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CORE: GI > Pancreas > Flashcards

Pancreas Flashcards

(54 cards)

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1
Q

solid pancreatic neoplasms

A

ductal adenocarcinoma, acinar cell carcinoma

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2
Q

cystic epithelial neoplasms

A

serous cystic, mucinous cystic, SPEN, IPMN

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3
Q

endocrine epithelial neoplasms

A

insulinoma, gastrinoma, glucagonoma, VIPoma, somatostatinoma

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4
Q

most common pancreatic tumor

A

ductal adenocarcinoma

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5
Q

pancreatic ductal adenocarcinoma

A

patients > 60, mostly male

risks: smoking, alcohol, chronic pancreatitis

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6
Q

pancreatic ductal adenocarcinoma imaging findings

A

pancreatic mass, most comspicuous on late arterial phase for a hypoenhancing tumor

usually in pancreatic head; ductal dilation, double duct sign

T1 hypointense, ill defiend hypovascular mass

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7
Q

pancreatic ductal dilation ddx

A

autoimmune panceatitis, groove pancreatitis, cystic pancreatic tumor, neuroendocrine tumor, duodenal GIST, peripancreatic LN, pancreatic met (RCC, thyroid, melanoma), lymphoma

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8
Q

unresectable vs resectable pancreatic ductal adenocarcinoma

A

unresectable: encasement >180 degrees of SMA, venous invasion, or mets
resectable: no celiac/SMA, portal vein invasion; limited extension to duodenum/stomach/CBD

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9
Q

acinar cell carcinoma

A

rare aggressive variant of pancreatic adenocarcinoma

exclusive in elderly males

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10
Q

lipase hypersecretion syndrome

A

subcutaneous fat necrosis, bone infarcts (polyarthralgia), eosinophilia

seen in acinar cell carcinoma in which large amount of lipase is present

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11
Q

serous cystadenoma

A

grandmother tumor

many small cysts that may have a solid appearance on CT; hypervascular

does not cause pancreatic duct dilation or tail atrophy

central stellate calcification

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12
Q

mucinous cystic neoplasm

A

mother tumor

single or few large cysts >2 cm; typically in body/tail

has a capsule (similar to SPEN)

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13
Q

treatment of mucinous cystic neoplasm

A

resection due to malignant potential

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14
Q

SPEN

A

daughter tumor; young women/children

large mass with heterogenous solid/cystic area; hemorrhage typical; capsule (similar to mucinous cystic neoplasm)

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15
Q

IPMN

A

grandfather tumor; elderlym men (although large age/sex variability)

sidebranch vs main duct (more malignant); nodular/enhancing component most concerning for malignancy

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16
Q

IPMN view on endoscopy

A

fish mouth papilla pouring out mucin; lesion contiguous with duct/sidebranch

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17
Q

IPMN treatment/followup

A

follow-up: simple cysts <1 cm followed annually

treatment: resect if >3 cm in size, mural nodule, or dilation of pancreatic duct >1 cm

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18
Q

pancreatic neuroendocrine tumor types

A

hyperfunctioning vs nonfunctioning (larger at diagnosis; mimic cystic neoplasms, central necrosis/calcification)

typically hypervascular; solid unless large
hypervascular liver mass with associated pancreatic mass, likely metastatic PNET

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19
Q

hyperfunctioning PNET tumors

A

insulinoma, gastrinoma, glucagonoma, VIPoma, somatostatinoma

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20
Q

most common PNET

A

insulinoma

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21
Q

insulinoma

A

hypoglycemia; present early and have best prognosis

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22
Q

whipple triad

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A

insulinoma: hypoglycemia, clinical symptoms of hypoglycemia, alleviation of symptoms after glucose admin

23
Q

gastrinoma

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A

hypersecretion of gastric acid in Zollinger-Ellison syndrome

associated with MEN1 (usually multiple and located in duodenum)

24
Q

gastrinoma triangle

Study These Flashcards
A

location of gastrinomas in area bounded by cystic duct/CBD, duodenum, and neck/body of pancreas

25
complication of gastrinoma
high gastrin levels --> carcinoid tumors in stomach (regress after gastrinoma resected)
26
3rd most common pancreatic endocrine tumor, prognosis
glucagonoma; poor prognosis
27
VIPoma/somatostatinoma prognosis
rare; poor prognosis
28
normal duct anatomy
main pancreatic duct > duct of Wirsung > major papilla (ampulla of Vater) duct of Santorini drains the minor papilla sphincter of Oddi surrounds ampulla of Vater
29
Santorini relation to duct of Wirsung
Santorini is suprior, drains into the small/minor papilla
30
stable anatomy in the pancreas
1. CBD always drains to major papilla/meets duct of Wirsung 2. main pancreatic duct drains pancreatic tail 3. duct of santorini always drains minor papilla
31
most common congenital pancreatic anomaly
pancreas divisum; failure of fusion of ventral/dorsal pancreatic ducts
32
how does pancreas divisum cause pancreatitis
obstruction at minor papilla from a Santorinicele; focal dilation of terminal duct of Santorini
33
crossing sign
CBD crossing over the main duct to join the duct of Wirsung CBD courses towards the ventral duct to empty into major papilla main pancreatic duct drains separately into minor papilla
34
annular pancreas
pancrease completely surounds duodenum, secondary t oincomplete rotation of pancreatic bud
35
annular pancreas complications
pancreatitis, PUD, duodenal obstruction (differential or double bubble sign in kids)
36
common channel syndrome
pancreaticobiliary maljunction missing thin septum dividing CBD and duct of Wirsung >> major papilla; reflux between two systems mild form of choledochocele >>cholangiocarcinoma??
37
systemic diseases affecting pancreas
VHL, CF, scwachman-Diamond, obesity, exogenous steroid use
38
VHL pancreas?
serous cystadenoma, PNET tumors
39
CS in pancreas?
most common cause of childhood pancreatic atrophy fatty atrophy or pancreatic cystosis (innumerable cyst replacements)
40
schwachman diamond
rare inherited disorder; diffuse fatty replacement of pancreas >> pancreatic exocrine insufficeincy, neutropenia, bone dysplasia
41
obesity/steroids affect on pancreas
fatty atrophy
42
intrapancreatic accessory spleen
mimics hypervascular pancreatic neoplasm similar intensity to spleen on MRI
43
diagnosis of an intrapancreatic accessory spleen
MRI diagnostic NM Tc99m sulfur colloid or RBC scintigraphy can confirm diagnosis in ambiguous cases
44
ideal phase of imaging for pancreatitis
pancreatic parenchymal phase (late arterial ~40 sec after IV contrast)
45
when is CT imaging not indicated in pancreatitis
mild acute pancreatitis, if pt improving (negative or mildly edematous)
46
grading systems for pancreatitis
Balthazar and CT severity index (CTSI)
47
balthazar grading system
A: Normal-appearing pancreas B: Focal or diffuse pancreatic enlargement C: Mild peripancreatic inflammatory changes D: Single fluid collection E: Two or more fluid collections increased mortality (54% in E) with increasing grade
48
CT severity index (CTSI)
integrates Balthazar with necrosis; Assigns 0–4 points for Balthazar A–E, with 0 points for Balthazar A and 4 points for Balthazar E. Adds 0–6 points for necrosis to create a total score from 0-10. 0 points: 0% necrosis 2 points: <30% necrosis 4 points: 30–50% necrosis 6 points: >50% necrosis CTSI 10: 92% morbidity
49
pancreatitis complications
pancreatic necrosis, fluid collection, pseudocyst, pancreatic absess; extrapancreatic pseudocyst, perihilar renal inflammation, bowel involvement, arterial bleeding, pseduoaneudrysm (splenic artery), venous thrombosis
50
chronic pancreatitis
calcifications in the distribution of the pancreatic duct
51
autoimmune pancreatitis, associations
inflammatory lymphoplasmacystic infiltrate (IgG4 levels elevated) associated with Sjogren
52
imaging findings of autoimmune pancreatitis
diffuse sausage shaped enlargement of the entire pancreas treatment: steroids
53
groove pancreatitis, population, ddx
uncommon form of focal pancreatitis between head of pancreas/duodenum/CBD young men who are heavy drinkers ddx: adenocarcinoma of pancreas
54
histopathologic hallmark of groove pancreatitis
fibrosis in pancreaticoduodenal groove; duodenal thickening; cystic change

CORE: GI (9 decks)

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