Term
|
Definition
inf PDA
(middle colic = first br going to bowel) |
|
|
Term
|
Definition
GDA-->sup PDA
SMA-->Inf PDA |
|
|
Term
Exocrine panc
-cell types/products/enzyme? |
|
Definition
Ductal = bicarb = carbonic anhydrase
Acinar = enzymes |
|
|
Term
| Panc enz secreted in active form? |
|
Definition
|
|
Term
|
Definition
| hydrolyze alpha 1-4 links of glucose chains |
|
|
Term
|
Definition
| convert TAG to FFA and Mono-acylglycerides |
|
|
Term
Enterokinase
-release from..?
-function? |
|
Definition
released from duodenum
converts trypsinogen-->trypsin
(trypsin then actives other enz including tyrpsinogen) |
|
|
Term
|
Definition
trypsinogen OR
auto-activation @ pH<6 |
|
|
Term
Cell type and product secreted
-alpha
-beta
-detla |
|
Definition
alpha = glucagon
beta = insulin
delta = SStatin |
|
|
Term
How do each of the following affect bicarb vs enzyme secretion?
-Secretin
-CCK
-ACh
-SStatin
-Glucagon |
|
Definition
-Secretin: Inc bicarb
-CCK: inc enzyme (most potent acinar stimulator)
-ACh: Inc both
-SStatin: dec exo (and endo)
-Glucagon: dec exo |
|
|
Term
| Where are CCK and secretin mostly released from? |
|
Definition
|
|
Term
| what parts of panc originate from ventral vs dorsal panc bud? |
|
Definition
ventral bud: uncinate, inf portion of head
dorsal bud: tail, body, superior part of head |
|
|
Term
| Which panc ducts come from which panc bud? |
|
Definition
major duct = Wirsung = ventral
accessory duct = Santorini = dorsal |
|
|
Term
transition of foregut to midgut
-anatomic definition? |
|
Definition
-occurs @ sphincter of Oddi
-where SMA takes over gut BS from celiac |
|
|
Term
|
Definition
failure of clockwise rotation of ventral bud
= duod trapped in panc band |
|
|
Term
|
Definition
feeling intolerance
pancreatitis |
|
|
Term
|
Definition
|
|
Term
|
Definition
Dx = AXR double bubble sign
UGI w/ stenosis |
|
|
Term
|
Definition
Duodeno-Jejunostomy = MC
**panc is not resected**
***if panc is problem..ERCP sphincteropl*** |
|
|
Term
Panc divisum
-ERCP findings |
|
Definition
-Minor pap has long/large duct of Santorini (minor)
-Major pap has short duct of Wirsung (major) |
|
|
Term
|
Definition
most asymptomatic
-if needed..ERCP sphincteroplasty |
|
|
Term
| MC location heterotopic panc? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| pancreatitis mortality rate? |
|
Definition
|
|
Term
| Pancreatitis signs of ecchymosis? |
|
Definition
Fox = inguinal lig
Cullen = per-umbo
Grey Turner = flank |
|
|
Term
|
Definition
1. Admission..
-age>55, WBC>16, Glu>200, AST>250, LDH>350
2. 48 hrs...
-crit drop of 10, Bun inc 5, Ca <8, PaO2<60, Base def > 4, fluid > 6L |
|
|
Term
| # ranson criteria with 100% mortality? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
-MCC = pseudoaneurysm rupture
-Tx w/ angio + embo |
|
|
Term
| benefits of enteral vs TPN @ pancreatitis? |
|
Definition
dec infections
inc survival |
|
|
Term
|
Definition
SURGERY
(drains don't work) |
|
|
Term
| part of pancreas affected with chronic panc? |
|
Definition
exocrine panc
*islets usually preserved* |
|
|
Term
| top 2 MCC of chronic panc |
|
Definition
|
|
Term
| sign of advanced chronic panc on CT? |
|
Definition
chain of lakes
-alternating dilation/stenosis of PDuct |
|
|
Term
celiac block
-% effective? |
|
Definition
|
|
Term
Chronic panc
-surg indications |
|
Definition
1. refractory, severe pain
2. can't r/o malig
3. biliary obstruction
4. abscess |
|
|
Term
Chronic panc
-surgical options |
|
Definition
1. Puestow (pancreatico-J)
-need duct > 8 mm
2. distal panc resection (normal duct size, only distal panc involved OR failed puestow
3. Whipple @ isolated head dz, nrml duct |
|
|
Term
Chronic panc
-% that get pain relief w/surg |
|
Definition
|
|
Term
|
Definition
leaking panc pseudocyst MC
PD leak
Tx = wait it out, as most resolve spont |
|
|
Term
|
Definition
1. octreotide, , NPO TPN if > 200 cc/day
2. ERCP stent
3. distal panc vs whipple
*most dont need anything* |
|
|
Term
| criteria for dx of pseudocyst? |
|
Definition
1. hx of pancreatitis, panc surg, trauma
2. not complex
3. not growing
*otherwise worry about CA* |
|
|
Term
Pseudocyst
-definition
-MC location |
|
Definition
non-epithelialized sac
-MC @ panc head |
|
|
Term
|
Definition
1. if sxs x 6 wk: ERCP
a. if duct involved-->sphincterotomy/stent
b. if not..perc drain
2. if recurs/cant drain..
