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absite pancreas

QuestionAnswer
where is head of pancreas portion behind SMA
where is neck of pancreas in front of SMA and portal vein
what supplies head of pancreas artery gastroduo giving off superior apncreticoduo, SMA giving off inferior pancreaticoduo
body and tail of pancreas supplied by arteries off what main vessel splenic
where does pancreatic venous drainage go portal system
2 types of cells in pancreas and what secrete ductal: carbonic anhydrase/HCO3, acinar CL and enzymes
5 enzymes secreted by exocrine pancreas amylase, lipase, trypsinogen, chymotrypsin, carboxypeptidase
which is the only pancreatic enzyme excreted in active form amylase
what are the 4 endocrine cell types of the pancreas and what do they secrete alpha-glucagon, beta-insulin, delta-somatostatin, PP or F cells-pancreatic polypeptide
where does enterokinase come from? Fxn? duodenem, turns trypsinogen to trypsin
what 4 other enzymes come from pancreas (not lettered cell types) VIP, serotonin, neuropeptide Y, gastric releasing peptide
how do somatostain and glucagon affect pancreatic exocrine fxn decrs exocrine fxn
control of pancreatic enzymes from 2 duo enzymes include secretin increases HCO3, CCK increases enzymes
how does acetylchol affect pancreatic enzymes increases HCO3 and enzymes
what is the accessory pancreatic duct called? Where does it drain duct of santorini, drain directly into duo
how does pancreas develop ventral bud (uncinate and head, connected to duct of Wirsung) migrates clockwise to fuse w dorsal bud (body, tail, accessory duct)
what's the main pancreatic duct called duct of Wirsung
annular pancreas assoc w Down
tx of annular pancreas duodenojejunostomy or duodenoduodenostomy and sphincteroplasty (don't need to resect pancreas)
what see on AXR w annular pancreas? Which portion duo abnl dbl bubble, 2nd portion duo
what's pancreas divisum 2 separate ducts remain, from failed fusion of pancreatic ducts
MC location of heterotopic pancreas duo, usu asympt
causes acute pancreatitis GET SMASHED=gallstone (40%), ETOH (40%), trauma, steroids, mumps/coxB, autoimmune, scorpion, HyperCa and lipid, ERCP, Drugs (azathioprine, Lasix, steroids, cimetidine)
MC drugs causing pancreatitis azathioprine, Lasix, steroids, cimetidine)
s/s hemorrhagic pancreatitis ecchymosis following fascial plane (Gray Turner's sign (flank), Cullen's sign (periumbilical), Fox's sign)…mortality 50%
lung and bowel findings w pancreatitis L sided pl eff w high amylase and sentinel loop (small bowel dilated near pancreas)
which more specific for pancreatitis lipase (amylase nonspecific)
what can LFTs tell u re pancreatitis LFTs can indicate if gallstones, and AST:ALT >2 can indicate EtOH
Ranson's criteria admission: age>55, WBC>16, glu>200, AST>250, LDH>350; 48h: 48hrs: Hct decrs by 10%, BUN incrs by 5, Ca<8, PaO2 <60, base deficit >4, fluid sequestration >6L
w/u and tx pancreatitis U/S check for stones, would do chole after recovery; key avoid morphine
how manage necrosis, how often necrosis 15% develop necrosis, do nothing unless gets infected
why does ARDS develop s/p pancreatitis phospholipases
why coagulopathy develop in pancreatitis proteases released [also causes the necrosis]
infxn w pancreatitis is most common what class of bugs GNR
things that can cause a mild incrs amylase/lipase cholecystitis, perf'd ulcer, inflamm of salivary gland, SBO, intestinal infarct
who gets pancreatic pseudocysts, when and where occur chronic pancreatitis, often head of pancreas and <5cm can resolve sponatneously--a non epitheliazed sac (so pseudo)
how can pancreatic pseudocyst present pain,F, WBC, jaundice, palpable mass
w/u pancreatic pseudocyst need MRCP or ERCP to check for duct involvement, if duct involved cystogastrotomy, otherwise perQ drainage
which parts of pancreas are damaged in chronic pancreatitis exocrine tissue is fibrosed, but islet cells (VIP, serotonin, neuroY, gastric rel peptide) preserved
which method very sensitive for diagnosing chronic pancreatitis ERCP
when surgery for chronic pancreatitis if can't control pain, do Puestow (pancreaticojejunostomy for ducts >8mm,slice open pancreas like french baguette and attach side to side to jejunum), Can do distal pancreactectomy if duct not dilated or when small part is affected
differentiating bw endocrine and exocrine pancreas endocrine=into bloodstream or paracrine to nearby cells; exocrine=into duct
mgmt pancreatic fistula most close spontaneously (<200/d), can use TPN and octreotide, if fails do ERCP w sphincterotomy and stent…if this fails distal pancreatectomy or Whipple (prox lesion)
jaundice w/u based on U/S and presence of stone if stones ERCP, if no stone and no mass CT, if mass CT
#1RF pancreatic cancer smoking
marker pancreatic cancer CA19-9
#1 cxn Whipple, tx delayed emptying, metocloparmide or erythromycin
how manage pain in unresectable pan ca celiac plexus block
are nonfunctional endocrine tumors malignant? 90%
tx nonfxnl endocrine tumors resection
what tumors can octreotide be used for? insulinoma, glucagonoma, gastrinoma, VIPoma
which 2 fxnl endocrine tumors are commonly found in pancreatic head gastrinoma, somatostatinoma
nonfunctional endocrine and fxnl endocrine fumors both spread where liver
MC islet cell tumor insulinoma
s/s insulinoma, malignant? 90% benign, Whipple's triad: fasting hypoglu (<50), symptoms of hypogly incl palpitations, tachycardia, diaphoresis, relief w glu
tx insinulinoma enucleate if <2cm, resxn if larger
s/s gastrinoma ZES, MC of pancreatic islet tumors in MEN1, ulcers, diarrhea
what scan can help locate gastrinoma somatostatin R scintography
tx gastrinoma enucleate if <2cm, resxn if larger
s/s somatostatinoma DM, gallstones, steatorrhea, hypoCl
are somatostinomas malignant yes
are gastrinomas malignant? 50%
tx somatostatinoma resxn and chole
s/s glucagonoma DM, stomatitis, dermatitis
are glucagonomas malignant yes
s/s VIPomas watery diarrhea, hypoK, no CL
are VIPomas malignant yes
Created by: ehstephns on 2013-01-22



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