Term
| Genetic mutation a/w tropical pancreatitis |
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Definition
| mutation of the pancreatic secretory trypsinogen inhibitor or SPINK1 gene |
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Term
Tropical Pancreatitis
Chronic or Acute
Who gets it
Assoc environmental exposure |
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Definition
| Chronic pancreatitis that presents in younger patients in tropical climates and is a/w ingestion of casaval root |
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Term
| Natural hx of tropical pancreatitis |
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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 |
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Term
| Tx of tropical pancreatitis |
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Definition
pain control and digestive enzyme supplementation
If obstruction develops, may require endoscopic or surgical (rarely) decompression |
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Term
| Surgical options for tx of a symptomatic pancreatic pseudocyst |
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Definition
cystgastrostomy
RNY cystojejunostomy
and a cyst duodenostomy |
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Term
| How to predict the success of endoscopic approach to cystogastrostomy |
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Definition
| finding of a major ductal disruption or stenosis on ERCP or MRCP |
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Term
| New onset DM a/w skin rash and a pancreatic mass in the tail |
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Definition
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Term
| Name and location of rash a/w glucagonoma |
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Definition
Necrolytic migratory erythema
Lower abdomen or perineum |
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Term
| Way to diagnose glucagonoma |
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Definition
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Term
| Intermittent vague RUQ pain, jaundice a/w greasy, floating stools and a pancreatic head mass |
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Definition
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Term
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Definition
| inhibits panreatic and biliary secretions |
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Term
| Pancreatic head mass a/w exocrine pancreas dysfunction (steatorrhea and gallstones) |
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Definition
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Term
| Pancreatic tail mass a/w episodic large volume watery/secretory diarrhea |
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Definition
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Term
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Definition
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Term
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Definition
VIPoma
Watery diarrhea, hypokalemia, achlorhydria |
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Term
| Best medical tx for sx of VIPoma |
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Definition
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Term
| surrgical tx of sx of VIPoma |
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Definition
| Tumor debulking, hepatic artery embolization and radio frequency ablation |
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Term
| Risk factors for pancreatic cancer |
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Definition
Smoking
BRCA2
Diabetes
Chronic pancreatitis
Obesity
Atypical multiple mole melanoma,
hereditary pancreatitis, FAP
HNPCC
Peutz-Jeghers |
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Term
| MC functional pancreatic endocrine neoplasm |
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Definition
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Term
| Pancreatic mass (anywhere in pancreas) a/w multiple syncopal episodes, palpitations, trembling, diaphoresis, confusion/disorientation or seizures |
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Definition
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Term
| Way to diagnose an insulinoma |
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Definition
| Low fasting glucose level and an elevated c-peptide level |
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Term
| MC location in the pancreas of an insulinoma |
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Definition
| evenly distributed b/w the head, body, tail |
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Term
| Best way to diagnose a gastrinoma |
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Definition
| Octreotide scanning combindedd with EUS |
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Term
| Tumors for which octreotide scanning can be most useful |
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Definition
| Gastrinomas and carcinoid tumors |
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Term
| Why are octreotide scans necessary to localize gastrinomas? |
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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 |
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Term
| MC location of gastrinomas |
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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 |
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Term
| Admission Ranson criteria |
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Definition
Age older than 55
WBC > 16000
Glucose > 200
LDH > 350
AST > 250 |
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Term
| Additional Ranson criteria at 48 hours |
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Definition
Hct decrease > 10%
BUN increase by more than 5%
Serum Calcium less than 8
PO2 < 60
Base deficit > 4
Fluid sequestration > 6L |
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Term
| Role of ERCP/Chole in biliary-pancreatic disease |
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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 |
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Term
| Best predictor of residual CBD stone in gallstone pancreatitis |
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Definition
| persistantly elevated tbili |
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Term
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Definition
| Hyponatremia a/w hypertriglyceridemia in which the lipids displace the water in the serum leading to a falsely low sodium levels |
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Term
| Hereditary pancreatitis: pathophys, mode of inheritance, presentation, natual hx |
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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 |
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Term
| Anomaly of pancreas divisum, incidence, major risk and treatment |
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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 |
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Term
| Preferred tx of dilated pancreatic duct with distal obstuction in chronic pancreatitis |
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Definition
| Puestow procedure: cutting open the dilated duct length-wise and anastamosis it to at Roux limb of jejunum |
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Term
| Most common location of pancreatic adeno ca |
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Definition
| main pancreatic duct (66% in the head or uncinate process) |
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Term
| Indications for a biopsy in the setting of a obstructive jaundice and weight loss |
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Definition
# When lesions appear to be unresectable because it may guide chemo
# When the appearance of the mass suggests other less common pathology (lymphoma) |
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Term
| Type of diet common amongst alcoholic pancreatitis pts |
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Definition
| High protein and high fat |
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Term
| Difference b/w type 3 DM from Types 1/2 |
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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 |
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Term
Function of pancreatic polypeptide
location of PP cells
Name of PP cells |
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Definition
# increases hepatic insulin sensitivity
# located in uncinate process and posterior head
# Fcells |
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Term
| W/u of suspicious pancreatic cystic mass |
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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) |
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Term
| DDx cystic lesion which displays solid components or septations on CT |
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Definition
Serous cystadenoma
Mucinous cystic neoplasm
Inraductal papillary-mucinous adenoma IPMN
Solid pseudopapillary neoplasm |
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Term
| Cystic lesion on CT with peripheral eggshell calcifications |
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Definition
| mucinous cystic neoplasm (highly suggestive of cancer |
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Term
| Persistant ascites in a pt with a recent h/o blunt abd trauma, w/u and managment |
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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 |
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Term
| Surgical management of an internal pancreatic fistula |
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Definition
Depends on location of ductal injury:
# Tail- distal pancreatectomy
# body- RnY pancreaticojejunostomy |
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Term
Autoimmune pancreatitis:
# clinical presentation
# imaging characteristics
# histological findidngs
# lab findings
# treatment |
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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 |
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Term
Pancreatic lymphoma:
# findings suggestive of lymphoma (vs. adenocarcinoma)
# Way to differentiate lymphoma from adeno ca pre-operatively
# management |
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Definition
# large bulky pancreatic mass or diffuse pancreatic involvement
# CT guided needle bx
# chemotherapy |
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Term
| MCC of chronic pancreatitis worldwide |
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Definition
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Term
| MCC of acute pancreatitis worldwide |
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Definition
| Gallstones/biliary pancreatitis |
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