Tropical Pancreatitis EXCEPT It is common in adolescent It is associated with proteincaloric malnutrition It has a familial pattern Frequently leads to chronic pancreatitis It is not associated with diabetes ID: 929007
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Slide1
Pancreas
Slide2All of the following are true about
Tropical
Pancreatitis EXCEPT:
It is common in adolescent
It is associated with protein-caloric malnutrition
It has a familial pattern
Frequently leads to chronic pancreatitis
It is not associated with diabetes
Slide3All of the following are true about Topical Pancreatitis EXCEPT:
It is common in adolescent
It is associated with protein-caloric malnutrition
It has a familial pattern
Frequently leads to chronic pancreatitis
It is not associated with diabetes
Slide4Tropical panreas
Genetic mutation of the pancreas
secretory
trypsinogen
inhibiter or SPINK1 gene
Abd
pain & DM
Pancreatic duct stone
Risk of cancer
Ttt
: pain + enzymes
Slide5Which of the following is the
least
faverable
management option for a chronic large pancreatic cyst:
Endoscopic
transpapillary
drainage using stent
CT-guided pig tail catheter
Open Roux-en Y
cystojejunostomy
Laparascopic
cystogastrostomy
Endoscpic
transgasric
cystogastrostomy
Slide6Which of the following is the least
faverable
management option for a chronic large pancreatic cyst:
Endoscopic
transpapillary
drainage using stent
CT-guided pig tail catheter
Open Roux-en Y
cystojejunostomy
Laparascopic
cystogastrostomy
Endoscpic
transgasric
cystogastrostomy
Slide7A 65 year old man present with persistent skin rash over the lower abdomen and perineum with mild left upper quadrant pain. Serum glucose 160 mg/dl. Ct showed a large mass in the tail of pancreas. Most likely
Dx
:
VIPoma
Glucagonoma
Somatostatinoma
Gastrinoma
Insulinoma
Slide8A 65 year old man present with persistent skin rash over the lower abdomen and perineum with mild left upper quadrant pain. Serum glucose 160 mg/dl. Ct showed a large mass in the tail of pancreas. Most likely
Dx
:
VIPoma
Glucagonoma
Somatostatinoma
Gastrinoma
Insulinoma
Necrolytic
Migratory
Erythema
Slide945
yo
woman presents with RUQ pain and jaundice. Greasy floating stool. US showed GS and pancreatic head mass. Most likely
Dx
:
VIPoma
Glucagonoma
Somatostatinoma
Gastrinoma
Insulinoma
Slide1045
yo
woman presents with RUQ pain and jaundice. Greasy floating stool. US showed GS and pancreatic head mass. Most likely
Dx
:
VIPoma
Glucagonoma
Somatostatinoma
Gastrinoma
Insulinoma
Proximal Pancreas
Metastatic at
Dx
Dx
>>> elevated serum
somatostatin
Slide11The most common functional pancreatic endocrine neoplasm:
VIPoma
Glucagonoma
Somatostatinoma
Gastrinoma
Insulinoma
Slide12The most common functional pancreatic endocrine neoplasm:
VIPoma
Glucagonoma
Somatostatinoma
Gastrinoma
Insulinoma
Whipple triad
High fasting blood sugar
Low C peptide
Even distribution
90% benign
TTT>>
enucleation
Slide13Octereotide
scanning is most
usaful
for localization of which of the following:
VIPoma
Glucagonoma
Pancreatic polypeptide-secreting tumor
Gastrinoma
Insulinoma
Slide14Octereotide
scanning is most
usaful
for localization of which of the following:
VIPoma
Glucagonoma
Pancreatic polypeptide-secreting tumor
Gastrinoma
Insulinoma
Detect smaller than 1 cm
Somatostatinoma
and
VIPoma
are large bulky >> CT
40% of
insulinoma
have no sufficient
somatostatin
receptors
Slide15A 35
yo
female present with episodic sever watery diarrhea. Stool cultures are negative. O/E a mass is palpable in the
epigastric
and RUQ. CT showed large bulky pancreatic mass with
extention
into the SMV and
adjecnt
organs. Best
pallitive
Mx
:
Octreotide
Streptotazocin
Embolization
Chemotherapy
Radiation therapy
Slide16A 35
yo