a. after 3 months ->cystogastrostomy |
|
|
Term
|
Definition
glycogen from pseudocyst tap
-tx resection |
|
|
Term
| Ca risk of serous cystadenoma? |
|
Definition
-considered benign, but CA reported
-mixed serous/mucinous = definite CA risk |
|
|
Term
mucinous or mixed cystadenoCA
-5YSR |
|
Definition
|
|
Term
| tx bleeding from panc pseudocyst? |
|
Definition
|
|
Term
|
Definition
| fecal fat testing w/sudan red |
|
|
Term
|
Definition
high carb, high protein
low fat
panc enz replacement |
|
|
Term
|
Definition
painless J..then weight loss
-new DM, malab, pancreatitis,
-later can have pain |
|
|
Term
|
Definition
| migratory thrombophlebitis w/panc CA |
|
|
Term
| % pancreatic CA that arise from exocrine panc? |
|
Definition
|
|
Term
|
Definition
head (70%)
-also higher cure rate @ head dz |
|
|
Term
| % panc CA that are ductal? |
|
Definition
|
|
Term
| what are the pre-malig pancreatic exocrine CA types? |
|
Definition
mucinous and mixed cyast-adenomas
*VAST majority of serous cystadenoCa are benign* |
|
|
Term
|
Definition
k-ras (GTPase)
*present @ 90% of panc CA* |
|
|
Term
| % panc CA that are resectable? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
3 mm cuts
triple phase contrast |
|
|
Term
|
Definition
panc head CA
-->dilated panc duct + bile duct |
|
|
Term
| origin of bleeding behind pancreatic neck after dissection? |
|
Definition
| SMV-->divide panc and control bleeding |
|
|
Term
| anastomosis performed in whipple? |
|
Definition
pancreatico-J
choledocho-J
Gastro-J |
|
|
Term
chemo regimen @ panc CA?
-benefit? |
|
Definition
5FU + gemcitabine
-inc survival with RO or R1 resection |
|
|
Term
| drug regimen used for locally advnaced, unresectable or metastatic panc CA? |
|
Definition
Gemcitabine (anti-metabolite)
Erlotinib (Tyrosine kinase inihibitor, EGFR) |
|
|
Term
|
Definition
delayed gastric emptying
-->reglan |
|
|
Term
|
Definition
From acid on jejunal side of gastro-J
-tx PPI |
|
|
Term
| post op whipple bleed mgmt |
|
Definition
IR for embo
-avoid surgery |
|
|
Term
| High volume center definition? |
|
Definition
> 12 whipple per year
-dec mortality |
|
|
Term
| 5YSR pancreatic adenoCA based on nodes? |
|
Definition
30% if node neg
10% if node +ve
(25% overall after resection) |
|
|
Term
| high vs low output cutoff for panc fistula? |
|
Definition
200 cc/day
-NPO TPN if high |
|
|
Term
|
Definition
-6 weeks conservative mgmt
-ERCP/stent if fails |
|
|
Term
apullary villous adenoma/carcinoma
-classic pres |
|
Definition
obstructive jaundice
heme pos stool
+/- pancreatitis |
|
|
Term
apullary villous adenoma/carcinoma
dx |
|
Definition
ERCP bx
**high false neg rate: 70% of adenoma harbor CA** |
|
|
Term
apullary villous adenoma/carcinoma
-tx |
|
Definition
resection (incise 2nd portio duod)
-->FS and whipple if malignant
**NO WHIP IF BENIGN** |
|
|
Term
pancreatic endocrine neoplasms
1. % that are non-functional?
2. % that are malig? |
|
Definition
|
|
Term
pancreatic endocrine neoplasms
-non functional-->MC MET |
|
Definition
|
|
Term
| 5YSR for non functional pancreatic endocrine neoplasms? |
|
Definition
|
|
Term
funcitonal pancreatic endocrine neoplasms
-which amenable to octreotide? |
|
Definition
1. for treating mets?
