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Flashcards in Fiser: Pancreas Deck (29)
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1
Q

blood supply: head of pancreas

A

superior: off GDA
Inferior: pancreaticoduodenal ateries

2
Q

blood supply: body of pancreas

A

great, inferior and dorsal pancreatic arteries (all off splenic aa)

3
Q

Blood supply: tail of pancreas

A

splenic, gastroepiploic and caudal pancreatic arteries

4
Q

ductal cells of pancreas secrete what?

A

HCO3- solution

5
Q

Acinar cells of pancreas secrete what?

A

digestive enzymees

6
Q

what is the only pancreatic enzyme thats secreted in active form?

A

amylase

7
Q

Secretion: Alpha islet cells

A

glucagon

8
Q

Secretion: Beta Islet Cells

A

insulin

9
Q

Secretion: Delta islet cells

A

somatostatin

10
Q

Secretion: PP or F islet cells

A

pancreatic polupetide

11
Q

what activated typsinogen to trypsin?

A

enterokinase: released from duodenum

12
Q

Action of: secretin

A

release of bicarb from pancreas (secreted from the duodenum)

13
Q

Action of CCK

A

release of pancreatic enzymes (secreted from the duodenum)

14
Q

Action of Somatostatin

A

decreases exocrine function of pancreas

15
Q

two pancreatic ducts and embryology

A
  1. ventral pancreatic bud -> duct of wirsung, this bud migrates posterior and clockwise (uncinate and inferior head)
  2. dorsal pancreatic bud -> duct of santorini, this bud forms the body, tail and superior aspect of head
16
Q

pathophysiology of annular pancreas

A

forms from the ventral pancreatic bud from failure of clockwise rotation

17
Q

what will you se on ERCP for pancreas divisum?

A

minor papilla will show long duct of santorini, major will have short duct of wirsung (opposite of what it should be)

18
Q

buzzword: chain of lakes

A

chronic panceratitis, alternating segments of dilation and stenosis of pancreatic duct

19
Q

genetic mutation found in 95% of pancreatic adenocarcinomas?

A

p16 mutation (tumor suppressor, binds cyclin complexes)

20
Q

what’s whipple’s triad?

A
  • symptoms of insulinoma
    1. Fasting hypoglycemia (<50)
    2. Symptoms of hypoglycemia
    3. Relief with glucose
21
Q

how to diagnose insulinoma?

A

insulin to glucose ration >0.4, increase C peptide and proinsulin

22
Q

NET: refractory PUD and diarrhea, how to diagnose?

A

Gastinoma, diagnose with gastrin >200 (usually 1,000’s) and secretin stimulation test -> increased gastrin (normal is decreased)

23
Q

single best study for localizing a gastrinoma?

A

octreotide scan

24
Q

NET and how to diagnose: diabetes, stomatitis, dermatitis

A

Glucagonoma, diagnose with a fasting glucose level

25
Q

NET and how to diagnose: watery diarrhea, hypokalemia, achlorhydria

A

VIPoma, see increased VIP levels

26
Q

NET and how to diagnose: diabetes, gallstones, steatorrhea

A

somatostatinoma, fasting somatostatin level

27
Q

what are the criteria for performing diagnostic laparoscopy in pancreatic cancer?

A
  1. Large tumors (>3cm)
  2. Significantly elevated CA 19-9
  3. Equivocal CT
  4. Pancreatic body and tail tumors
28
Q

what is the treatment for autoimmune pancreatitis?

A

corticosteroids for 2-4 weeks or until symptoms resolve (must rule out pancreatic cancer)

29
Q

what is genetic mutation behind hereditary pancreatitis?

A

PRSS1: cationic trypsinogen gene mutation