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MC site of carcinoma pancreas?
Head and uncinate processQ
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Significance of Pain in carcinoma pancreas?
Pain suggests unresectabilityQ in carcinoma pancreas
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MC functioning tumor of the endocrine pancreasQ?
Insulinoma
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Location of Insulinoma?
- 97% in pancreas (equal distribution in the head, body, and tail)Q
- 3% in duodenum, splenic hilum, or gastrocolic ligamentQ
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Diagnostic hallmark is Whipple’s triad?
Symptoms of hypoglycemia + Low blood glucose levels (40-50 mg/dL) + Relief of symptoms after the administration of glucoseQ
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Gold standard test for the diagnosis of insulinoma?
- 72-hour fastingQ test
- An insulin-to-glucose ratio > 0.4 is consistent with insulinomaQ
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CECT or MRI finding of insulinoma?
- Hyperattenuating as compared with surrounding pancreatic tissue because of rich vascular supplyQ
- Portal venous sampling for insulin with or without arterial stimulation with calcium is the best pre-operative method of localizationQ
- EUS with intra-operative palpation is best localization technique for Insulinoma
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Surgical treatment of Insulinomas?
- Insulinoma of head of pancreas - Enucleation is TOCQ
- Insulinoma of body or tail of pancreas - Distal pancreatectomy is TOCQ
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Treatment of metastatic neuroendocrine tumors?
Streptozotocin, with or without 5-fluorouracil
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MC benign NET of Pancreas?
InsulinomaQ
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MC malignant functional NET of Pancreas?
GastrinomaQ
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MC site of Gastrinoma?
- Duodenum > PancreasQ,
- In Duodenum, MC in 1st partQ
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Boundaries of Passaro’s Triangle
- • Junction of the cystic and CBDQ
- • Junction of 2nd and 3rd part of duodenumQ
- • Junction of neck and body of pancreas
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MC presenting symptoms in ZES?
Abdominal painQ
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Unique characteristic of acid-induced diarrhea?
Halted by nasogastric aspiration of gastric secretionsQ
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MC cause of death in ZES?
Liver metastasisQ
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Serum gastrin level in gastrinoma?
- • 100% patients will have a fasting serum gastrin level >100 pg/mL
- • Secretin Provocation Test: An increase of >200 pg/mL in the gastrin value after administration of secretin is diagnosticQ
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Basic acid output in Gastrinoma?
- • BAO >15 meq/hr in most patients and >5 mEq/hr in patients with prior surgery to decrease gastric acid secretion
- • Levels >1000 pg/mL are diagnosticQ
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ZES in MEN-1, Management?
Hyperparathyroidism should be treated first because it can complicate the management of their gastrinoma, neck exploration should be performed before resection of gastrinomaQ.
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Treatment of Gastrinoma?
- Distal pancreatectomy: Gastrinoma involving body or tailQ of pancreas
- Pancreaticoduodenectomy: Gastrinoma involving headQ of pancreas
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Classic presentation of glucagonoma?
4Ds: Diabetes, dermatitis, DVT, and depression.
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What is Necrolytic erythema migrans?
The characteristic rash occur in areas of friction; rash is migratory, red, and scaling, associated with intense pruritusQ
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Localization of NET of Pancreas?
Somatostatin receptors
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MC presenting symptom in VIPoma?
Profuse, watery, iso-osmotic secretary diarrhea
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Diagnostic triad of VIPoma?
Secretary diarrhea + High levels of circulating VIP + Pancreatic tumorQ, Characterized by Hypokalemia, hypercalcemia, hypochlorhydria and hyperglycemiaQ.
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Treatment of VIPoma?
- Aggressive preoperative hydration and correction of electrolyte abnormalities and acid-base disturbancesQ.
- Octreotide is commonly used preperatively to reduce diarrhea volume and facilitate fluid and electrolyte replacement.
- Resection is the treatment of choice for VIPomas, glucagonomas, somatostatinomas, and nonfunctional pancreatic NET and remains the only curative optionQ.
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Most common site of neuroendocrine tumor of pancreasjQuery110109881647237234255_1505477652189
- Gastrinoma - Duodenum (1st part) >PancreasQ
- Insulinoma - Equally distributedQ in head, body and tail
- Glucagonoma - Body and TailQ
- Somatostatinoma and PPoma - HeadQ
- VIPoma - TailQ
- All pancreatic cancers and neoplastic cysts are most common in pancreatic head except:
- • Mucinous cystic neoplasm and Glucagonoma: MC in body and tailQ
- • VIPoma: MC in TailQ
- • Insulinoma: Equally distributedQ in head, body and tail
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MC congenital anomaly of the pancreasQ?
Pancreas Divisum - ductal systems of the dorsal and ventral pancreatic duct fail to fuseQ
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Treatment of pancreatic divisum?
- • Operative dorsal duct sphincterotomy, with or without sphincteroplastyQ, is the preferred surgical treatment.
- • Patients with pancreas divisum and acute recurrent pancreatitis are good candidates for endoscopic therapyQ whereas patients with chronic pancreatitis or chronic pain alone (or both) do not appear to do as well.
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Annular Pancreas involves which part of duodenum?
2nd part of the duodenumQ
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Treatment of choice for annular pancreas?
- DuodenoduodenostomyQ >Duodenojejunostomy.
- Duodenoduodenostomy has replaced duodenojejunostomy as the treatment of choice because it has a lower incidence of postoperative complications, particularly obstruction and blind-loop syndromesQ.
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MC segment of the pancreas affected in pancreatic trauma?
BodyQ
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MC mechanism of pancreatic injury in adults and children?
- Adults - Penetrating injuries into the abdomen are the MC injuries seen in adultsQ
- Children - Abdominal blunt traumaQ. Direct compression of the epigastrium against the vertebral column and a blunt object (handlebar) is typically seen after bicycle injuriesQ.
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Most reliable test to demonstrate pancreatic duct integrityQ?
ERCP
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Treatment of pancreatic injury?
- Major pancreatic resections in stable patients with isolated pancreatic injuryQ.
- Damage control surgery is indicated for complex injuries or unstable patientsQ.
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MC complication after pancreatic traumaQ?
A persistent drain output or pancreatic fistula
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MC common site of ectopic pancreas?
Walls of the stomachQ, duodenumQ, or ileum, in a Meckels diverticulumQ, or at the umbilicusQ
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Cells of pancreas and their secretion?
- Alpha cells - Glucagon, glicentinQ, pancreastatinQ
- Beta cells - Insulin, amylinQ, pancreastatinQ
- D cells - Somatostatin
- D2 cells - VIP
- G cells - Gastrin
- PP cells - Pancreatic polypeptide
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