Pancreas & Spleen Flashcards
Most common location for accessory spleen
Splenic hilum
Beger procedure
Head resection, 2 anastomoses with RNY jejunum to pancreatic tail, and side-to-side of excavated head
Bern procedure
Modifcation of Beger procedure without head resection
Cattell maneuver
Done in Whipple for visualization of SMV/SMA as they emerge from base of pancreatic neck
Medial retraction of mass off SMV-portal confluence in Whipple allows visualization of what?
Inferior pancreaticoduodenal branches (may also see first jejunal branches of middle colic vein - divide)
IPMN resected - positive margin with high grade dysplasia. Next step?
Re-resect if patient is surgically fit
IPMN resected - positive margin with low grade dysplasia
Surveillance imaging Q6mo
IPMN resected - negative margin, no invasive disease in specimen
Surveillance imaging in 2 and 5 years
Most common mutation in hereditary pancreatitis
PRSS1
Best test for accessory spleen tissue
Radionucleotide imaging
Management of insulinoma
If <2cm enucleate
If >2cm formal resection
How to treat insulinoma if not a surgical candidate
Diazoxide (symptom relief)
Management of symptomatic annular pancreas
Duodenoduodenostomy, gastrojejunostomy, or duodenojejunostomy (don’t resect annular segment bc it’s associated with pancreatitis, fistula, and incomplete relief)
Diagnostic test for pancreas divisum
Secretin-enhanced MRCP
Most common congenital pancreatic anomaly
Pancreas divisum
