CIS Tieman - Pancreatic Neoplasia - 12.11.14 Flashcards Preview

Year2 GI Exam II > CIS Tieman - Pancreatic Neoplasia - 12.11.14 > Flashcards

Flashcards in CIS Tieman - Pancreatic Neoplasia - 12.11.14 Deck (26):
1

case 67yo abdominal discomfort, jaundice, loss of appetite, weight loss
-recent diabetes onset
-fam hx - pancreatic ca
-smoker - 50 pack year
-alcohol - heavy for many years
-mass RUQ abdomen

DDx - pancreatic cancer, cholelithiasis, chronic pancreatitis, cholangiocarcinoma

work up - abdominal CT, CBC

elevated direct bilirubin - obstructive jaundice - with elevated alk phos and GGT

CA 19-9 - pancreatic cancer monitor tx

2

majority of pancreatic cancer

in head - earlier picked up - obstructive jaundice

body and tail - tend to get diagnosed later

3

diabetes type I

autoimmune - appears in adolescence

4

family history of pancreatic cancer

yes, significant

5

pancreatic cancer

typically hard - bc of desmoplasia - gets CT

6

soft mass palpable in RUQ

gallbladder

7

cholangiocarcinoma

of bile ducts

8

CA 19-9

for monitoring the progress of pancreatic cancer

9

tx of pancreatic adenocarcinoma

surgery is best**

10

pancreatic cancer only cured by...

surgery**!

11

CEA

often elevated with mucinous tumors

important - bc mucinous are premalignant

12

resectable pancreatic cancer?

vessel invasion - if so, can't resect it

extended outside pancreas to lymph nodes or invaded other organs - not resectable

look with a scope - biopsy nodes

13

whipple procedure

take head of pancreas out

14

57yo F left side upper abdominal pain and back pain 4 months
-nausea, weight loss
-diabetic type I
-had cholecystectomy for stones
-palpable mass in LUQ

DDx - splenomegaly, gastric ca, pancreatic ca

work up - abdominal CT, CBC

CA 19-9 and CEA normal

cyst on CT

mucinous cystadenoma of pancreas - most likely

15

GIST

from cells of cajal

16

mucinous cystadenoma of pancreas

often tail of pancreas

in older women

CEA positive - mucinous - premalignant

17

pancreatic pseudocyst

occur after pancreatitis - so need hx of pancreatitis

caused by disruption of cyst architecture

18

IPMN

intraductal papillary mucinous neoplasm
-can be in main duct or branch ducts
-either one - premalignant - need to resect

common cystic neoplasm of pancreatic

thought to be precursor lesion of pancreatic cancer

19

only found in women

lined with ovarian epithelium

mucinous cystic neoplasm
-premalignant

20

mucinous

premalignant - bad

21

serous

benign

22

serous cystic neoplasm

central scar
-don't connect with ductal epithelium

ERCP - no connection to ducts - probably SCN

can leave alone - unless get bigger >3-4cm or become symptomatic

23

pancreatic cystic lesions

link in PPT - check it out - overview of cystic pancreatic cancers

24

55yo M epigastric abdominal pain, nausea, weight loss
-watery diarrhea
-gastric ulcer - 2 yrs ago
-no masses or organomegaly
-stool guaiac negative

hypertrophic rugal folds
-multiple small ulcers

DDx - gastrinoma

elevated gastrin levels
gastric pH 2.5 - very low

-looks like zollinger ellison

25

diarrhea

lose potassium

26

elevated gastrin levels and low pH in gastric

zollinger ellison - gastrinoma