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ACG Guidelines > Pancreas > Flashcards

Pancreas Flashcards

1
Q

physiology of secretin

A

secreted into the blood by S sells of the small intestine in response to duodenal pH.

secretin binds to duct cells to create a bicarb-rich secretion into pancreatic ducts

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2
Q

physiology of cholecystokinin

A

cholecystokinin is a hormone secreted by the Ito cells of the small intestine into the bloodstream in response to a meal and bind to acinar cells of the pancreas.

zymogen granules are secreted from acing cells into the pancreatic duct

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3
Q

recommended fluid for resuscitation in acute pancreatitis?

A

LR

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4
Q

pancreatic serous cystadenomas. benign or malignant?

A

serous cystadenomas are benign. they are glycogen rich and just need to be observed

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5
Q

secretin physiology

A

secretin is secreted by S-cells in the proximal duodenum.

secretin is released when duodenal pH falls below 4.5

secretin causes increased chloride output and secretin is required to stimulate pancreatic bicarb secretion

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6
Q

how do you categorize chronic pancreatitis?

what are their treatments?

A

large duct chronic pancreatitis vs small duct pancreatitis

large duct chronic pancreatitis:
drainage procedure such as lateral pancreatico-jejunostomy (better pain control than ERCP w/ pancreatic stenting)

small duct chronic pancreatitis:
total pancreatectomy w/ islet autotransplantation can be considered

pts w/ focal disease and pain can be managed by surgical resection of the diseased ductal segment (Whipple, distal pancreatectomy)

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7
Q

what are the indications for resection when you have IPMN?

A

Indications for resection:

  • main duct IPMN (high potential for malignant transformation)
  • symptomatic branch-duct IPMN (pancreatitis) a/w obstructive jaundice, main duct involvement, have a solid component w/n the cyst, or have concerning features on EUS-FNA
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8
Q

under what circumstances should you resect for side branch IPMN?

A

main duct IPMN, which has a high potential for malignant transformation and should be resected if possible. Resection is also indicated for branch-duct IPMN’s which are symptomatic (e.g. pancreatitis), associated with obstructive jaundice or main duct involvement, have a solid component within the cyst, or have concerning features on EUS-FNA.

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9
Q

h/o necrotizing pancreatitis
isolated gastric varices that bleed

tx?

A

splenectomy for splenic vein thrombosis

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10
Q

most common type of functioning pancreatic endocrine tumor?

A

insulinoma (1-2 cases/million/yr)

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11
Q

pt presents w/ acute pancreatitis and concurrent cholangitis. how quickly should pt get ERCP?

A

w/n 24hrs of admission

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12
Q

pt has pancreatic mass, polyarthritis, panniculitis, and subcutaneous nodules. what do they likely have?

A

acinar cell carcinoma - a rare pancreatic tumor

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13
Q

pancreatic pseudopapillary tumor.

typical pt?
imaging findings?
tx?

A

pancreatic pseudopapillary tumor

  • young females in 20-30s
  • may see well-encapsulated mass w/ peripheral calcification on CT in 30% of pts
  • EUS-FNA shows fluid CEA is low
  • surgical resection for tx
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14
Q

pancreatic serous cystadenoma

  • typical pt?
  • imaging findings?
  • other labs?
  • tx
A

pancreatic serous cystadenoma

  • females age 50-60s
  • imaging w/ cystic appearance and central fibrous scar (only seen in 30% of pts)
  • low yield on EUS-FNA cytology, but low CEA
  • benign, but if symptomatic, can consider surgery
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15
Q

for pts with chronic pancreatitis, what is their risk of pancreatic cancer?

A

for pts w/ chronic pancreatitis greater than or equal to 5 yrs, the risk of pancreatic cancer is 8-fold the risk of the general population

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16
Q

T or F. all pts w/ biliary pancreatitis need an ERCP

A

False

only biliary pancreatitis pts w/ evidence of cholangitis or biliary obstruction require ERCP

17
Q

fluid resuscitation model for acute pancreatitis

A

oal-directed fl therapy for the first 24hrs from presentation: LR 20mL/kg bolus followed by 3mL/kg/hr with repeat bolus (20mL/kg followed by 3mL/ Kg/hr) at 12hrs into therapy if increases in HCT, BUN, or Cr are seen.

18
Q

what is the strongest environmental risk factor for pancreatic adenoma?

A

smoking

19
Q

interventions to minimize post-ERCP pancreatitis?

A

rectal indomethacin

if pancreatic duct has been cannulated repeatedly, prophylactic PD stent placement

20
Q

what is hemosuccus pancreaticus and how do you treat it?

A

bleeding from the main pancreatic duct. This can be due to a pseudoaneurysm in the peripancreatic arterial circulation, or bleeding from small vessels within a pseudocyst or fluid collection that communicates with the pancreatic duct.

tx: angiogram w/ embolization

21
Q

vitamin B12 absorption physiology

A

intrinsic factor (made by parietal cells; atrophic gastritis)

B12 must be released from binding w/ R-protein, via pancreatic proteases (chronic pancreatitis can’t break down/activate R-protein)

B12 and IF bind.

B12 absorbed in the terminal ileum (Crohn’s, ideal resection)

22
Q

describe presentation, findings, tx of type 2 autoimmune pancreatitis?

A

Type 2 AIP patients usually present with acute pancreatitis and/ or obstructive jaundice due to mass-like lesion in the pancreatic head.

Characteristic features include: association with inflammatory bowel disease, mass-like lesion or other focal features on imaging, biopsy showing granulocyte-epithelial lesions with absent or very mildly positive IgG4 staining. Unlike type 1 AIP, type 2 involves only the pancreas.

Type 2 AIP, like type 1 AIP, is very responsive to treatment with glucocorticoids.

Surgical resection is not indicated given the high likelihood of response to medical therapy.

23
Q

in pts w/ azathioprine-induced acute pancreatitis, what do you do?

A

stop the AZA

do not rechallenge w/ AZA or w/ other mercaptopurines

24
Q

new DM, diarrhea, rash (blistering red, around mouth and perineum), weight loss

A

glucagonoma

a rare neuroendocrine tumor from pancreatic alpha-2 cells

insulin resistance, diarrhea, weight loss.

necrolytic migratory erythema - limbs, personal, perineum. seen in up to 80% of pts w/ glucagonoma

25
Q

what is the risk of pancreatic adenoCa in pts w/ hereditary pancreatitis?

A

hereditary pancreatitis (caused by mutation in cationic trypsinogen gene - PRSS1) carries a 40-60 fold increased lifetime risk for pancreatic adenoCa

hereditary pancreatitis is an auto-dom condition w/ incomplete penetrance

ACG Guidelines (13 decks)

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