The Surgical Review- Pancreas Flashcards
what gene is associated with tropical pancreatitis? and what is it associated with ingesting?
secretory trypsinogen inhibitor or SPINK1 gene, ingesting cassava root
new onset diabetes in association with a skin rash and a pancreatic mass in the tail is suggestive of what?
glucagonoma
what is rash called in glucagonoma?
necrolytic migratory erythema- seen mostly in the lower abdomen or perineum
steatorrhea and gallstones + pancreatic head tumor
somatostatinoma: inhibits pancreatic and biliary secretions
what is another name for VIPoma?
WDHA: watery diarrhea, hypokalemia, and achlorhydria
aka Verner-Morrison syndrome
medical treatment of VIPoma?
octreotide: a somatostatin analogue
how do you confirm diagnosis of insulinoma?
low fasting blood sugar and an elevated C peptide level
treatment of insulinoma?
enucleation
octreotide scanning is most useful for localization of which tumor?
gastrinoma
what is passer triangle?
the area where 90% of gastrinomas reside, junction of cystic duct and CBD, 2nd and 3rd portion of duo, and the neck and body of the pancreas
Ranson Criteria: 5
- Age >55yrs
- WBC >16,000
- BG >200
- Serum LDH >350
- AST >250
preoperative ERCP in pts w gallstone pancreatitis needing lap chole is reserved for which two patient populations?
- Concomitant cholangitis
2. Clearly biliary obstruction (TBili >4, jaundice)
pathophys of hereditary pancreatitis?
defect in trypsin inactivation, missense mutation of the trypsinogen gene (PRSS1)
the preferred definitive treatment for recurrent acute pancreatitis due to pancreas divisum is
minor papilla sphincterotomy
most common anatomic site of adenocarcinoma of the pancreas?
main pancreatic duct
what are 4 effects alcohol has on the pancreas?
- A metabolic toxin to the pancreatic acinar cells
- increases pancreatic duct permeability
- transiently decreases pancreatic blood flow
- inappropriately activated trypsin
what is the mean amount of alcohol consumed in patients in whom pancreatitis develops?
100-175g/day
what is type 3 pancreatitis?
diabetes in the setting of chronic pancreatitis or after pancreatic resection
what is the function of PP (pancreatic polypeptide)?
regulates the expression of the hepatic insulin receptor gene
how do you diagnose factitious hypoglycemia?
low C peptide levels and high insulin
thus insulin:C peptide ratio >1
most common cause of acute vs chronic pancreatitis?
acute : biliary pancreatitis
chronic: alcohol
