Flashcards in Fiser: Pancreas Deck (29)
blood supply: head of pancreas
superior: off GDA
Inferior: pancreaticoduodenal ateries
blood supply: body of pancreas
great, inferior and dorsal pancreatic arteries (all off splenic aa)
Blood supply: tail of pancreas
splenic, gastroepiploic and caudal pancreatic arteries
ductal cells of pancreas secrete what?
Acinar cells of pancreas secrete what?
what is the only pancreatic enzyme thats secreted in active form?
Secretion: Alpha islet cells
Secretion: Beta Islet Cells
Secretion: Delta islet cells
Secretion: PP or F islet cells
what activated typsinogen to trypsin?
enterokinase: released from duodenum
Action of: secretin
release of bicarb from pancreas (secreted from the duodenum)
Action of CCK
release of pancreatic enzymes (secreted from the duodenum)
Action of Somatostatin
decreases exocrine function of pancreas
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
pathophysiology of annular pancreas
forms from the ventral pancreatic bud from failure of clockwise rotation
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)
buzzword: chain of lakes
chronic panceratitis, alternating segments of dilation and stenosis of pancreatic duct
genetic mutation found in 95% of pancreatic adenocarcinomas?
p16 mutation (tumor suppressor, binds cyclin complexes)
what's whipple's triad?
- symptoms of insulinoma
1. Fasting hypoglycemia (<50)
2. Symptoms of hypoglycemia
3. Relief with glucose
how to diagnose insulinoma?
insulin to glucose ration >0.4, increase C peptide and proinsulin
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)
single best study for localizing a gastrinoma?
NET and how to diagnose: diabetes, stomatitis, dermatitis
Glucagonoma, diagnose with a fasting glucose level
NET and how to diagnose: watery diarrhea, hypokalemia, achlorhydria
VIPoma, see increased VIP levels
NET and how to diagnose: diabetes, gallstones, steatorrhea
somatostatinoma, fasting somatostatin level
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
what is the treatment for autoimmune pancreatitis?
corticosteroids for 2-4 weeks or until symptoms resolve (must rule out pancreatic cancer)