Fiser ABSITE Ch. 33 Pancreas Flashcards Preview

Surgery > Fiser ABSITE Ch. 33 Pancreas > Flashcards

Flashcards in Fiser ABSITE Ch. 33 Pancreas Deck (47):
1

Uncinate process

on aorta, behind SMA

2

Pancreatic Blood supply

Head - GDA, SMA; Body - splenic; Tail - Splenic, gastroepiploic, dorsal pancreatic

3

Acinar cells

secrete Cl- and digestive enzymes

4

amylase

secreted in active form

5

Endocrine pancreas

Alpha cells - glucagon; Beta - insulin; Delta - somatostatin; PP/F - pancreatic polypeptide; Islet - VIP, serotonin, neuropeptide Y, gastrin-releasing peptide

6

Enterokinase

trypsinogen to trypsin

7

trypsin

activates all pancreatic enzymes

8

Decrease pancreatic exocrine function

somatostatin and glucagon

9

Which is the major and minor duct of pancreas? What is pancreas divisum?

Santorini is Small duct, Wirsung is major duct. Pancreas divisum = failure of fusion (5% of population, prone to pancreatitis), Santorini is then major duct

10

Duct of Wirsung

primary, ventral pancreatic bud (uncinate and inferior head)

11

Duct of Santorini

accessory, dorsal pancreatic bud (superior head, body, tail), drains directly into duodenum

12

Annular pancreas: abdominal x-ray, associated congenital anomaly, treatment

double bubble on abdominal x-ray; Down syndrome; dudenoJ or duodenoduodeno and sphincteroplasty

13

Pancreas divisum: pathophy, clinical manifestation, dx, tx

failed fusion of pancreatic ducts; Duct of Santorini stenosis -> pancreatitis; Dx: ERCP; Tx: sphincteroplasty and stent, longitudinal PJ

14

Heterotopic Pancreas: MC location, symptom, tx

Most commonly found in duodenum; usually asymptomatic; resection if symptomatic

15

Pancreatitis without cause

malignancy

16

Ranson's Criteria

GALAW and CHOBBS -- On admission: glucose > 200, AST > 250, LDH > 350, age > 55, WBC > 16,

17

Acute pancreatitis: Underlying pathology

Intra-acinar activation of pancreatic proenzymes leading to autodigestion and release of proinflammatory mediators

18

Acute pancreatitis: Signs

Grey Turner sign (flank ecchymosis), Cullen's sign (periumbilical ecchymosis), Fox's sign (inguinal ecchymosis)

19

Pancreatic abscess

overt gas in previous pancreatic necrosis (8 weeks ltr), ABSOLUTE indication for surgical debridement

20

Incidental pancreatic cyst, tx

resect

21

Pancreatic pseudocyst

chronic pancreatitis, head, MRCP/ERCP -> cystogastrostomy if duct involved. Complications: SBO, infxn, portal/splenic v thrombosis.

22

Most important risk factor for necrotizing pancreatitis

Obesity

23

Chronic pancreatitis

fibrosis, pain, ETOH, exocrine tissue calcified, islet cells preserved, "chain of lake" appearance, malabsorption. Rx: Puestow: PJ (longitudinal)

24

ARDS in pancreatitis is due to

Release of phospholipases

25

Splenic vein thrombosis cause

chronic pancreatitis, bleeding gastric varices -> splenectomy

26

Pancreatic AC

Sx: weight loss, jaundice, pain. Tobacco, CA 19-9, lymphatic spread, 70% in head. Local invasion = unresectable. 90% ductal. Only biopsy if mets. Tx: Gemcitabine/XRT. Prognosis: vascular, nodal invasion, margins

27

Bleeding after Whipple

embolization

28

Nonfunctional Endocrine Tumors

1/3 of panc endocrine neoplasms, 90% malig, resect, 5FU/streptozocin, liver mets, 50% survival

29

Octreotide effective for

insulin-, glucagon-, gastrin-, VIPoma

30

Pancreatic Head neoplasms

gastrinoma, somatostatinoma

31

insulinoma

#1 islet cell tumor, Sx: Whipple's Triad (fasting hypo, catecholamine surge, relief with glucose), benign, I:G >0.4. Tx: streptozocin/octreotide/5FU if mets, o/w enucleation

32

Gastrinoma

ZES, #1 panc islet cell tumor in MENI, 50% multiple and malig. Sx: ulcer dz, diarrhea. Dx: gastrin >200, secretin stim test (ZES: inc gastrin). Tx: enucleate if

33

Gastrinoma triangle

CBD, pancreatic neck, D3

34

cannot find gastrinoma

duodenostomy, resect with primary closure

35

study for localizing pancreatic tumor

somatostatin receptor scintigraphy

36

Relation of SMA and SMV to pancreas

SMA and SMV lay behind neck of pancreas

37

Relation of portal vein to pancreas

Forms behind the neck of the pancreas (SMV and splenic vein)

38

Venous drainage of pancreas

Drains into portal system

39

Lymphatics of pancreas

Celiac and SMA nodes

40

Released by duodenal epithelial cells; located on brush border; activates trypsinogen to trypsin; Trypsin then activates other pancreatic enzymes including trypsinogen

Enterokinase

41

Major pancreatic duct that merges with CBD before entering the duodenum

Duct of Wirsung

42

mortality of pancreatic CA

overall 90% dead in one year

43

mutation in pancreatic cancer? marker?

CA 19-9 (serum marker) is generally high in pancreatic CA. 90% have mutated K-Ras.

44

what type of block can be done for non resectable cancer?

celiac plexus block is effective pain relief for non-resectable CA (50% EtOH on both sides of aorta near celiac)

45

gallstones, steatorrhea, pancreatitis, diabetes

Somatostatinoma

46

diabetes, glossitis, stomatitis, migratory necrolytic erythema, streptozocin and octreotide help

Glucagonoma

47

WDHA syndrome = Watery Diarrhea Hypokalemia Achlohydria. Diarrhea does not improve with NGT or H2 blockers

VIPoma