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Pancreas SCORE Flashcards

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1
Q

Pseudocysts have what cytology?

A

low CEA

high amylase

serous fluid

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2
Q

Serous cystic neoplasms have what cytology?

A

low CEA

low amylase

serous fluid

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3
Q

IPMN and MCN have what fluid cytology?

A

IPMN: high CEA, high amylase, mucinous fluid

MCN; high CEA, low amylase, mucinous fluid

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4
Q

What do we do with asymptomatic pseudocysts?

A

don’t require treatment

50% of pts will develop psueodocysts after an episode of severe acute pancreatitis

70% will resolve spontaneously

**you operate when pts have intractable abdominal pain, oral intolerance, and can’t exclude cystic neoplasm

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5
Q

What % of cases of chronic pancreatitis in US are due to etoh?

A

50%

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6
Q

Management of main-duct IPMN vs branched type IPMN:

A

main duct–> surgical resection; 60% malignant potential

branched type–> plan based on tumor size

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7
Q

Mortality of surgical intervention in acute pancreatitis within 2 weeks is?

A

75%

decreases to 8% after 28 days

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8
Q

What are two duodenum-preserving pancreatic head resection procedures?

A

Begger

Frey

(these procedures are not appropriate when pancreatic cancer is considered)

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9
Q

Do we resect mucinous cystic neoplasms of pancreas?

A

YES

considered pre-malignant

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10
Q

What are pancreatic MCNs?

A

mucinous cystic neoplasms

made of mucin producing epithelial cells

walls of cyst contain a distinctive ovarian-type stroma

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11
Q

For a Puestow procedure, what is the minimal length of your anastomosis?

A

6cm

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12
Q

Gold standard to diagnose pancreas divisum?

A

MRCP

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13
Q

What’s the risk of post-ERCP pancreatitis?

A

5%

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14
Q

What enzymes produced by pancreas in active form, that helps digest starch (sugars)?

A

amylase secreted in active form from pancreas and saliva

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15
Q

When do we performa a longitudinal pancreaticojejunostomy?

A

dilated pancreatic duct >6 mm w/out pancreatic head enlargement

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16
Q

When do we perform a Frey procedure?

A

enlarged pancreatic head

dilated pancreatic duct

(involves pancreatic duct drainage and a focal pancreatic head resection)

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17
Q

Pts w/ Lynch syndrome have an increased risk of pancreatic cancer; Lynch syndrome is caused by what??

A

germline mutation in mismatch repair

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18
Q

Most common symptom assc/ w pancreas divisum?

A

no symptoms

95% of pts remain asymptomatic

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19
Q

Serous cystadenomas of pancreas tend be located anywhere in pancreas, and their fluid cytology shows:

A

clear fluid

low CEA
neg mucin
low amylase

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20
Q

Most frequent complication of pancreaticoduodenectomy?

A

pancreatic fistula

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21
Q

For all patients undergoing surgical debridement of pancreatic necrosis; what’s the incidence of developing DM?

A

25%

risk is assc/ w % of gland lost, with more gland lost, more chance of developing DM

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22
Q

30 days following a necrosectomy, a pt’s JP drain has been putting out 60 /cc a day, what do you do next?

A

most pancreatic fistulas will close in 4-6 weeks

if they fail to close, ERCP and stent placement help close > 85% of fistulas

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23
Q

When is the Beger procedure used?

A

used for pancreatitis w/ large pancreatic head and small pancreatic ducts

it’s a duodenal preserving pancreatic head resection

transect the pancreatic neck, core out pancreatic head

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24
Q

Puestow procedure?

