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