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PANCREAS Flashcards

1
Q

2 pancreatic ducts

A

Wirsung duct

Santorini duct

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2
Q

Major duct

A

Wirsung duct

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3
Q

Blood supply (head of the pancreas)

A
  1. Celiac trunk –> gastroduodenal –> Anterior superior pancreaticoduodenal artery

Posterior superior pancreaticoduodenal artery

  1. Superior mesenteric artery –> Anterior inferior pancreaticoduodenal artery

Posterior inferior pancreaticoduodenal artery

  1. Splenic artery –> Dorsal pancreatic artery
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4
Q

Endocrine function of the pancreas

A

Islets of Langerhans:

alpha-cells: glucagon
beta-cells: insulin
delta cells: somatostatin
PP cells: pancreatic polypeptide

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5
Q

Exocrine function of the pancreas

A

Digestive enzymes: amylase, lipase, trypsin, chymotrypsin, carboxypeptidase

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6
Q

Kocher maneuver

A

Used to mobilize the duodenum and pancreas and evaluate the
entire pancreas

Incise the lateral attachments of the duodenum and then lift the pancreas to examine the posterior surface

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7
Q

Admission Ranson Criteria

A

“GA LAW (Georgia law)”:

Glucose >200
Age >55
LDH >350
AST >250
WBC >16,000
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8
Q

Ranson’s criteria at less than 48 hours be remembered

A

“C HOBBS (Calvin and Hobbes)”:

Calcium <8 mg/dL
Hct drop of >10%
O2 <60 (PaO2)
Base deficit >4
Bun >5 increase
Sequestration >6 L
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9
Q

Chronic inflammation of the pancreas region causing destruction of the parenchyma, fibrosis, and calcification, resulting in loss of endocrine and
exocrine tissue

A

Chronic Pancreatitis

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10
Q

Chronic inflammatory changes that are caused by the compression or occlusion of the proximal ductal system by tumor, gallstone, posttraumatic scar, or inadequate duct caliber (as in pancreas divisum)

A

Chronic Pancreatitis

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11
Q

TIGAR-O Classification

A 
Toxic and metabolic
Idiopathic
Genetic Predisposition
Autoimmune
Recurrent and Severe acute pancreatitis
Obstructive
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12
Q

Represents a special case of obstructive pancreatitis and the MC congenital anomaly involving the pancreas

A

Pancreas divisum

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13
Q

Characterized by diffuse fibrosis and a loss of acinar elements with a predominant mononuclear cell infiltration throughout the gland

A

Chronic Inflammatory Pancreatitis

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14
Q

Common feature of all forms of chronic pancreatitis

A

perilobular fibrosis

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15
Q

The MC symptom of chronic pancreatitis

A

pain

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16
Q

For patients with focal inflammatory changes localized to the body and tail, or in whom no significant ductal dilatation exists

A

Distal Pancreatectomy

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17
Q

Proximal pancreatectomy or pancreaticoduodenectomy, with or without pylorus preservation

A

Proximal Pancreatectomy

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18
Q

Origin of cells of the endocrine pancreas, or islet cells

A

neural crest cells

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19
Q

Multiple Endocrine Neoplasm (MEN) I – 3 Ps

A

pituitary tumors
parathyroid hyperplasia
pancreatic neoplasms

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20
Q

The MC functional pancreatic endocrine neoplasms

A

Insulinomas

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21
Q

Associated with beta-cell hypertrophy, islet hyperplasia and ↑ beta-cell mass

A

Noninsulinoma Hyperinsulinemia Hypoglycemia Syndrome

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22
Q

Endocrine tumor that secretes gastrin –> acid hypersecretion and peptic ulceration

causes Zollinger-Ellison syndrome (ZES)

A

Gastrinoma

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23
Q

Whipple’s triad

A
  1. symptomatic fasting hypoglycemia
  2. documented serum glucose level <50 mg/dL
  3. relief of symptoms with the administration of glucose
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24
Q