A

longitudinal pancreaticojejunostomy

used for pancreatic ducts 6 mm >, without enlarged pancreatic head

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25
Frey procedure?
lateral pancreaticojejunostomy with local pancreatic head resection
26
When do we use Frey procedure?
dilated pancreatic duct from obstruction due to enlarged pancreatic head
27
Duodenal sparing pancreatic head resection?
Beger procedure
28
When is Beger used?
enlarged pancreatic head with normal caliber pancreatic duct
29
Most common cause for pancreatic insufficiency is chronic pancreatitis, 2nd most common cause is?
cystic fibrosis
30
When we have food in the duodenum, pancreatic ductal cells secrete HCO3 to neutralize acidity of food, HCO3 release is mediated by?
secretin HCO3 is pumped outside the ductal cell into the lumen, and Cl is exchanged inside the cell
31
Pancreas divisom is failure of the ventral and dorsal pancreatic ducts to fuse, rarely does it present with symptoms, how is it treated?
ERCP and sphincteroplasty
32
Wirsung and Santorini ducts drain via what papilla?
duct of Wirsong drains via major papilla; drains head and uncinate process duct of Santorini drains via minor papilla; drains body and tail
33
Mucinous cystic neoplasms are commonly found where?
body and tail of pancreas due to malignancy risk; laparoscopic spleen preserving pancreatectomy can be performed there is no risk to rest of pancreas once removed, so no need for surveillance
34
In terms of cystic neoplastic lesion of pancreas, which one has a starburst calcification pattern?
serous cystic neoplasms
35
In terms of cystic neoplastic lesion of pancreas, which one has a eggshell calcification pattern?
MCNs
36
Why are mucinous cystic neoplasms usually amenable to spleen preserving distal pancreatectomy?
b/c they are usually found in tail of pancreas
37
Normal pancreatic duct drainage vs what happens in pancreas divisum:
normally; 70% of pancreas drained by ventral duct via major papilla PD; major pancreatic drainage is via dorsal duct which drains into minor papilla
38
What % of pts with acute pancreatitis that develop peri-pancreatic fluid collections will develop pseudocysts?
5-15%
39
What enzyme secreted by pancreas in active form?
lipase
40
How long does it take for pancreatic pseudocysts to develop?
4-8 weeks
41
Tell me things about insulinomas;
benign usually less than 2 cm can be found anywhere in pancreas
42
What is the most common neuroendocrine tumor?
insulinomas
43
Ranson criteria and morality;
each category gets 1 point 0-2--> 2 % mortality 3-4--> 15% 5-6-->40% +7 --> 100%
44
Which enzyme cleared first in pancreatitis?
amylase usually cleared in less than 48 hrs
45
Whipple's triad in insulinomas?
hypoglycemia neuro-glycopenic symptoms ; weak, confused, palpatations relief of sxs with glucose
46
What are the most common functional pancreatic neuroendocrine tumors?
insulinomas
47
Diagnostic study for insulinomas?
72 hr fast period in a hospital monitored setting pts have a high ratio of insulin;glucose
48
Whipple's triad of insulinma?
hypoglycemia when fasting blood glucose less than 50 relief after glucose given
49
Insulinomas, benign or malignant?
BENIGN
50
Diabetes associated with necrolytic migratory erythema?
glucagonoma
51
What rash is seen with glucagonoma>
necrolytic migratory erythema
52
Where are glucagonomas normally located?
head + tail tend to be large with mets when diagnosed
53
Tx for glucagonomas?
surgical removal with debulking if necessary
54
How do we diagnose glucagonomas?
serum glucagon >500
55
With this PNET; pts are at an increased risk of DVT?
glucagonoma
56
Watery diarrhea, achlorhydria, hypokalemia?
VIPOMA
57
What is WDAH syndrome seen with VIPOMAS?
watery diarrhea achlorhydria hypokalemia
58
Most VIPOMAs found where?
Tail
59
Pts with VIPOMAs, why do they have hypokalemia?
massive amts of watery diarrhea (>5L/day)
60
This causes ZE syndrome;
gastrinomas
61
Gastrinomas cause what syndrome?
ZE syndrome
62
How do we diagnose gastrinoams?
gastrin level > 1000
63
Borders of gastrinoma triangle;
cystic duct/CBD 2nd/3rd part of duodenum neck/body pancreas
64
How do we find gastrinomas?
ocreotide scanning with EUS
65
With gastrinomas, what do we have to make sure?
MEN1
66
How do pts with somatistainomas present?
gallstones DM steatorrhea
67
How do we confirm diagnosis of somatistainomas?
>10 most have mets at time of presentation resection and GB removal appropriate in many times
68
Serous cystic neoplasms of pancreas, stain positive for what?
periodic acid schiff stain
69
Periodic acid schiff staining seen in what Ca>
serous cystic neoplasms
70
Fish mouth ampulla seen in?
main duct IPMN
71
Single best predictor of 30 day mortality in cirrhotic pts?
MELD (Bilirubin, INR, Cr)
72
MOst common PNET in a MEN syndrome?
gastrinoma

Appendix (39 decks)

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