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Branches of celiac that supply the pancreas (2)
GDA/superior pancreaticoduodenals; splenic/pancreatic artery
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Branches of SMA that supply the pancreas (1)
Inferior pancreaticoduodenals
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Blood supply to pancreas (4)
GDA, splenic, pancreaticoduodenals (superior and inferior, anterior and posterior of each), dorsal pancreatic artery
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Location of uncinate process of pancreas
Resting on aorta behind SMA
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Location of neck of pancreas
Laying anterior to SMA and SMV
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Blood supply to pancreatic head
Superior and inferior pancreaticoduodenals
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Blood supply to pancreatic body
Great, inferior and caudal pancreatic artery
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Blood supply to pancreatic tail
Splenic, gastroepiploic, dorsal pancreatic artery
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Pancreatic cells with carbonic anhydrase that secrete bicarb
Ductal cells
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Pancreatic cells that secrete Cl- and digestive enzymes
Acinar cells
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Only pancreatic enzyme secreted in active form
Amylase
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Exocrine hormones of the pancreas (5)
Amylase, lipase, trypsinogen, chymotrypsinogen, carboxypeptidase
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Hormone secreted by alpha cells
Glucagon
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Hormone secreted by beta cells
Insulin
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Hormone secreted by delta cells
Somatostatin
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Hormone secreted by PP or F cells
Pancreatic polypeptide
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Enzyme that activates trypsinogen to trypsin
Enterokinase
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Role of secretin
Pancreatic bicarb excretion
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Role of CCK
Increased pancreatic enzyme secretion
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role of somatostatin
decreased exocrine secretion of pancreas
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major pancreatic duct that merges with CBD prior to entering duodenum
duct of Wirsung
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minor pancreatic duct that drains directly into duodenum
duct of Santorini
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failure of clockwise rotation of ventral pancreatic bud during development, resulting in 2nd portion of duodenum being trapped in pancreatic band
annular pancreas
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failed fusion of pancreatic ducts; can result in pancreatitis from duct stenosis
pancreas divisum
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treatment of pancreas divisum
sphincteroplasty and stent placement, or longitudinal pancreaticojejunostomy if refractory
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most common cause of pancreatitis in US (2)
gallstones, ETOH
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most common location for heterotopic pancreas
duodenum
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medications that can cause pancreatitis (4)
lasix, cimetidine, azathioprine, steroids
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dilated small bowel near pancreas seen in pancreatitis
sentinel loop
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Ranson�s criteria on admission (5)
Age>55, WBC>16, glucose>200, AST>250, LDH>350
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Ranson�s criteria after 48 hours (5)
Hct drop 10%, BUN inc 5%, Ca<8, PaO2<60, base deficit >4, fluid sequestration >6L
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Gray Turner sign
Flank ecchymosis secondary to hemorrhagic pancreatitis
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Cullen�s sign
Periumbilical ecchymosis secondary to hemorrhagic pancreatitis
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Fox�s sign
Inguinal ecchymosis secondary to hemorrhagic pancreatitis
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Cause of ARDS in pancreatitis
Release of phospholipases
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Cause of coagulopathy in pancreatitis
Release of proteases
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Causes of elevated lipase (6)
Pancreatitis, cholecystitis, perforated ulcer, sialoadenitis, SBO, intestinal infarct
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Treatment of pseudocyst if duct is involved
Cystgastrostomy
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Treatment of pseudocyst if duct not involved
Perc drainage
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Complications of pseudocyst (3)
SBO, infection, portal/splenic vein thrombosis
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Treatment of pancreatic fistula (medical and surgical)
Drainage, TPN, octreotide, ERCP/sphincterotomy, distal panc/Whipple
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Alternating segments of dilation and stenosis of pancreatic duct
Chain of lakes (due to chronic pancreatitis)
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Surgical indications for chronic pancreatitis (5)
Pain, nutrition, narcotic addiction, question of malignancy, biliary obstruction
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Surgical treatment of chronic pancreatitis
Puestow (pancreaticojejunostomy), distal pancreatectomy or whipple if anatomy indicates
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Test to determine pancreatic insufficiency
Fecal fat
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Pancreatic etiologies of biliary stenosis (2)
Pseudocyst, fibrosis
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#1 risk factor for pancreatic cancer
Smoking
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Serum marker for pancreatic cancer
CA 19-9
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Most common location for pancreatic cancer
Head
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Dilation of both CBD and pancreatic duct on imaging
Double duct sign
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#1 complication from Whipple
Delayed gastric emptying
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Treatment of pancreatic duct leak
Drain, ERCP, possible stent
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Most common site of metastasis for endocrine pancreatic tumors
Liver
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5-year survival of nonfunctional endocrine pancreatic neoplasms
50%
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Medical treatment for insulinoma, glucagonoma,gastrinoma, VIPoma
Octreotide
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Most common location for gastrinoma and somatostatinoma
Pancreatic head
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Most common islet cell tumor of pancreas
Insulinoma
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Fasting hypoglycemia + symptoms of hypoglycemia + relief with glucose
Whipple�s triad
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Medical treatment for metastatic pancreatic endocrine cancers
Streptozosin, octreotide, 5FU
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Most common pancreatic islet cell tuor in MEN I patients
Gastrinoma
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% of gastrinomas that are malignant
50
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% of gastrinomas that are spontaneous (vs assoc. with MEN)
75
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Gastrinoma triangle
CBD, neck of pancreas, third portion of duodenum
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Diagnostic test for gastrinoma/ZES
Secretin stimulation test (will increase gastrin in patients with ZES)
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Best study for localizing gastrinomas
Somatostatin receptor scintigraphy
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Endocrine tumor causing whipple�s triad
Insulinoma
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Endocrine tumor causing refractory ulcer disease and diarrhea
Gastrinoma
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Endocrine tumor causing diabetes, gallstones, steatorrhea, hypochlohydria
Somatostatinoma
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Endocrine tumor causing diabetes, stomatitis, dermatitis, weight loss
Glucagonoma
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Most common location of glucagonoma and VIPoma in pancreas
Distal
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Endocrine tumor causing watery diarrhea, hypokalemia, achlorhydria
VIPoma
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