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Flashcards in Pancreas Deck (29):
1

Embryology of pancreas

Develops from endoderm of duodenum. Two pouches develop (ventral and dorsal) that then rotate and fuse by 8th week.

2

Annular pancreas

Ventral pancreas malrotates and encircles 2nd portion of duodenum -> pancreatitis, bowel obstruction, peptic ulcer. Tx: duodenoduodenostomy (bypass)

3

Pancreas divusm

Failure to fuse two duct systems, such that duct of Santorini (normally accessory duct) becomes the main duct. Majority are asymptomatic, but if it results in inadequate drainage -> chronic pain, recurrent pancreatitis

4

Exocrine function of pancreas

Acinar cells secrete enzymes. Centroacinar and ductal cells secrete water and electrolytes. Overall 1-5 L/day of isosmotic, pH 8 fluid.

5

Cephalic phase of digestion

Stimuli of sight/smell of food -> vagal activation -> gastric acid production -> duodenal acidification -> secretin release -> pancreatic HCO3 release

6

Gastric phase of digestion

Antral distention and protein -> gastrin -> gastric acid production -> duodenal acidification -> secretin release -> pancreatic HCO3 release

7

Intestinal phase

Duodenal acid and bile stimulate secretin, duodenal fat/protein release CCK -> release of pancreatic enzymes

8

Endocrine function of pancreas

Insulin (beta cells), glucagon (alpha cells), somatostatin (delta cells), pancreatic polypeptide

9

Clinical uses of somatostatin

1. Tx sx of neuroendocrine tumors (e.g. carcinoid, VIPoma, gastrinoma) 2. Convert high-output fistulae to low-output fistulae

10

Drugs that can cause pancreatitis

Isoniazid, estrogens, azathioprine (Imuran), HCTZ, sulfonamides, pentamidine (antifungal for PCP), didanosine (HAART), chemo for ALL, Depakote

11

What is a sentinel loop on XRay?

Distention and/or air-fluid levels near a site of abdominal distention. Can be seen in pancreatitis due to secondary ileus

12

Ranson's criteria

see attached

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13

Causes of chronic pancreatitis other than alcohol

HyperPTH, CF, congenital pancreatic anomalies, hemochromatosis. NOT commonly gallstones though

14

Pancreatic pseudocyst definition

Fluid collection without epithelial lining

15

Pancreatic pseudocyst treatment

1/3 resolve on own with TPN and NPO. After 4 weeks (wall has matured) can do internal drainage: RenY cyst-jejunostomy or cyst-gastrostomy

16

Pancreatic adenocarcinoma epi

Arises from exocrine pancreas. M > F, older, blacks > whites, smoking risk factor, most occur in the head, association with MEN1.

17

Trousseau's syndrome

Migratory thrombophlebitis assoc with GI adenocarcinoma, esp pancreatic

18

Tumor markers for pancreatic adenocarcinoma

Ca 19-9, alk phos

19

Whipple procedure

Removal of gallbladder, CBD, antrum of stomach, duodenum, proximal jejunum and head of pancreas

20

Palliative procedures for pancreatic cancer

Relieve biliary and/or duodenal obstruction. Pain control with chemical splanchicectomy (sympathetic nerves to pancreas)

21

Pancreatic cystadenocarcinoma

Females age 40-60 yrs, more commonly in the body/tail. Malignant potential, but better prognosis than adencarcinoma. Tx: resection.

22

Pancreatic cystadenoma

Older/middle aged women, presents with vague abdominal sx. Two types: serous = benign, mucinous = malignant potential. Tx: resection

23

Insulinoma

Majority are benign, solitary lesions. Diagnosis: fasting serum insulin > 25. To distinguish from exogenous insulin, check C-peptide. Tx: surgical resection

24

Gastrinoma

Causes ZES. Majority malignant/multiple. About 20% assoc with MEN1. Dx: serum gastrin > 1000. Tx: resection difficult bc often multiple; PPI.

25

VIPoma

Causes achlorhydria and watery, secretory diarrhea -> hypokalemia. Most are malignant. Tx: surgery, chemo; octreotide (somatostatin analogue).

26

Why does VIPoma cause watery diarrhea?

VIP is a potent stimulator of gut cyclic adenosine monophosphate (cAMP) production, which leads to massive secretion of water and electrolytes (mainly potassium).

27

Why does VIPoma cause achlorhydria?

In the stomach, VIP inhibits histamine- and pentagastrin-stimulated acid secretion.

28

Glucagonoma

Rare; most are malignant, large primary tumors that metastasize. Causes 4Ds – DM (hyperglycemia), dermatitis (necrolytic migratory erythema), deep vein thrombosis (DVT) and depression. Dx: glucagon > 1000

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29

Somatostatinoma

Very rare, large tumor that metastasizes. Gallstones, diarrhea, hypochlorhydria, weight loss, abdominal cramps. Dx: somatostatin > 1000