ABSITE ch 33 pancreas.txt

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alshada
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ABSITE ch 33 pancreas.txt
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2010-01-11 11:03:38
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pancreas ABSITE
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ABSITE pancreas
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  1. Branches of celiac that supply the pancreas (2)
    GDA/superior pancreaticoduodenals; splenic/pancreatic artery
  2. Branches of SMA that supply the pancreas (1)
    Inferior pancreaticoduodenals
  3. Blood supply to pancreas (4)
    GDA, splenic, pancreaticoduodenals (superior and inferior, anterior and posterior of each), dorsal pancreatic artery
  4. Location of uncinate process of pancreas
    Resting on aorta behind SMA
  5. Location of neck of pancreas
    Laying anterior to SMA and SMV
  6. Blood supply to pancreatic head
    Superior and inferior pancreaticoduodenals
  7. Blood supply to pancreatic body
    Great, inferior and caudal pancreatic artery
  8. Blood supply to pancreatic tail
    Splenic, gastroepiploic, dorsal pancreatic artery
  9. Pancreatic cells with carbonic anhydrase that secrete bicarb
    Ductal cells
  10. Pancreatic cells that secrete Cl- and digestive enzymes
    Acinar cells
  11. Only pancreatic enzyme secreted in active form
    Amylase
  12. Exocrine hormones of the pancreas (5)
    Amylase, lipase, trypsinogen, chymotrypsinogen, carboxypeptidase
  13. Hormone secreted by alpha cells
    Glucagon
  14. Hormone secreted by beta cells
    Insulin
  15. Hormone secreted by delta cells
    Somatostatin
  16. Hormone secreted by PP or F cells
    Pancreatic polypeptide
  17. Enzyme that activates trypsinogen to trypsin
    Enterokinase
  18. Role of secretin
    Pancreatic bicarb excretion
  19. Role of CCK
    Increased pancreatic enzyme secretion
  20. role of somatostatin
    decreased exocrine secretion of pancreas
  21. major pancreatic duct that merges with CBD prior to entering duodenum
    duct of Wirsung
  22. minor pancreatic duct that drains directly into duodenum
    duct of Santorini
  23. failure of clockwise rotation of ventral pancreatic bud during development, resulting in 2nd portion of duodenum being trapped in pancreatic band
    annular pancreas
  24. failed fusion of pancreatic ducts; can result in pancreatitis from duct stenosis
    pancreas divisum
  25. treatment of pancreas divisum
    sphincteroplasty and stent placement, or longitudinal pancreaticojejunostomy if refractory
  26. most common cause of pancreatitis in US (2)
    gallstones, ETOH
  27. most common location for heterotopic pancreas
    duodenum
  28. medications that can cause pancreatitis (4)
    lasix, cimetidine, azathioprine, steroids
  29. dilated small bowel near pancreas seen in pancreatitis
    sentinel loop
  30. Ranson�s criteria on admission (5)
    Age>55, WBC>16, glucose>200, AST>250, LDH>350
  31. Ranson�s criteria after 48 hours (5)
    Hct drop 10%, BUN inc 5%, Ca<8, PaO2<60, base deficit >4, fluid sequestration >6L
  32. Gray Turner sign
    Flank ecchymosis secondary to hemorrhagic pancreatitis
  33. Cullen�s sign
    Periumbilical ecchymosis secondary to hemorrhagic pancreatitis
  34. Fox�s sign
    Inguinal ecchymosis secondary to hemorrhagic pancreatitis
  35. Cause of ARDS in pancreatitis
    Release of phospholipases
  36. Cause of coagulopathy in pancreatitis
    Release of proteases
  37. Causes of elevated lipase (6)
    Pancreatitis, cholecystitis, perforated ulcer, sialoadenitis, SBO, intestinal infarct
  38. Treatment of pseudocyst if duct is involved
    Cystgastrostomy
  39. Treatment of pseudocyst if duct not involved
    Perc drainage
  40. Complications of pseudocyst (3)
    SBO, infection, portal/splenic vein thrombosis
  41. Treatment of pancreatic fistula (medical and surgical)
    Drainage, TPN, octreotide, ERCP/sphincterotomy, distal panc/Whipple
  42. Alternating segments of dilation and stenosis of pancreatic duct
    Chain of lakes (due to chronic pancreatitis)
  43. Surgical indications for chronic pancreatitis (5)
    Pain, nutrition, narcotic addiction, question of malignancy, biliary obstruction
  44. Surgical treatment of chronic pancreatitis
    Puestow (pancreaticojejunostomy), distal pancreatectomy or whipple if anatomy indicates
  45. Test to determine pancreatic insufficiency
    Fecal fat
  46. Pancreatic etiologies of biliary stenosis (2)
    Pseudocyst, fibrosis
  47. #1 risk factor for pancreatic cancer
    Smoking
  48. Serum marker for pancreatic cancer
    CA 19-9
  49. Most common location for pancreatic cancer
    Head
  50. Dilation of both CBD and pancreatic duct on imaging
    Double duct sign
  51. #1 complication from Whipple
    Delayed gastric emptying
  52. Treatment of pancreatic duct leak
    Drain, ERCP, possible stent
  53. Most common site of metastasis for endocrine pancreatic tumors
    Liver
  54. 5-year survival of nonfunctional endocrine pancreatic neoplasms
    50%
  55. Medical treatment for insulinoma, glucagonoma,gastrinoma, VIPoma
    Octreotide
  56. Most common location for gastrinoma and somatostatinoma
    Pancreatic head
  57. Most common islet cell tumor of pancreas
    Insulinoma
  58. Fasting hypoglycemia + symptoms of hypoglycemia + relief with glucose
    Whipple�s triad
  59. Medical treatment for metastatic pancreatic endocrine cancers
    Streptozosin, octreotide, 5FU
  60. Most common pancreatic islet cell tuor in MEN I patients
    Gastrinoma
  61. % of gastrinomas that are malignant
    50
  62. % of gastrinomas that are spontaneous (vs assoc. with MEN)
    75
  63. Gastrinoma triangle
    CBD, neck of pancreas, third portion of duodenum
  64. Diagnostic test for gastrinoma/ZES
    Secretin stimulation test (will increase gastrin in patients with ZES)
  65. Best study for localizing gastrinomas
    Somatostatin receptor scintigraphy
  66. Endocrine tumor causing whipple�s triad
    Insulinoma
  67. Endocrine tumor causing refractory ulcer disease and diarrhea
    Gastrinoma
  68. Endocrine tumor causing diabetes, gallstones, steatorrhea, hypochlohydria
    Somatostatinoma
  69. Endocrine tumor causing diabetes, stomatitis, dermatitis, weight loss
    Glucagonoma
  70. Most common location of glucagonoma and VIPoma in pancreas
    Distal
  71. Endocrine tumor causing watery diarrhea, hypokalemia, achlorhydria
    VIPoma

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