1. 1st branch of sma
    inf pancreaticoduodenal
  2. marks transition from foregut to midgut
    sphincter of oddi
  3. pathophys of annular pancreas
    failure of clockwise rotation of ventral pancreatic bud
  4. sxs of annular pancreas
    • emesis-postprandial
    • pancreatitis-mainly seen in adults
  5. tx of annular pancreas
    • duodenojejunostomy
    • if mainly pancreatitis then can do ercp with sphincterotomy
  6. risk factor for necrotizing pancreatitis
    RFs for pancreatitis plus obesity
  7. ransons criteria on admission
    • age> 55
    • WBC >16
    • Glucose >200
    • AST >250
    • LDH >350
  8. Ranson's criteria after 48 hours
    • hct decrease of 10
    • bun increase of 5
    • ca< 8
    • paO2 <60
    • base deficit > 4
    • fluid sequestration > 6L
  9. pt with chronic pancreatitis presents with tachycardia, hypotension, shock and ecchymosis of his flank
    Grey Turner's sign..think retroperitoneal bleed from arterial pseduoaneurysm

    proceed to IR embolization
  10. Puestow procedure is indicated for what size pancreatic duct
    > or = 8mm
  11. histo of serous cystic neoplasms
    cuboidal glycogen rich creating numerous small cysts can be small or up to 10cm
  12. most patients with serous cystadenomas present as
    abdominal pain, nausea/vomiting- only 25% are asx
  13. ct findings of microcystic adenoma
    honecomb pattern with thin septa sometimes with sunburst pattern of central calcification
  14. microcystic adenoma
    Image Upload 1
  15. surgery for microcystic adenomas indicated
    when symptomatic or cannot be clearly differentiated from ca
  16. histo of mucinous cystic neoplasms
    tall columnar cells with abundent apical mucin with ovarian type stroma
  17. major differentiation of IPMN from mucinous cystic neoplasms
    involve the larger ducts and do not have ovarian type stroma
  18. serous cystadenomas stain positive for what and negative for what
    • positive periodic acid schiff stain (glycogen)
    • negative for mucin
  19. ct findings of mucionous cystic tumors
    unilocular or multilocular with thick wall +/- calcification within wall
  20. MCN typically have high levels of what with FNA
    CEA CA 19-9 CA-125
  21. management of cystic neoplasm found in pancreas in a symptomatic patient
    if symptomatic resect- don't need to differentiate between Mucinous and serous
  22. acceptable growth rate for cystic neoplasms
    6mm per year
  23. ct parameters indicating malignancy in MCN
    calcification of wall and papillary growths
  24. surgical resection is required for branched duct IPMN 1-3cm in size based upon what
    • mural nodules
    • dilated main duct
    • positive cytology
  25. cyst lesions of pancreas that require resection
    • all symptomatic
    • SCA >4 cm
    • BD IPMN 1-3cm with high risk features
    • BD IPMN >3cm
    • MD IPMN
    • MCN
  26. Risk factors for pancreatic cancer
    • smoking
    • chronic pancreatitis
    • HNPCC
    • Peutz-Jeghers
    • ataxia telangiectasias
    • BRCA2
    • FAMMM (familial atypical multiple mole melanoma)
  27. bleeding after whipple
    IR likely GDA
  28. tx of ampullary villous adenoma
    • open resection with frozen section
    • need whipple if positive
  29. chemo for endocrine tumors
    5 FU and streptozosin
  30. grade of pancreatic neuroendocrine tumors based on
    mitotic count and ki-67 proliferative index
  31. ct features of neuroendocrine tumor
    • enhance on ct
    • can have cystic degeneration or calcification
  32. octreotide scan is effective in locating all NETs except
  33. NET in head of pancreas
    glucagonoma, somatostatinoma
  34. most common functional NET
  35. location of insulinoma
    evenly distributed
  36. malignancy potential of insulinoma
    90% benign
  37. labs diagnostic of insulinoma
    • insulin to glucose ratio >.4 after fasting
    • fasting glucose <50
    • fasting insulin >24
  38. if ct or eus fails to identify insulinoma what else can you do
    selective arterial calcium with hepatic venous sampling
  39. prevents release of insulin and can be used in metastatic disease
  40. tx of insulinoma
    • formal resection if greater than 2cm
    • enucleation if less
    • if MEN enucleate the dominant tumor
  41. most common pancreatic islet cell tumor in MEN
  42. malignancy potential of gastrinoma
    • 1/2
    • less likely for MEN
  43. dx gastrinoma
    • fasting gastrin >200
    • basal acid output >15 meq/hr >5 if prev vagotomy
  44. worst prognosis of pancreatic NETs
  45. dx somatostatinoma
    fasting somatostatin level
  46. location and malignancy potential of glucagonoma
    • distal panc
    • majority malignant
  47. dx glucagonoma
    fasting glucagon > 500
  48. VIPoma malignancy potential and location
    • majority malignant
    • distal pancreas
  49. mets with VIPoma treated with
    inf and 5 FU
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