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DVG- pancreas
Pancreas questions from de Virgilio
48
Medical
Professional
11/19/2013

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Term
Genetic mutation a/w tropical pancreatitis
Definition
mutation of the pancreatic secretory trypsinogen inhibitor or SPINK1 gene
Term
Tropical Pancreatitis
Chronic or Acute
Who gets it
Assoc environmental exposure
Definition
Chronic pancreatitis that presents in younger patients in tropical climates and is a/w ingestion of casaval root
Term
Natural hx of tropical pancreatitis
Definition
presentation is with abd pain; may lead to pancreatic duct stone formation and diabetes when the pancreatitis becomes chronic; a/w higher risk of pancreatic cancer
Term
Tx of tropical pancreatitis
Definition
pain control and digestive enzyme supplementation
If obstruction develops, may require endoscopic or surgical (rarely) decompression
Term
Surgical options for tx of a symptomatic pancreatic pseudocyst
Definition
cystgastrostomy
RNY cystojejunostomy
and a cyst duodenostomy
Term
How to predict the success of endoscopic approach to cystogastrostomy
Definition
finding of a major ductal disruption or stenosis on ERCP or MRCP
Term
New onset DM a/w skin rash and a pancreatic mass in the tail
Definition
Glucagonoma
Term
Name and location of rash a/w glucagonoma
Definition
Necrolytic migratory erythema
Lower abdomen or perineum
Term
Way to diagnose glucagonoma
Definition
Measuring glucagon level
Term
Intermittent vague RUQ pain, jaundice a/w greasy, floating stools and a pancreatic head mass
Definition
Somatistatinoma
Term
Function of somatistatin
Definition
inhibits panreatic and biliary secretions
Term
Pancreatic head mass a/w exocrine pancreas dysfunction (steatorrhea and gallstones)
Definition
somatistatinoma
Term
Pancreatic tail mass a/w episodic large volume watery/secretory diarrhea
Definition
VIPoma
Term
Verner-Morrison syndrome
Definition
VIPoma
Term
WDHA
Definition
VIPoma
Watery diarrhea, hypokalemia, achlorhydria
Term
Best medical tx for sx of VIPoma
Definition
Octreotide
Term
surrgical tx of sx of VIPoma
Definition
Tumor debulking, hepatic artery embolization and radio frequency ablation
Term
Risk factors for pancreatic cancer
Definition
Smoking
BRCA2
Diabetes
Chronic pancreatitis
Obesity
Atypical multiple mole melanoma,
hereditary pancreatitis, FAP
HNPCC
Peutz-Jeghers
Term
MC functional pancreatic endocrine neoplasm
Definition
Insulinoma
Term
Pancreatic mass (anywhere in pancreas) a/w multiple syncopal episodes, palpitations, trembling, diaphoresis, confusion/disorientation or seizures
Definition
Insulinoma
Term
Way to diagnose an insulinoma
Definition
Low fasting glucose level and an elevated c-peptide level
Term
MC location in the pancreas of an insulinoma
Definition
evenly distributed b/w the head, body, tail
Term
Best way to diagnose a gastrinoma
Definition
Octreotide scanning combindedd with EUS
Term
Tumors for which octreotide scanning can be most useful
Definition
Gastrinomas and carcinoid tumors
Term
Why are octreotide scans necessary to localize gastrinomas?
