylase
What antibiotics are indicated for patients with mild pancreatitis?
None! Antibiotics neither improve the course nor prevent septic complications.
What CT scan findings are suggestive of chronic pancreatitis?
CPD
Calcifications,
parenchymal atrophy
Dilated pancreatic duct,
What are the early Ranson criteria (on admission)?
GAWA
Glucose >200 mg/dL,
Age >55, LDH >350 IU/L,
WBC >16k
AST >250 IU/L,
What are the late Ranson criteria (48 hours)?
Calcium <8.0 mg/dL
HCT drop >10%,
PaO2 <60 mm Hg,
BUN increase by 5
or more mg/dL,
base deficit >4 mEq/L
fluid sequestration >6 L
How do Ranson criteria predict mortality?
0 to 2 signs
2% mortality
How do Ranson criteria predict mortality?
3 to 4 signs
15%
How do Ranson criteria predict mortality?
5 to 6 signs
40%
How many signs do you need to have 100% mortality based on Ranson Criteria
7 to 8 signs, ~100%
The ff are indications for surgery in chronic pancreatitis EXCEPT
a. intermittent abdominal pain
b. common bile duct obstruction
c. pancreastic fistula
d. variceal hemorrage
A
The ff are possible complications of pancreatitis except
a. pancreatic necrosis
b. pseudocyst
c. pancreatic fistulas
d. hemorrhage
e. pancreatic ascites
f. abscess/sepsis
NOTA
Initial management of pancreatic duct stricture from chronic pancreatitis:
Pancratic duct stenting
distal pancreatectomy with end-to-end pancreaticojejunostomy a. Puestow procedure b. Duval procedure c. Frey procedure d. Beger procedure
B
duodenum-preserving pancreatic head resection
a. Puestow procedure
b. Duval procedure
c. Frey procedure
d. Beger procedure
D
coring out of diseased portion of pancreatic head and then
lateral pancreaticojejunostomy for chronic pancreatitis
a. Puestow procedure
b. Duval procedure
c. Frey procedure
d. Beger procedure
C
lateral side-to-side pancreaticojejunostomy a. Puestow procedure b. Duval procedure c. Frey procedure d. Beger procedure
A
Most widely used and preferred procedure for chronic pancreatitis
a. Puestow procedure
b. Duval procedure
c. Frey procedure
d. Beger procedure
A
What surgery is done for type I DM?
a. Puestow procedure
b. Duval procedure
c. Frey procedure
d. Beger procedure
NOTA; pancreatic resection, pancreatic denervation, islet cell transplantation is done
What percentage of pseudocysts spontaneously resolve within 4 to 6 weeks?
50%
How long does it take a pseudocyst to mature?
4-6 weeks
Indication for surgical intervention for pancreatic pseudocysts:
Pseudocyst has not resolved by 6 weeks and also persistently greater than 6 cm
List the enteric methods of pseudocyst drainage
Cystogastrostomy, cystoduodenostomy, and Roux-en-y cystojejunostomy, lateral
pancreaticojejunostomy
What is the usual time frame for development of pancreatic abscesses
associated with acute pancreatitis?
2-4 weeks
What CT scan criteria are used for diagnosis of pancreatic necrosis?
Well-demarcated areas of nonenhancing pancreatic tissue >3 cm or occupying
more than 30% of the gland
How is infected pancreatic necrosis diagnosed?
CT-guided percutaneous fine-needle aspiration
What antibiotics are indicated in pancreatic necrosis involving >30% of the
gland?
Imipenem or meropenem
How are pancreatic fistulas managed? The ff are involved except
a. glucagon
b. NPO
c. parenteral nutrition
d. somatostatin
D
Which congential anomaly results from failure of fusion of the dorsal and
ventral pancreatic ducts?
Pancreas divisum
What is the most common benign neoplasm in the pancreas?
Serous cystadenoma
What is the treatment for serous cystadenoma?Resection generally recommended but this lesion can be closely followed in
high-operative-risk patients.
Resection
…
generally recommended but this lesion can be closely followed in
high-operative-risk patients.
What tumor exhibits sunburst central calcification on CT scan?
Serous cystadenoma
Overall 5-year survival rate for pancreatic cancer:
<5%
Median survival time of pancreatic cancer patients:
4-6 months
What is the most significant modifiable risk factor for pancreatic cancer?
Cigarette smoking
What are the presenting signs of pancreatic cancer?
Abdominal pain
jaundice
weight loss
Painless jaundice in patient with cancer. Where is the tumor?
Periampullary/ duodenal neoplasm
What imaging studies are needed for diagnosis?
Ultrasound to evaluate biliary anatomy, CT scan
The ff are inherited disorders that increase the risk of pancreatic cancer EXCEPT
a. MEN1
b. Familial adenomatous polyposis
c. HNPCC
d. Von Hippel-Lindau
e. Gardner Syndrome
NOTA, all increase risk
What serologic tumor markers are measured for pancreatic CA?
a. CA 19-9
b. CEA
c. both
d. neither
C
What imaging modality is beneficial in assessing the T stage of the tumor in
pancreatic cancer?
EUS
FDA approved for combination with gemcitabine for first-line treatment of
locally advanced, unresectable, or metastatic pancreatic cancer:
Erlotinib
What percentage of patients with pancreatic cancer will have had a new
diagnosis of diabetes?
20%
T1 pancreatic cancer:
Tumor limited to the pancreas, <2 cm
T2 pancreatic cancer:
Tumor limited to the pancreas, >2 cm
T3 pancreatic cancer:
Tumor extends beyond the pancreas but without involvement of the celiac axis
or the SMA
T4 pancreatic cancer:
Tumor involves the celiac axis or the SMA
What T stage denotes unresectable disease?
T4, by definition
What reconstruction is performed during after standard
pancreaticoduodenectomy (Whipple procedure)?
End-to-side pancreaticojejunostomy, hepaticojejunostomy, gastrojejunostomy
What percentage of pancreatic neoplasms are mucinous cystic neoplasms?
2%
What distinguishes mucinous cystic neoplasm from intraductal papillary
mucinous neoplasm?
Mucinous cystic neoplasm rarely communicates with the main pancreatic duct.
Should mucinous cystic neoplasm be resected?
Yes, because of malignant potential.
What rash is seen with glucagonoma?
Necrolytic migratory erythema
From which islet cells do glucagonoma arise?
α-cells
What laboratory test confirms the diagnosis of glucagonoma?
Elevated plasma glucagon >150 pg/mL (many will have levels in excess of 500
pg/mL)
Which test is used for localization of glucagonoma?
CT or MRI
What is another name for VIPoma?
Verner Morrison syndrome
What triad is associated with VIPoma?
Watery diarrhea, hypokalemia, and achlorhydria