female present with episodic sever watery diarrhea. Stool cultures are negative. O/E a mass is palpable in the
epigastric
and RUQ. CT showed large bulky pancreatic mass with
extention
into the SMV and
adjecnt
organs. Best
pallitive
Mx
:
Octreotide
Streptotazocin
Embolization
Chemotherapy
Radiation therapy
VIPoma
Tail
Metastsis
at
Dx
All of the following are true regarding alcohol EXCEPT:
It relaxes the sphincter of
Oddi
It has metabolic toxins to the pancreatic
acinar
cells
It increases pancreatic duct permeability
It transiently decreases pancreatic blood flow
It inappropriately activates
trypsin
Slide18All of the following are true regarding alcohol EXCEPT:
It relaxes the sphincter of
Oddi
It has metabolic toxins to the pancreatic
acinar
cells
It increases pancreatic duct permeability
It transiently decreases pancreatic blood flow
It inappropriately activates
trypsin
Spasm
Slide19Which of the following is true regarding
panceatogenic
(type3) diabetes:
Ketoacidosis
is common
The diabetes is easily controlled
Peripheral insulin sensitivity is decrease
Glucagon and pancreatic polypeptide (PP) levels are low
Hyperglycemia is usually sever
Slide20Which of the following is true regarding
panceatogenic
(type3) diabetes:
Ketoacidosis
is common
The diabetes is easily controlled
Peripheral insulin sensitivity is decrease
Glucagon and pancreatic polypeptide (PP) levels are low
Hyperglycemia is usually sever
Slide21All of the following are true regarding PP EXCEPT:
Proximal
pancreactomy
is associated with a greater PP deficiency than distal
pancreactomy
Patients with PP producing tumor present with sever hypoglycemia
PP regulates expression of the hepatic insulin receptor gene
PP deficiency
corelates
with
sverity
of chronic pancreatitis
It is secreted by F cells
Slide22All of the following are true regarding PP EXCEPT:
Proximal
pancreactomy
is associated with a greater PP deficiency than distal
pancreactomy
Patients with PP producing tumor present with sever hypoglycemia
PP regulates expression of the hepatic insulin receptor gene
PP deficiency
corelates
with
sverity
of chronic pancreatitis
It is secreted by F cells
Slide23Which is true regarding pancreatic
divisum
:
The duct of
Santorini
ends in a blind
bouch
The inferior portion of the pancreas drains through the duct of
Santorini
The majority of the pancreas drains through the duct of
Wirsung
The duct of
Santorini
drains through the major papilla
The duct of
Santorini
and
Wirsung
fail to fuse
Slide24Which is true regarding pancreatic
divisum
:
The duct of
Santorini
ends in a blind
bouch
The inferior portion of the pancreas drains through the duct of
Santorini
The majority of the pancreas drains through the duct of
Wirsung
The duct of
Santorini
drains through the major papilla
The duct of
Santorini
and
Wirsung
fail to fuse
Slide25Slide26Slide27The preferred definitive treatment of recurrent acute pancreatitis
d.t
. pancreatic
divisim
is:
Lateral
pancreaticojeunostomy
(
Puestow
procedure)
Pancreaticoduodenectomy
(
Wipple
)
Minor papilla
sphincterotomy
Major papilla
sphinctrotomy
and pancreatic
ductal
septotomy
Distal
pancreatictomy
Slide28The preferred definitive treatment of recurrent acute pancreatitis
d.t
. pancreatic
divisim
is:
Lateral
pancreaticojeunostomy
(
Puestow
procedure)
Pancreaticoduodenectomy
(
Wipple
)
Minor papilla
sphincterotomy
Major papilla
sphinctrotomy
and pancreatic
ductal
septotomy
Distal
pancreatictomy
Slide29Insulinomas
Usually require selective venous sampling for localization
Are more common in the head of the pancreas
Are usually benign
Are treated with anatomic
pancreactomy
Slide30Insulinomas
Usually require selective venous sampling for localization
Are more common in the head of the pancreas
Are usually benign
Are treated with anatomic
pancreactomy
90%
spradic
