Surgical diseases of the Pancreas Flashcards
the body and tail of the pancreas lie anterior to the
splenic artery and vein
Chief excretory channel
Duct of Wirsung
accessory duct
duct of santorini
Blood supply to the pancreas comes from multiple
branches from the _____ and _____
celiac and superior mesenteric
arteries
artery that supplies the body and tail of the pancreas
splenic artery
arteries that supply the head of the pancreas
superior and inferior pancreaticoduodenal artery
stimulates endocrine and exocrine secretion
parasympathetic
inhibits secretion
sympathetic system
responsible for exocrine secretion
acinar cells
Responsible for endocrine secretion
Islet cells
Hydrolyzes starch and glycogen to glucose, maltose,
maltotriose and dextrins
PANCREATIC AMYLASE
missense mutation on the cationic trypsinogen, or
PRSS1, results
premature, intrapancreatic
activation of trypsinogen
Activated to form chymotrypsin.
CHYMOTRYPSINOGEN
Secreted by the pancreas as a proenzyme that
becomes activated by trypsin.
PHOSPHOLIPASE A2
function of phospholipase A2`
Hydrolyzes phospholipids and, as with all lipases,
requires bile salts for its action
Hydrolyze neutral lipid substrates like esters of
cholesterol, fat-soluble vitamins, and triglycerides
CARBOXYLIC ESTER HYDROLASE AND
CHOLESTEROL ESTERASE
fxn of CARBOXYLIC ESTER HYDROLASE AND
CHOLESTEROL ESTERASE
Hydrolyze neutral lipid substrates like esters of
cholesterol, fat-soluble vitamins, and triglycerides
secrete glucagon
alpha cells
secrete insulin
β-cells
secrete somatostatin
delta cells
secrete ghrelin
epsilon cells
secrete PP
PP cells
function of insulin
Inhibits glycogenolysis, fatty acid breakdown, and
ketone formation, and stimulates protein synthesis
major stimulant of somatostatin
intraluminal fat
Release is stimulated by hypoglycemia, and by the
amino acids arginine and alanine
GLUCAGON
glucagon release is stimulated by
hypoglycemia, and by the
amino acids arginine and alanine
most important role of pancreatic polypeptide
glucose regulation through its
regulation of hepatic insulin receptor gene expression
most potent enteral stimulator of PP release
protein
function of amylin
modulation or counterregulation of insulin
secretion and function
Inhibits insulin, and possibly somatostatin release, and
augments glucagon release
• Inhibits pancreatic exocrine secretion
PANCREASTATIN
Stimulates growth hormone secretion via growth
hormone releasing hormone release from the pituitary
GHRELIN
classification of Pancreatic true cysts
- IPMN (intraductal papillary mucinous neoplasms)
- SCN (Serous Cystadenoma)
- MCN ( Mucinous Cystic Adenoma)
most commonn type of precancerous cyst
IPMN
3 clinical problems of pancreatic ductal adenocarcinoma
pain
jaundice
duodenal obstruction
a collection of enzyme rich pancreatic juice that occurs early in the course of acute pancreatitis, or that forms after a pancreatic duct leak; located in or near the pancreas; it lacks a well organized wall of granulation or fibrous tissue
peripancreatic fluid collection
A focal or diffuse area of nonviable pancreatic parenchyma, typically occupying > 30% of the gland and containing liquefied debris and fluid
Early pancreatic (sterile) necrosis
an organized collection of sterile necrotic debris and fluid with a well defined margin or wall within the normal domain of the pancreas
late pancreatic (sterile) necrosis
a collection of pancreatic juice enclosed within a perimitere of early granulation tissue, usually as a consequence of acute pancreatitis that has occured within the preceding 3-4 weeks
acute pseudocyst
pancreatic fluid collection in which gross purulence (pus) is present, withh bacterial or fungal organisms documented to be present
pancreatic abcess
a collection of pancreatic fluid surrounded by a wall of normal granulation and fibrous tissue, usually persisting for >6 weeks
chronic pseudocyst
etiology of chronic pancreatitis
Toxic Metabolic Ideopathic Genetic Autoimmune Recurrent acute and severe Obstruction
2 minimally invasive interventions for acute pancreatitis
video assissted retroperitoneal debridement
endoscopic transgastric neurosectomy
surgical interventions for necrotizing pancreatitis
percutaneous drainage endoscopic neurosectomy combined percutaneous and endoscopic laparoscopic transabdominal debridement open debridement transgastric approach
clinical feautre of mild acue pancreatitis according to classification of seveity
no organ failure
no local symptoms
clinical feautre of moderate severe pancreatitis according to classificate of seveity
Transient organ failure (resolves in 48hrs) Local or systemic complications without persistent organ failure
clinical feautre of severe acute pancreatitis according to classificate of seveity
Persistent organ failure
involving 1 or more
organs (>48hrs)
