Chapter 54: Pancreas- Misc.

Question 1

What is an annular pancreas?

Answer 1

• Pancreas encircling the duodenum.
• if obstruction is present, bypass, do not resect

Question 2

What is pancreatic divisum?

Answer 2

• Failure of the two pancreatic ducts to fuse
• the normally small duct (Small =Santorini) of Santorini acts as the main duct in pancreatic divisum

(Think: the two pancreatic ducts are Divided = Divisum)

Question 3

What is heterotopic pancreatic tissue?

Answer 3

Heterotopic pancreatic tissue usually found in the stomach, intestine, duodenum

Question 4

What is a Puestow procedure?

Answer 4

Longitudinal filleting of the pancreas/pancreatic duct with a side-to-side anastomosis with the small bowel

Question 5

What medication decreases output from a pancreatic fistula?

Answer 5

Somatostatin (GI-inhibitory hormone)

Question 6

Which has a longer half-life: amylase or lipase?

Answer 6

Lipase; therefore, amylase may be normal and lipase will remain elevated longer

Question 7

What is the WDHA syndrome?

Answer 7

• Pancreatic VIPoma (Vasoactive Intestinal Polypeptide tumor)
• Tumor secretes VIP, which causes:
  
  • Watery
  • Diarrhea
  • Hypokalemia
  • Achlorhydria (inhibits gastric acid secretion)

Question 8

What is the Whipple triad of pancreatic insulinoma?

Answer 8

• Hypoglycemia (Glucose <50)
• Symptoms of hypoglycemia: mental status changes/vasomotor instability
• Relief of symptoms with administration of glucose

Question 9

What is the most common islet cell tumor?

Answer 9

Insulinoma

Question 10

What pancreatic tumor is associated with gallstone formation?

Answer 10

Somatostatinoma (inhibits gallbladder contraction)

Question 11

What is the triad found with pancreatic somatostatinoma tumor?

Answer 11

1. Gallstones
2. Diabetes
3. Steatorrhea

Question 12

What are the two classic findings with pancreatic glucagonoma
tumors?

Answer 12

1. Diabetes
2. Dermatitis/rash (necrotizing migratory erythema)

Question 13

Name the diagnostic modality:

40-year-old female with “migratory necrolytic dermatitis,”
diabetes

Answer 13

1. Glucagon assay (glucagon level)
2. CT scan for glucagonoma

Question 14

What is the treatment?

2-year-old with annular pancreas

Answer 14

Bypass obstruction

Question 15

What is the treatment?

40-year-old alcoholic with dead pancreatic tissue on CT scan
develops hypotension and fever

Answer 15

Operative pancreatic débridement

Question 16

28-year-old male with diarrhea, diabetes, and gallstones

What is the correct diagnosis?

Answer 16

Somatostatinoma

Question 17

80-year-old with new onset of jaundice has a palpable, distended,
nontender gallbladder on exam

What is the correct diagnosis?

Answer 17

Courvoiser’s sign for head of the pancreas cancer mass