Flashcards in Pancreas Deck (29):
TX for annular pancreas
surgical bypass of the pancreatic tissue causing obstruction (duodenojejunostomy) and avoid pancreas parenchymal divison bc high risk of fistula
Branches of celiac trunk
common hepatic a, splenic a, L gastric a
Branches of common hepatic a
Hepatic a proper, R gastric, Gastroduodenal (which branches into ant. & post. pancreaticoduodenal a)
Where does the cystic a branch from
R hepatic a.
Cl- concentration amount released
varies inversely with bicarb secretion of pancreas
Major stimulus for pancreatic bicarb production
Duodenal pH <3 which stimulates release of secretin which acts on the pancreas
Only enzyme released by the pancreas in active form
amylase; works best at pH 7
How does EtOH cause pancreatitis?
EtOH promotes protein rich secretions which can precipitate and plug the small ductules.
Common causes of Pancreatitis
EtOH, gallstones, uremia, hypertriglycerides, hyperlipidemia, hypercalcemia, ERCP (1%), any tumor obstructing the duct, ischemia from hypoTN or after surgery involving nearby vasculature.
Grey Turner Sign
In severe pancreatitis with bleeding, blood dissects into retroperitoneal soft tissue causing flank ecchymosis.
In severe pancreatitis with bleeding, blood dissects up the falciform ligament causing periumbilical ecchymosis
Imaging for suspected acute pancreatitis
CXR r/o pleural effusion, atalectasis, free air
ABD XR r/o calcifications of Chronic pancreatitis, gallstones, SBO, adynamic ileus
US: gallstones, CBD dilation, peripancreatic fluid, pancreatic enlargement
Best imaging to detect peripancreatic fluid, pancreatic necrosis, and pancreatic edema
What can you say about pancreatic tissue that does NOT enhance with IV contrast
it is devoid of blood supply and thus necrotic
Is pancreatic necrosis an indication for surgery?
No; only if infected as well
What do elevated amylase and lipase mean in acute pancreatitis?
Acinar cell damage
What is Ranson's criteria used for?
Determining severity and possibility of complications of pancreatitis during the first 48hrs. >/= 3: severe.
TX for pancreatitis
NPO, IVF, monitor respiratory function & glucose, nasojejunal feeding tube if severe and req. prolonged NPO.
3 indications for surgical tx of pancreatitis
1. Dx uncertainty and wanting to avoid infectious pancreatitis
2. Gallstone Pancreatitis= do cholecystectomy
3. Complications like CBD obstruction, fibrosis, gastric outlet obstruction, splenic/portal v thrombosis from inflammation and edema; also necrosis, pseudocyst, infection. These would prompt need for surgery
What is a pancreatic Pseudocyst?
Peripancreatic fluid that remains after pancreatitis.
Lining of a pseudocyst?
Difference between a communicating and non-communicating pseudocyst?
Whether the cyst is connected to the pancreatic duct
How are pseudocysts treated?
Communicating must be drained internally via stomach, duod, or R en Y to avoid fistula. Non- communicating are drained percutaneously.
What is whipples procedure and why is it done?
pancreaticoduodenectomy: Removal of head of the pancreas, duodenum, gallbladder, and distal CBD. Performed for carcinoma of the pancreas, duodenum, or distal common bile duct, and for trauma.
MC pancreatic endocrine tumor? Functional?
Insulinoma is functional. Benign usually.
Describe the secretin test for insulinoma
Secretin normally stimulates insulin release. However, insulinoma is not responsive to this stimulus so secretin administration causes NO increase in insulin concentration
Majority of Gastrinomas are found where?
gastrinoma triangle: junction of the common bile and cystic ducts, the neck and body of the pancreas, and the second and third portion of the duodenum
Imaging for pancreatic endocrine tumors
MRI or CT