Definition
1) because they can be located in multiple places within a wide area
2) because they have a high concentration of somatostatin receptors
3) are often too small to find with a CT
Term
MC location of gastrinomas
Definition
Passaro's triangle:
Jxn of cystic and CBD, the 2nd and 3rd portion of the duodenum, and the neck and body of the pancreas
Term
Admission Ranson criteria
Definition
Age older than 55
WBC > 16000
Glucose > 200
LDH > 350
AST > 250
Term
Additional Ranson criteria at 48 hours
Definition
Hct decrease > 10%
BUN increase by more than 5%
Serum Calcium less than 8
PO2 < 60
Base deficit > 4
Fluid sequestration > 6L
Term
Role of ERCP/Chole in biliary-pancreatic disease
Definition
Only for patients with concomitant cholangitis or clear evidence obstruction (jaundice, persistant elevation of tbili > 4)
O/w, for severe pancreatitis, wait until resolves; For moderate or mild pancreatitis early lap CCY is safe with intro-op IOC +/- post-op ERCP or intra-op CBD exploration if IOC is pos
Term
Best predictor of residual CBD stone in gallstone pancreatitis
Definition
persistantly elevated tbili
Term
Pseudohyponatremia
Definition
Hyponatremia a/w hypertriglyceridemia in which the lipids displace the water in the serum leading to a falsely low sodium levels
Term
Hereditary pancreatitis: pathophys, mode of inheritance, presentation, natual hx
Definition
Pathophys: genetic mutation that prevents trypsin from being inactivated leading to uncontrolled proteolytic distruction of the pancreas;
Inheritance: auto-dominant (equal distribution in both sexes)
Presentation: abd pain in 1st or 2nd decade with calcifications of the pancreas on imaging
Natural hx: progressive pancreatic dysfunction, sx of pancreatic duct obstruction, 40% risk of cancer
Term
Anomaly of pancreas divisum, incidence, major risk and treatment
Definition
# Failure of Ducts of Wirsung and Santorini to fuse
# ~10%
# Risk of pancreatitis b/c the minor papilla, which drains the majority of the pancreas, can't handle the hight flow of pancreatic juices
# Minor papilla sphincterotomy
Term
Preferred tx of dilated pancreatic duct with distal obstuction in chronic pancreatitis
Definition
Puestow procedure: cutting open the dilated duct length-wise and anastamosis it to at Roux limb of jejunum
Term
Most common location of pancreatic adeno ca
Definition
main pancreatic duct (66% in the head or uncinate process)
Term
Indications for a biopsy in the setting of a obstructive jaundice and weight loss
Definition
# When lesions appear to be unresectable because it may guide chemo
# When the appearance of the mass suggests other less common pathology (lymphoma)
Term
Type of diet common amongst alcoholic pancreatitis pts
Definition
High protein and high fat
Term
Difference b/w type 3 DM from Types 1/2
Definition
# It is associated with decreased glucagon and PP as well as insulin due to Pancreatic destruction
# peripheral insulin sensitivity increased while hepatic insulin sensitivity is decreased making hypoglycemia much more common but ketoacidosis and marked hyperglycemia more rare
Term
Function of pancreatic polypeptide
location of PP cells
Name of PP cells
Definition
# increases hepatic insulin sensitivity
# located in uncinate process and posterior head
# Fcells
Term
W/u of suspicious pancreatic cystic mass
Definition
MRI, EUS and CT guided aspiration of the fluid for amylase and tumor markers (CEA, CA 19-9, CA 125, CA 72-4, CA 15-3)
Term
DDx cystic lesion which displays solid components or septations on CT
Definition
Serous cystadenoma
Mucinous cystic neoplasm
Inraductal papillary-mucinous adenoma IPMN
Solid pseudopapillary neoplasm
Term
Cystic lesion on CT with peripheral eggshell calcifications
Definition
mucinous cystic neoplasm (highly suggestive of cancer
Term
Persistant ascites in a pt with a recent h/o blunt abd trauma, w/u and managment
Definition
# likely pancreatic ascities from disrupted pancreatic duct
# paracentesis- (elevated amylase level and protein level > 25 g/L diagnostic of pancreatic ascites)
# first non-operative (bowel rest, TPN), if this fails then ERCP with stenting, if this fails then surgery
Term
Surgical management of an internal pancreatic fistula
Definition
Depends on location of ductal injury:
# Tail- distal pancreatectomy
# body- RnY pancreaticojejunostomy
Term
Autoimmune pancreatitis:
# clinical presentation
# imaging characteristics
# histological findidngs
# lab findings
# treatment
Definition
# Chronic epigastric pain and jaundice in a pt s h/o alcohol abuse
# diffusely enlarged and hypoechoic pancreas on US; diffuse narrowing of pancreatic duct without calcifications on CT
# lymphocytic and plasma cell infiltrate
# elevated IgG levels and diabetes
# steroids
Term
Pancreatic lymphoma:
# findings suggestive of lymphoma (vs. adenocarcinoma)
# Way to differentiate lymphoma from adeno ca pre-operatively
# management
Definition
# large bulky pancreatic mass or diffuse pancreatic involvement
# CT guided needle bx
# chemotherapy
Term
MCC of chronic pancreatitis worldwide
Definition
Alcohol abuse
Term
MCC of acute pancreatitis worldwide
Definition
Gallstones/biliary pancreatitis
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