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absite pancreas
| Question | Answer |
|---|---|
| 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
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