10% MEN 1
Slide31Which of the following is the most common presenting symptom in patients with
Somatostatinoma
:
Cholelithiasis
Constipation
Hypoglycemia
Hypocalcemia
Slide32Which of the following is the most common presenting symptom in patients with
Somatostatinoma
:
Cholelithiasis
Constipation
Hypoglycemia
Hypocalcemia
Diabetes
steatorhea
Slide33What percentage of patients with
gastrinoma
have a MEN1 syndrome:
5%
10%
25%
40%
Slide34What percentage of patients with
gastrinoma
have a MEN1 syndrome:
5%
10%
25%
40%
Slide35The majority of
gastrinoma
are found in :
Triangle of
Calot
Passaro’s
triangle
Body of the pancreas
Tail of the pancreas
Slide36The majority of
gastrinoma
are found in :
Triangle of
Calot
Passaro’s
triangle
Body of the pancreas
Tail of the pancreas
Slide3770 to 90%
Slide38For VIP-secreting tumor all are true EXCEPT:
Diarrhea unresponsive to anti-
diarreal
agents
Diarrhea that persists during fasting
Hypokalemia
Sever metabolic alkalosis
Slide39For VIP-secreting tumor all are true EXCEPT:
Diarrhea unresponsive to anti-
diarreal
agents
Diarrhea that persists during fasting
Hypokalemia
Sever metabolic alkalosis
Slide40During abdominal exploration after RTA, a deep laceration across the body of the pancreas with disruption of the pancreatic duct was discovered,
Mx
is external drainage and:
Direct repair of the duct
Distal
pancreatictomy
Implantation of the pancreas into the posterior wall of the stomach
Lateral
pancreaticojejunostomy
Slide41During abdominal exploration after RTA, a deep laceration across the body of the pancreas with disruption of the pancreatic duct was discovered,
Mx
is external drainage and:
Direct repair of the duct
Distal
pancreatectomy
Implantation of the pancreas into the posterior wall of the stomach
Lateral
pancreaticojejunostomy
Slide42Pancreatograph
is performed in 54 y o m, alcoholic with chronic pancreatitis. The study showed a “chain of lakes” pattern, with areas of
ductal
dilatation joined by areas of
ductal
stenosis
.
Mx
:
Cholecystectomy
with CBD exploration
Cholecystectomy
with
sphincteroplasty
Open the pancreatic duct longitudinally and perform side to side
pancreaticojejunostomy
Resect
the tail of the pancreas and perform a
pancreaticjejunostomy
Slide43Pancreatograph
is performed in 54 y o m, alcoholic with chronic pancreatitis. The study showed a “chain of lakes” pattern, with areas of
ductal
dilatation joined by areas of
ductal
stenosis
.
Mx
:
Cholecystectomy
with CBD exploration
Cholecystectomy
with
sphincteroplasty
Open the pancreatic duct longitudinally and perform side to side
pancreaticojejunostomy
Resect
the tail of the pancreas and perform a
pancreaticjejunostomy
Slide44Slide45Slide46What is the recommended treatment of an adult with duodenal obstruction caused by annular pancreas:
Endoscopic division
Gastrojejunostomy
Duodenojejunostomy
Surgical division
pancreaticoduodenectomy
What is the recommended treatment of an adult with duodenal obstruction caused by annular pancreas:
Endoscopic division
Gastrojejunostomy
Duodenojejunostomy
Surgical division
pancreaticoduodenectomy
Which of the following is more
characterestic
of pancreatic
centroacinar
cells than
acinar
cells:
Carbonic
anhydrase
Zymogen
granules
Golgi apparatus
Rough endoplasmic reticulum
Contractile proteins
Slide49Which of the following is more
characterestic
of pancreatic
centroacinar
cells than
acinar
cells:
Carbonic
anhydrase
Zymogen
granules
Golgi apparatus
Rough endoplasmic reticulum
Contractile proteins
H2O + CO2 >> H + HCO3
Slide50A 45 y o non-diabetic male with
chroinc
alcoholic pancreatitis and intractable abdominal pain has a 10 mm pancreatic duct. The best option of
Mx
:
Sphincteroplasty
Lateral
pancreaticojejunostomy
Distal
pancreatectomy
Total
pancreatectomy
