Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery M4 part 2 > Benign Pancreatic Diseases > Flashcards

Benign Pancreatic Diseases Flashcards

1
Q

What are the relations of the pancreas?

A

POSTERIORLY

  • IVC
  • beginning of portal vein
  • aorta
  • superior mesenteric vessels
  • suprarenal gland

ANTERIORLY

  • stomach -> separated by lesser sac
  • transverse colon
  • mesocolon

UPPER BORDER
- splenic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the endocrine function of the pancreas?

A
  • Type A -> glucagon
  • Type B -> insulin
  • Type D -> somatostatin
  • Type F -> pancreatic polypeptide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the effects of insulin?

A

Within seconds

  • increase entry of glucose into cells, muscles, fat, liver cells
  • increases K entry into cells

Within minutes

  • increase synthesis of glycogen
  • inhibits gluconeogenesis
  • activates lipoprotein lipase
  • inhibits hormone sensitive lipase

Within hours
- increases mRNA for the enzyme involved in anabolism -> increased growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What abnormalities does insulin cause?

A
  • excess (insulinoma) -> hypoglycemia

- deficiency -> diabetes mellitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the effects of glucagon?

A
  • glycogenolysis
  • gluconeogenesis
  • lipolysis
  • ketogenesis
  • increased metabolic rate
  • positive inotropic effect on heart

EXCESS -> hyperglycemia -> give somatostatin analogs (octreotide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the effects of somatostatin?

A

act as inhibitory hormone to

  • insulin
  • glucagon
  • pancreatic polypeptide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What controls the exocrine function of the pancreas?

A
  • CHOLINERGIC NERVES -> stimulate secretion of pancreatic enzymes & aqueous component
  • SYMPATHETIC -> inhibits its secretions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the classification of pancreatic lesions?

A

BENIGN

  • autoimmune
  • chronic pancreatitis
  • pseudo-cyst
  • pseudo-tumor

POTENTIALLY MALIGNANT

  • serous/mucinous cystadenoma
  • IPMN

MALIGNANT

  • primary -> exocrine (adenocarcinoma) OR endocrine
  • secondary (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What’s the difference between serous & mucinous cystadenoma?

A

SEROUS MUCINOUS

  • F > M - F > M
  • 6-7th decade - 5th decade
  • on the head - on body/tail
  • benign - history of pancreatitis
    - potentially malignant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are intrapapillary mucinous neoplasms (IPMN)?

A
  • cystic neoplasms derived from pancreatic ducts
  • MD lesions have higher malignancy potential
  • occurs at head of pancreas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is IPMN diagnosed?

A

can present with pancreatitis or jaundice

  • CT/MRI -> main duct disease = high risk of malignancy
  • ERCP & aspiration -> mucin rich

observe low risk lesion
resect high risk or multiple worrisome features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How are potentially malignant pancreatic lesions managed?

A

Serous cystadenoma

  • > 4cm or symptomatic -> surgical resection
  • < 4cm & asymptomatic -> observe

Mucinous cystadenoma -> surgical resection

IPMN

  • main duct -> surgical resection
  • side branch -> < 3cm & no worrisome features -> observe
    - > >3cm, symptomatic & has worrisome features -> surgical removal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the main difference between pancreatic cystadenomas & IPMN?

A
  • IPMN communicates with ductal systems

- Cystadenomas has ovarian stroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the main difference between pseudocysts & IPMN?

A

mucous production in IPMN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MEN mutations are present in which pancreatic tumor?

A

Pancreatic Neuroendocrine Tumor

  • rare
  • most are non functioning

graded based on

  • differentiation
  • mitotic index
  • Ki-67 index
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Whipple’s triad?

A
  • fasting hypoglycemia
  • serum glucose <50
  • relief with glucose

in INSULINOMA

17
Q

What are the symptoms of insulinoma?

A
  • obtundation
  • confusion
  • diaphoresis
  • palpitation
  • high insulin
  • high C-peptide
18
Q

How is insulinoma diagnosed?

A
  • 72h fasting -> measure C-peptide, proinsulin, insulin, & glucose levels are drawn every 6 hours until symptoms emerge
  • CT -> localize
  • intraoperative US
  • angiograohy & venous sampling
19
Q

Which pancreatic tumor is MEN1 associated & secretes gastrin?

A

GASTRINOMA

  • solitary
  • Zollinger-Ellison syndrome associated
20
Q

Which pancreatic tumor causes watery diarrhea, hypokalemia, achlorhydria? (WDHA)

A

VIPoma (Verner Morrison syndrome)

  • distal pancreas
  • 70% malignant
  • high serum VIP > 200
21
Q

how is VIPoma diagnosed & treated?

A

CT & octreoscan
EUS -> localize

treatment

  • IV fluids
  • electrolyte correction
  • somatostatin
  • debulking
  • hepatic artery embolization for liver metastasis
22
Q

a patients present with serum glucagon >500 & mass in body & tail of pancreas, biopsy of skin shows vacuolated keratinocytes, what is your diagnosis?

A

Glucagonoma

treatment

  • control BS
  • TPN
  • octreotide
  • debulking
23
Q

What diseases is PNET associated with?

A
  • MEN1
  • Hippel-Lindau disease
  • Von Recklinghausen disease
24
Q

What are the signs & symptoms of PNET?

A
  • abdominal pain
  • weight loss
  • anorexia & nausea
  • obstructive jaundice
  • intra-abdominal hemorrhage
  • palpable mass
25
Q

How is PNET diagnosed?

A

1- history of symptoms of functioning tumors
2- Chromogranin A biochemical confirmatory test
3- imaging for localization -> CT -> MRI -> EUS -> SRCS -> angio -> surgical exploration
4- evaluate for metastatic disease

26
Q

How is nonmetastatic PNET management?

A

SURGICAL treatment

  • if not well localized -> surgical exploration with US -> full pancreatic mobilization
  • asymptomatic nonfunctional -> elective surgery
27
Q

How is metastatic PNET managed?

A

MEDICAL therapy, liver directed therapy. & SURGERY

  • surgical resection if all visible tumor can be removed
  • if not -> debulking -> symptom control -> liver only disease

Surgery M4 part 2 (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions