Pancreas Flashcards
(65 cards)
What is the duct Wirsung?
major pancreatic duct that forms in head and joins CBD to form common pancreaticobiliary channel proximal to ampulla of Vater
What is the duct of Santorini?
accessory pancreatic duct that drains the anterior portion of the pancreatic head
what is the blood supply to the head of the pancreas?
anterior and postero-superior pancreaticoduodenal arteries from GDA
forms collaterals with branches of SMA (inferoanterior and posterior pancreaticoduodenal arteries)
what is the venous drainage?
drains into portal system via SMV and splenic veins
which enzyme is responsible for pancreatic necrosis in the presence of bile?
phospholipase A
what is high output pancreatic fistula?
more than 200 ml/day
what are other causes of pancreatitis
hypercalcemia trauma hyperlipidemia pancreatic duct obstruction ischemia drugs familial idiopathic
what are the main causes of pancreatitis
gallstones and alcohol
how is pancreatitis dx?
needs 2 of the 3:
abdominal pain
serum amylase or lipase at least 3 times the upper limit of normal
characteristic findings of pancreatitis on CT
which enzyme is implicated in the etiology of pancreatitis?
trypsin
which serum enzyme rises within 2 hours of onset of pancreatitis and peaks within 48 hrs?
amylase
what are the early Ranson criteria (on admission)?
Glucose > 200 age > 55 LDH > 350 AST > 250 WBC >16k
what are the late ransom criteria (48 hours)?
calcium < 8 Hct drop > 10% PaO2 < 60 mmHg BUN increase by 5 or more base deficit > 4 fluid sequestration > 6 L
initial management of pancreatic duct stricture from chronic pancreatitis
pancreatic duct stenting
What is a Duval procedure?
distal pancreatectomy with end to end pancreaticojejunostomy
what is a Puestow procedure?
longitudinal pancreaticojejunostomy
lateral side to side pancreaticojejunostomy
most widely used and preferred for chronic pancreatitis with dilation of the pancreatic duct (7 mm or more); pancreatic resection, pancreatic denervation, islet cell transplantation (for T1DM)
what is a Frey procedure?
coring out diseased portion of pancreatic head with longitudinal dissection of pancreatic duct toward the tail and then lateral pancreaticojejunostomy for chronic pancreatitis
reserved for smaller inflammatory masses of the head and dilated pancreatic ducts (7 mm or more)
What is a Beger procedure?
duodenum preserving pancreatic head resection
uses 2 anastomoses with RNY jejunal loop to pancreatic tail remnant (end to side) and to the excavated pancreatic head (side to side)
For patients with a large inflammatory mass in the head with no evidence of distal ductal dilation – makes the end to side PJ the most appropriate anastomosis
what are the 4 types of acute pancreatitis complications per the revised Atlanta classification?
- acute peri pancreatic fluid collection or post necrotic/peripancreatic fluid collection (within 4 weeks), categorized as sterile or infected
- pancreatic pseudocyst or walled off necrosis (within 4 weeks), categorized as sterile or infected
How to manage a pseudocyst?
supportive for 4-6 weeks
if no resolution, wait until thick fibrous wall and do internal cyst drainage via open or endoscopic cystgastrostomy, cystojejunostomy, or cystuodenostomy
always perform biopsy to r/o malignancy
external drainage can be done for infected collections of pseudocysts
indication for surgical intervention for pseudocyst
has not resolved in 6 weeks and persistently greater than 6 cm
how is infected peripancreatic fluid collection or infected walled off necrosis dx?
CT guided perc FNA
what abs is used for pancreatic necrosis involving > 30% of the gland?
imipenem or meropenem
pancreatic tumor that exhibits sunburst central calcifications on CT scan?
serous cystadenoma
