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Flashcards in Fiser: Pancreas Deck (29)
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1

blood supply: head of pancreas

superior: off GDA
Inferior: pancreaticoduodenal ateries

2

blood supply: body of pancreas

great, inferior and dorsal pancreatic arteries (all off splenic aa)

3

Blood supply: tail of pancreas

splenic, gastroepiploic and caudal pancreatic arteries

4

ductal cells of pancreas secrete what?

HCO3- solution

5

Acinar cells of pancreas secrete what?

digestive enzymees

6

what is the only pancreatic enzyme thats secreted in active form?

amylase

7

Secretion: Alpha islet cells

glucagon

8

Secretion: Beta Islet Cells

insulin

9

Secretion: Delta islet cells

somatostatin

10

Secretion: PP or F islet cells

pancreatic polupetide

11

what activated typsinogen to trypsin?

enterokinase: released from duodenum

12

Action of: secretin

release of bicarb from pancreas (secreted from the duodenum)

13

Action of CCK

release of pancreatic enzymes (secreted from the duodenum)

14

Action of Somatostatin

decreases exocrine function of pancreas

15

two pancreatic ducts and embryology

1. ventral pancreatic bud -> duct of wirsung, this bud migrates posterior and clockwise (uncinate and inferior head)
2. dorsal pancreatic bud -> duct of santorini, this bud forms the body, tail and superior aspect of head

16

pathophysiology of annular pancreas

forms from the ventral pancreatic bud from failure of clockwise rotation

17

what will you se on ERCP for pancreas divisum?

minor papilla will show long duct of santorini, major will have short duct of wirsung (opposite of what it should be)

18

buzzword: chain of lakes

chronic panceratitis, alternating segments of dilation and stenosis of pancreatic duct

19

genetic mutation found in 95% of pancreatic adenocarcinomas?

p16 mutation (tumor suppressor, binds cyclin complexes)

20

what's whipple's triad?

- symptoms of insulinoma
1. Fasting hypoglycemia (<50)
2. Symptoms of hypoglycemia
3. Relief with glucose

21

how to diagnose insulinoma?

insulin to glucose ration >0.4, increase C peptide and proinsulin

22

NET: refractory PUD and diarrhea, how to diagnose?

Gastinoma, diagnose with gastrin >200 (usually 1,000's) and secretin stimulation test -> increased gastrin (normal is decreased)

23

single best study for localizing a gastrinoma?

octreotide scan

24

NET and how to diagnose: diabetes, stomatitis, dermatitis

Glucagonoma, diagnose with a fasting glucose level

25

NET and how to diagnose: watery diarrhea, hypokalemia, achlorhydria

VIPoma, see increased VIP levels

26

NET and how to diagnose: diabetes, gallstones, steatorrhea

somatostatinoma, fasting somatostatin level

27

what are the criteria for performing diagnostic laparoscopy in pancreatic cancer?

1. Large tumors (>3cm)
2. Significantly elevated CA 19-9
3. Equivocal CT
4. Pancreatic body and tail tumors

28

what is the treatment for autoimmune pancreatitis?

corticosteroids for 2-4 weeks or until symptoms resolve (must rule out pancreatic cancer)

29

what is genetic mutation behind hereditary pancreatitis?

PRSS1: cationic trypsinogen gene mutation