Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
56 Cards in this Set
- Front
- Back
|
blood supply to the head
|
superior and inferior pancreaticoduodenal arteries
|
|
|
blood supply to the body
|
great, inferior, caudal pancreatic arteries (all off splenic artery)
|
|
|
blood supply to tail
|
splenic, gastroepiploic, dorsal pancreatic arteries
|
|
|
2 cell types in the exocrine pancreas
Functions of each |
ductal cells-carbonic anhydrase, secretin bicarbonate solution
Acinar cells-secrete chloride and digestive enzymes |
|
|
5 enzymes produced by exocrine pancreas
|
amylase
Lipase Trypsinogen chymotrypsinogen Carboxypeptidase Bicarbonate |
|
|
this is the only pancreatic enzyme secreted in active form
|
amylase
|
|
|
name the 5 cell types of the endocrine pancreas and give their functions
|
alpha cells-glucagon
beta cells-insulin delta cells-somatostatin PP or F cells- pancreatic polypeptide islet cells-VIP, serotonin, neuro-peptidase Y, gastrin releasing peptide |
|
|
released by the duodenum, this activates trypsinogen to trypsin
|
enterokinase
|
|
|
give hormonal control of pancreatic excretion for
Secretin- CCK- Acetylcholine- Somatostatin and glucagon- |
Secretin-increased bicarbonate
CCK-increase pancreatic enzymes Acetylcholine-increased bicarbonate and enzymes Somatostatin and glucagon-decrease exocrine function |
|
|
name the 2 ducts of the pancreatic head, what each does
|
duct of Santorini-small accessory pancreatic duct entering directly into the duodenum
Duct of Wirsung- major pancreatic duct that merges with common bile duct before entering the one |
|
|
described as entrapment of the second portion of the duodenum by pancreatic band, look for double bubble, seen in Down syndrome
|
annular pancreas
|
|
|
Ranson's criteria
On admission |
age > 55
WBC > 16 Glucose > 200 AST >250 LDH > 350 |
|
|
Ranson's criteria
After 48 hours |
hematocrit decreased by 10%
BUN increase by 5 Calcium< 8 PaO2 <60 base deficit> 4 Fluid sequestration> 6 L |
|
|
described:
Gray Turner sign- Cullen's Sign- Fox's sign- |
Gray Turner sign-flank ecchymosis
Cullen's Sign-periumbilical ecchymosis Fox's sign-inguinal ecchymosis |
|
|
this is the most important risk factor for necrotizing pancreatitis
|
obesity
|
|
|
one complications arise from pancreatitis causing release of phospholipases and protease
|
ARDS
Coagulopathy Pancreatic/fat necrosis |
|
|
patient presents with pain, fever, increased WBC, palpable masses, jaundice, weight loss, bowel obstruction. significant history for chronic pancreatitis
Most common location |
pancreatic pseudocyst
Head of the pancreas |
|
|
patient's with symptomatic or growing pseudocysts need MRCP or ERCP to determine duct involvement,
How will this affect management |
duct involved-cystogastrostomy
no duct involved, percutaneous drainage of pseudocyst |
|
|
3 main complications of pancreatic pseudocyst
|
small bowel obstruction
Infection Portal or splenic vein thrombosis |
|
|
chronic pancreatitis corresponds to irreversible parenchymal fibrosis 2 most common causes
Most common symptoms |
alcohol, idiopathic
Anorexia, weight loss, malabsorption, steatorrhea, recurrent acute pancreatitis. |
|
|
which cells are typically preserved in chronic pancreatitis
|
islet cells
|
|
|
what are the surgical indications for chronic pancreatitis
|
pain interfering with quality of life
Nutrition abnormalities Addiction to narcotics Failure to rule out malignancy Biliary obstruction Abscess |
|
|
describes the puestow procedure
|
pancreaticojejunostomy (for ducts greater than 8 mm). opened along the main pancreatic duct and drain into the jejunum
|
|
|
most common cause of splenic vein thrombosis
treatment |
chronic pancreatitis
splenectomy |
|
|
2 symptoms of pancreatic insufficiency
how to diagnoses |
malabsorption and steatorrhea
Fecal fat testing |
|
|
treatment for pancreatic insufficiency
|
high carbohydrate, high protein, low fat diet with pancreatic enzyme replacement
|
|
|
workup for jaundice, first ultrasound
Positive stone, no mass- No stones no mass- Positive mass- |
Positive stone, no mass- ERCP
No stones no mass- abdominal CT/MRI Positive mass- abdominal MRI/CT |
|
|
pancreatic adenocarcinoma
Etiology Signs and symptoms 5 year survival rate if resected |
males, 6-7 decade
Weight loss, jaundice, pain 20% five-year survival |
|
|
pancreatic adenocarcinoma
#1 risk factor Serum marker Site a first metastatic spread |
smoking
CA 19-9 Lymphatics |
|
|
pancreatic adenocarcinoma
In general what indicates unresectable disease |
invasion of portal vein SMV or retroperitoneum at time of diagnosis
Metastasis to peritoneum, omentum, liver |
|
|
differentiate prognosis of papillary cystic adenocarcinoma versus serous cystadenocarcinoma versus mucinous cystadenomas
|
papillary cystic and serous cystadenomas majority are benign
Mucinous cystadenoma are considered premalignant |
|
|
when Do you obtain biopsy in patients with resectable pancreatic mass and no sign of metastatic disease
|
never, you do not need a biopsy because you were taking it out regardless.