-all except SStatinoma
2. for localization?
-all except insulinoma |
|
|
Term
| Which pancreatic endocrine neoplasms are MC located in panc head? |
|
Definition
|
|
Term
| chemo that is toxic to islet cells? |
|
Definition
|
|
Term
| MC islet cell tumor of panc? |
|
Definition
|
|
Term
| % insulinoma hat are beign? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
fasting hypogly
symptomatic hypogly
relief w/glucose |
|
|
Term
|
Definition
-insulin:glucose ratio > 0.4 after 72hr fast
-inc c-peptide and pro-insulin (r/o munchausen)
-fasting hypogly, w/insulin > 24 |
|
|
Term
insulinoma dx
-locatlization options |
|
Definition
-CT for mets to liver
-EUS (80% located)
-selective arterial Ca stim w/hepatic venous insulin sampling
**Ca causes release of insulin** |
|
|
Term
|
Definition
1. Enucleate if < 2 cm (even if multiple)
*whip/distal panc if > 2cm
**can check intra-op glucose to see if tumor removed (insulin t1/2 = 4 min)** |
|
|
Term
| Mgmt if can't find insulinoma? |
|
Definition
1. Intra-op US
2. still cant?-->NO BLIND RSXN
*close and post-op arterial calcium stim w/hepatic venous insulin sampling* |
|
|
Term
|
Definition
Sertozosin, 5FU
Octreotide
Dizoxide (insulin release inhibitor) |
|
|
Term
| MC panc islet cell tumor in pts w/MEN1? |
|
Definition
|
|
Term
| % gastrinoma that are sporadic vs MEN1 associated? |
|
Definition
|
|
Term
| % gastrinoma that are malig |
|
Definition
50%
*pancreatic inc malig vs duod*
*sporadic inc malig vs MEN1* |
|
|
Term
| % gastrinoma that are multiple |
|
Definition
|
|
Term
|
Definition
75% in gastrinoma triangle
CBD--Panc neck--3rd part duod |
|
|
Term
|
Definition
refractory/complciated ulcer dz
diarrhea (improved with PPI) |
|
|
Term
|
Definition
1. fasting gsatrin >200 = suggestive, >1000 =dx
2. BAO > 15 (no hx vagotomy), >5 w/vagotomy
3. Gastrin >200, BAO >15 = DIAGNOSTIC |
|
|
Term
| Secretin stim test interp? |
|
Definition
Inc gastrin w/secretin admin (opposite normal)
->200 increase = +ve |
|
|
Term
| Best test for gastrinoma localization? |
|
Definition
|
|
Term
| Other test to perform pre-op before gastrinoma rsxn? |
|
Definition
hyperparathyroid screen
-treat it first if they have it |
|
|
Term
|
Definition
< 2cm
-duod = duodenotomy w/rsxn (take local nodes)
-panc = enuc + local nodes
> 2cm
-formal resection (whip) |
|
|
Term
| mgmt if can't find gastrinoma? |
|
Definition
duodenostomy and look around
-20% of microgastrinomas are here
**blind panc rsxn not advised** |
|
|
Term
Gasrinoma
-mgmt unresectable tumor with sxs? |
|
Definition
1. PPI
2. debulk + met ablation
3. streptozosin + 5FU
4. octreotide
*last option = total gastrectomy* |
|
|
Term
inc BAO and gastrin levels, but not to diagnostic level for gastrinoma..
-possible Dx? |
|
Definition
| Antral G cell hyperplasia |
|
|
Term
| panc endocrine tumor with worst prog? |
|
Definition
SStatinoma
-majority are malig |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| fasting somatostatin level |
|
|
Term
|
Definition
resection of tumor + cholecystectomy
-5fu + streptozosin vs mets |
|
|
Term
|
Definition
|
|
Term
|
Definition
DM,
Dermatitins (Necrotizing migratory erythema)
wt loss, stomatitis |
|
|
Term
|
Definition
fasting glucagon level > 500-1000 pg/mL
-resction
- |
|
|
Term
|
Definition
70% get necrotizing migratory erythema
-Zinc, aa, or FA |
|
|
Term
|
Definition
distal panc
-10% extra-panc: retroP, thoracic |
|
|
Term
|
Definition
WDHA
-watery D, hypoK, achlorhydia
**Diarrhea NOT improved with PI** |
|
|
Term
|
Definition
-fasting VIP levels
-resection +/- Interferon + 5FU |
|
|