Location of primary gastrinoma i in 70% to 90% of patients

A

Passaro’s triangle

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25
Also called WDHA syndrome due to the presence of WATERY DIARRHEA, HYPOKALEMIA, and ACHLORHYDIA
Vasoactive Intestinal Peptide-Secreting Tumor
26
DIABETES in association with DERMATITIS
Glucagonoma
27
Serum glucagon level in glucagonoma
>500 pg/mL
28
Presents with: GALLSTONES due to bile stasis DIABETES due to inhibition of insulin secretion STEATORRHEA due to inhibition of pancreatic exocrine secretion and bile secretion
Somatostinoma
29
MC site of somatostinoma
ampulla and periampullary area
30
Serum somatostatin level in somatostinoma
>10 ng/mL
31
The most commonly mutated gene in pancreatic cancer, with ~ 90% of tumors having a mutation
K-ras oncogene
32
The MC cystic lesion of the pancreas No epithelial lining and is a nonneoplastic complication of pancreatitis or pancreatic duct injury
Pseudocysts
33
Essentially considered benign tumors without malignant potential
Cystadenoma
34
encompass a spectrum ranging from benign but potentially malignant to carcinoma with a very aggressive behavior commonly seen in perimenopausal women about 2/3 are located in the body or tail of the pancreas
Mucinous Cystadenoma and Cystadenocarcinoma
35
Surgical Treatment for Chronic Pancreatitis
Puestow—LONGITUDINAL pancreaticojejunostomy (pancreatic duct must be dilated) Duval—DISTAL pancreaticojejunostomy Near-total pancreatectomy
36
Frey Procedure
Longitudinal pancreaticojejunostomy with core resection of the pancreatic head
37
Acute pancreatitis from a gallstone in or | passing through the ampulla of Vater (the exact mechanism is unknown)
Gallstone Pancreatitis
38
Encapsulated collection of pancreatic | fluid
Pancreatic Pseudocyst
39
Surgical option for pseudocyst ADHERENT to the STOMACH
Cystogastrostomy (drain into the stomach)
40
Surgical option for pseudocyst ADHERENT to the DUODENUM
Cystoduodenostomy (drain into the duodenum)
41
Surgical option for pseudocyst NOT ADHERENT to the stomach or duodenum
Roux-en-Y cystojejunostomy (drain into | the Roux limb of the jejunum)
42
Surgical option for pseudocyst in the TAIL of the pancreas
Resection of the pancreatic tail with the pseudocyst
43
MC cause of death due to pancreatic pseudocyst
massive hemorrhage into the pseudocyst
44
Adenocarcinoma of the pancreas arising | from duct cells
Pancreatic carcinoma
45
Pancreatic carcinoma
66% - pancreatic HEAD | 33% - BODY and TAIL
46
Why are most pancreatic cancers in the tail nonresectable?
These tumors grow without symptoms until it is too late and they have already spread— head of the pancreas tumors draw attention earlier because of biliary obstruction
47
Signs/ symptoms of tumors based on location
HEAD (pancreas) PAINLESS JAUNDICE from obstruction of CBD; weight loss; abdominal pain; back pain; weakness; pruritus from bile salts in skin; anorexia; Courvoisier’s sign; acholic stools; dark urine; diabetes BODY OR TAIL weight loss and pain (90%); migratory thrombophlebitis (10%); jaundice (<10%); nausea and vomiting; fatigue
48
The MC symptoms of cancer of the pancreatic HEAD
Weight loss (90%) Pain (75%) Jaundice (70%)
49
“Courvoisier’s sign”
palpable nontender distended gallbladder
50
Metastatic lymph nodes described classically for | gastric cancer which can be found with metastatic pancreatic cancer
Virchow’s node | Sister Mary Joseph’s nodule
51
Tumor markers associated with pancreatic cancer
CA - 19 | carbohydrate antigen
52
Treatment based on location
head of the pancreas - Whipple procedure (pancreaticoduodenectomy) tail - Distal resection
53
Whipple procedure | pancreaticoduodenectomy
``` Cholecystectomy Truncal vagotomy Antrectomy Pancreaticoduodenectomy—removal of head of pancreas and duodenum Choledochojejunostomy—anastomosis of CBD to jejunum Pancreaticojejunostomy—anastomosis of distal pancreas remnant to jejunum Gastrojejunostomy—anastomosis of stomach to jejunum ```
54
“pylorus preserving Whipple”
No antrectomy; anastomose duodenum | to jejunum
55
possible post-Whipple complications
delayed gastric emptying (if antrectomy is performed) anastomotic leak (from the bile duct or pancreatic anastomosis) causing pancreatic/biliary fistula wound infection postgastrectomy syndromes sepsis pancreatitis
56
Pancreas encircling the duodenum; if obstruction is present, bypass, do NOT resect
annular pancreas
57
Failure of the two pancreatic ducts to fuse; the normally small duct (Small Santorini) of Santorini acts as the main duct
Pancreatic Duct
58
Longitudinal filleting of the pancreas/ pancreatic duct with a side-to-side anastomosis with the small bowel
Puestow procedure
59
Pancreatic tumor is associated with gallstone | formation
Somatostatinoma
60
Triad found with pancreatic somatostatinoma | tumor
Gallstones Diabetes Steatorrhea
61
2 classic findings with pancreatic glucagonoma tumors
Diabetes | Dermatitis/rash (necrotizing migratory erythema)
62
The only therapy shown to prevent the progression of | chronic pancreatitis
Pancreatic duct decompression

SURGERY (27 decks)

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