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Essentials of Surgery > Pancreas > Flashcards

Flashcards in Pancreas Deck (29):
1

TX for annular pancreas

surgical bypass of the pancreatic tissue causing obstruction (duodenojejunostomy) and avoid pancreas parenchymal divison bc high risk of fistula

2

Branches of celiac trunk

common hepatic a, splenic a, L gastric a

3

Branches of common hepatic a

Hepatic a proper, R gastric, Gastroduodenal (which branches into ant. & post. pancreaticoduodenal a)

4

Where does the cystic a branch from

R hepatic a.

5

Cl- concentration amount released

varies inversely with bicarb secretion of pancreas

6

Major stimulus for pancreatic bicarb production

Duodenal pH <3 which stimulates release of secretin which acts on the pancreas

7

Only enzyme released by the pancreas in active form

amylase; works best at pH 7

8

How does EtOH cause pancreatitis?

EtOH promotes protein rich secretions which can precipitate and plug the small ductules.

9

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.

10

Grey Turner Sign

In severe pancreatitis with bleeding, blood dissects into retroperitoneal soft tissue causing flank ecchymosis.

11

Cullen Sign

In severe pancreatitis with bleeding, blood dissects up the falciform ligament causing periumbilical ecchymosis

12

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

13

Best imaging to detect peripancreatic fluid, pancreatic necrosis, and pancreatic edema

CT

14

What can you say about pancreatic tissue that does NOT enhance with IV contrast

it is devoid of blood supply and thus necrotic

15

Is pancreatic necrosis an indication for surgery?

No; only if infected as well

16

What do elevated amylase and lipase mean in acute pancreatitis?

Acinar cell damage

17

What is Ranson's criteria used for?

Determining severity and possibility of complications of pancreatitis during the first 48hrs. >/= 3: severe.

18

TX for pancreatitis

NPO, IVF, monitor respiratory function & glucose, nasojejunal feeding tube if severe and req. prolonged NPO.

19

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

20

What is a pancreatic Pseudocyst?

Peripancreatic fluid that remains after pancreatitis.

21

Lining of a pseudocyst?

Granulation tissue

22

Difference between a communicating and non-communicating pseudocyst?

Whether the cyst is connected to the pancreatic duct

23

How are pseudocysts treated?

Communicating must be drained internally via stomach, duod, or R en Y to avoid fistula. Non- communicating are drained percutaneously.

24

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.

25

MC pancreatic endocrine tumor? Functional?

Insulinoma is functional. Benign usually.

26

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

27

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

28

Imaging for pancreatic endocrine tumors

MRI or CT

29

Tx for Pancreatic endocrine tumors: insulinoma vs others

Insulinoma (b9) enucleation and lap ressection. Others surgical removal, somatostatin, chemo, radiation, ablation, cryo.