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Flashcards in PANCREAS Deck (16):
1

pancreatic lymphoma

The clinical presentation of patients with is often nonspecific, consisting of weight loss, nausea, vomiting, and abdominal pain. B-type lymphoma symptoms such as fever and night sweats may be present.

BUT NOT jaundice radiating back pain


CT images can suggest the diagnosis of pancreatic lymphoma by the presence of a bulky pancreatic mass with surrounding lymphadenopathy. CT evidence of a bulky pancreatic mass in the absence of weight loss, back pain, and extrahepatic biliary obstruction (normal bilirubin associated with an elevated lactate dehydrogenase) should cause one to consider lymphoma in the differential diagnosis.

Percutaneous or endoscopic ultrasound (EUS)-guided biopsy will confirm the diagnosis in most cases. If the diagnosis cannot be confirmed preoperatively, laparoscopic exploration and biopsy are indicated.
There is no role for resection in the management of pancreatic lymphoma (choice A, B, and C). Endoscopic stenting to relieve jaundice followed by chemotherapy is the standard treatment (choice E), and long-term remission is often achieved.
Treatment of pancreatic lymphoma traditionally has involved cytotoxic chemotherapy (choice D). The most common chemotherapy regimens include cyclophosphamide, doxorubicin (adriamycin), vincristine, and prednisone (CHOP).
Bottom Line: Pancreatic lymphoma may present similar to pancreatic adenocarcinoma but is treated with chemotherapy alone. Relief of biliary obstruction is accomplished with endoscopic stenting.

2

somatostatinoma syndrome

is the least common of the five generally accepted functional pancreatic endocrine neoplasia syndromes,

occurring in less than 1 in 40 million people.

The somatostatinoma syndrome is nonspecific, much more difficult to recognize, and exceedingly rare.

The clinical features are nonspecific including

steatorrhea,
diabetes,
hypochlorhydria,
cholelithiasis.

3

Most somatostatinomas are located

pancreatic head

or

periampullary region.

somatostatinoma - difficult to dx presentation
with difficult to manage (head tumor) location

"som"e enocrine tumors need whipples if you are going to make the head of the pancrease into swiss cheese

4

VIPoma location

distal pancreas

VIP = back of the bus = good treatement with distal panc as option

5

Glucagonoma are mostly located

distal pancreas

Glucagonoma = must have sat on glu = stuck to the tail =

6

Insulinoma are located

I nsulinoma = E verywhere

7

VIPoma is located where

VIP in the back of the bus

8

Glucaconoma are located where

glued on to the tail

9

compare Decompression of the obstructed biliary tract with endoscopic vs percutaneous-transhepatic

However, an endoscopic approach yields better results with fewer associated complications

The percutaneous-transhepatic approach to duct decompression is usually reserved for patients in whom, for technical reasons, a stent cannot be placed endoscopically.


10

compare Decompression of the obstructed biliary tract with plastic vs metal stents

metal stents give more complete and long-lasting relief of jaundice

Plastic stents can become obstructed by tumor or debris and, as a result, must be changed every 2 to 3 months.

11

Pancreatic head tumors can extend into what part of duodenum

second portion of the duodenum

12

Pancreatic body tumors can extend into what part of duodenum

invade the third or fourth portion of the duodenum and also cause obstruction.

13

duodenal obstruction from pancreatic cancer is managemed how

palliated by endoscopic placement of expandable endoluminal metal stents into the duodenum.

For lesions that are not amenable to stents, surgical gastrojejunostomy may be required

14

more advanced findings that may not need a staging laparoscopy for pancreatic cancer

large liver lesions (these can by biopsied percutaneously)

marked hypoalbuminemia

significant increases in the CA19-9 level,

..severe back or abdominal pain ; or marked weight loss...

15

for pancreatic cancer what generally considered to be a sign of unresectability findings (what is vascular exception)

Pancreatic cancer is considered unresectable with
any metastases,
extension into the retroperitoneum
or hepatoduodenal ligament,
involvement of major arterial structures, or involvement of nodal or neural structures around the celiac or superior mesenteric arteries.

Isolated involvement of the SMV or portal vein can be resected in selected patients.

16

blood supply to pancreas body and tail

branches of the splenic artery