*Do get biopsy if metastatic* |
|
|
3 signs of cancer on ERCP
|
duct with irregular narrowing,
Displacement, Distruction |
|
|
sign on abdominal CT seen in pancreatic head cancers
|
double-duct sign
dilation of both pancreatic and common bile ducts |
|
|
oncologic treatments for pancreatic cancers
|
gemcitabine
X-ray therapy |
|
|
most common complication from Whipple's
Give treatment |
delayed gastric emptying
Metoclopramide |
|
|
prognosis of nonfunctional endocrine pancreatic tumors
|
90% are malignant
|
|
|
nonfunctional pancreatic endocrine tumors
treatment Prognosis |
5-FU and streptozocin
Resection 50% five-year survival after resection |
|
|
functional pancreatic endocrine tumors
2 most common located in pancreatic head Octreotide is effective treatment for these 4 |
head-gastrinoma, somatostatinoma
Octreotide-insulinoma, glucagonoma, gastrinoma, VIPoma |
|
|
functional pancreatic endocrine tumors
First area to metastasize |
liver spread is first for all types
|
|
|
most common islet cell tumor of the pancreas
85-95% benign Diagnosis by insulin to glucose ratio >0.4 after fasting Increase C-peptide and probe insulin Differential diagnosis if C-peptide normal |
insulinoma
Munchausen syndrome |
|
|
insulinoma: Symptoms
Describes Whipple triad |
fasting hypoglycemia (<50)
hypoglycemia symptoms, ( catecholamine surge, Palpitations, increased heart rate and diaphoresis) Relief with glucose |
|
|
insulinoma
Treatment Chemotherapy? |
if< 2 cm enucleation
If> 2 cm formal resection Streptozocin, octreotide, 5-FU for metastatic disease |
|
|
gastronoma
Most common pancreatic islet cell tumor in this syndrome Prognosis Predetermining factors |
MEN-1
50% malignant, 50% multiple 75% spontaneous |
|
|
gastrinomas
Majority are found in the gastrinoma triangle bounded by |
common bile duct,
Neck of the pancreas, 3rd Portion of the duodenum |
|
|
gastrinoma
Symptoms |
refractory ulcer disease-abdominal pain
Diarrhea, improved with H2 blockers |
|
|
gastrinoma
Diagnosis |
serum gastrin > 200 (suggestive)
*Greater than 1000 is diagnostic Secretin stimulation test, if positive, will increase gastrin levels |
|
|
gastrinoma
Treatment |
if< 2 cm enucleation
If> 2 cm formal resection Excise all suspicious nodes |
|
|
gastrinoma
Preoperative identification of tumor single best study to localize the tumor |
somatostatin receptor scintigraphy
|
|
|
somatostatinoma
Extremely rare Symptoms Prognosis |
diabetes, gallstones, steatorrhea, hypochlorydia
next most malignant found in the head of the pancreas |
|
|
glucagonoma
Symptoms Prognosis Most common location |
diabetes, stomatitis, dermatitis (necrolytic migratory erythema), weight loss
Most malignant Most in distal pancreas |
|
|
VIPoma (Verner-Morrison syndrome)
symptoms Prognosis Most common location |
watery diarrhea causing hypokalemia, and achlorydia
Most malignant Most in distal pancreas |
|
|
primary features of
MEN-1 (wermer syndrome) |
pituitary adenoma
Parathyroid hyperplasia Pancreatic tumors |
|
|
primary features of
MEN-2a (simple syndrome) |
parathyroid hyperplasia
medullary thyroid carcinoma pheochromocytoma |
|
|
primary features of
MEN-2b |
mucosal neuromas
Marfanoid habitus medullary thyroid carcinoma Pheochromocytoma |
|
|
which genes are involved with each:
MEN-1 MEN-2a MEN-2b |
MEN-1 - MEN1
MEN-2a - RET Protoncogene MEN-2b - RET Protoncogene |