Continued non-operative therapy
Slide51A 45 y o non-diabetic male with
chroinc
alcoholic pancreatitis and intractable abdominal pain has a 10 mm pancreatic duct. The best option of
Mx
:
Sphincteroplasty
Lateral
pancreaticojejunostomy
Distal
pancreatectomy
Total
pancreatectomy
Continued non-operative therapy
Slide52Which of the following is the most important determinant of the need of drainage of pancreatic
pseudocyst
:
Pseudocyst
symptoms
Pseudocyst
size
Pseudocyst
duration
Associated chronic pancreatitis
Slide53Which of the following is the most important determinant of the need of drainage of pancreatic
pseudocyst
:
Pseudocyst
symptoms
Pseudocyst
size
Pseudocyst
duration
Associated chronic pancreatitis
Slide54In which one or more of the following situation is resection of pancreatic tumor contraindicated:
Age > 70
Tumor located in the body of the pancreas
Inability to verify malignancy
histologically
before resection
Tumor invading portal vein
Presence of small peritoneal metastasis
Slide55In which one or more of the following situation is resection of pancreatic tumor contraindicated:
Age > 70
Tumor located in the body of the pancreas
Inability to verify malignancy
histologically
before resection
Tumor invading portal vein
Presence of small peritoneal metastasis
Slide56Which of the following operations would not be
approperite
for a 3cm
adenoCa
of the head of pancreas:
Whipple with
hemigastrectomy
Whipple with preservation of the stomach and pylorus
Duodenum sparing Whipple
Total
pancreaticodeudonectomy
Slide57Which of the following operations would not be inappropriate for a 3cm
adenoCa
of the head of pancreas:
Whipple with
hemigastrectomy
Whipple with preservation of the stomach and pylorus
Duodenum sparing Whipple
Total
pancreaticodeudonectomy
Slide58True about pancreatic trauma:
Often 2ry to blunt abdominal trauma
It is the most common cause of pancreatic
pseudocyst
Hyperamylasemia
is
pathognomonic
Negative peritoneal tap exclude pancreatic injury
Exclusion requires exploration of all central retroperitoneal hematomas
Slide59True about pancreatic trauma:
Often 2ry to blunt abdominal trauma
It is the most common cause of pancreatic
pseudocyst
Hyperamylasemia
is
pathognomonic
Negative peritoneal tap exclude pancreatic injury
Exclusion requires exploration of all central retroperitoneal hematomas
Slide60Q 1. Regarding cystic lesions of the pancreas:
(a) Serous cystic
neoplasms
are usually benign.
(b) Serous cystic
neoplasms
usually communicate with the main pancreatic duct.
(c)
Intraductal
papillary
mucinous
tumours
(IPMTs) can be reliably differentiated from
pseudocysts
by demonstration of communication with the main pancreatic duct.
(d) Cystic degeneration of
adenocarcinoma
is a common occurrence.
Slide61Q 2. Regarding true cystic pancreatic
neoplasms
:
(a) All IPMTs are associated with a dilated main pancreatic duct.
(b) Both main-duct type (MDT-IPMT) and branch-duct type (BDT-IPMT)
intraductal
papillary
mucinous
tumours
never co-exist.
(c)
Mucinous
cystic
neoplasms
are almost always benign.
(d) Solid
pseudopapillary
tumours
are associated with better prognosis than
adenocarcinoma
of the pancreas.
Slide62Q 3. Regarding IPMTs:
(a) They are more commonly found in the tail of the pancreas.
(b) Ovarian-type stroma is characteristic of these lesions.
(c) They may have a “cluster of grape” like appearance on endoscopic ultrasonography.
(d) A diameter of the main pancreatic duct > 15 mm is suspicious for malignant change in an IPMT
Slide63Q 4. In a favourable pre-morbid patient, surgery is indicated for:
(a) 1-cm cystic tumour of the pancreas with no mural nodules.
(b) 5-cm cystic tumour with solid mural components.
(c) Suspected MDT-IPMT.
(d) 2-cm simple epithelial cyst of the pancreas.