33 Pancreas ANATOMY AND PHYSIOLOGY
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33 Pancreas ANATOMY AND PHYSIOLOGY

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Questions and Answers

Which cells of the pancreas secrete glucagon?

  • Alpha cells (correct)
  • Delta cells
  • PP or F cells
  • Beta cells

    • Which pancreatic artery supplies the body of the pancreas?

  • Superior pancreatic artery
  • Dorsal pancreatic artery (correct)
  • Great pancreatic artery
  • Inferior pancreatic artery

    • What is the primary function of ductal cells in the pancreas?

  • Produce vasoactive intestinal peptide (VIP)
  • Secrete digestive enzymes
  • Produce insulin
  • Secrete HCO3− solution (correct)

    • Which vein forms behind the neck of the pancreas?

    <p>Portal vein</p> Signup and view all the answers

    Where do the uncinate process of the pancreas rest?

    <p>On aorta, behind superior mesenteric vein (SMV)</p> Signup and view all the answers

    Which of the following is NOT an endocrine cell type in the pancreas?

    <p>Acinar cells</p> Signup and view all the answers

    What is the primary function of acinar cells in the pancreas?

    <p>Secrete digestive enzymes</p> Signup and view all the answers

    Which artery supplies the head of the pancreas?

    <p><strong>Superior pancreaticoduodenal arteries</strong> from the gastroduodenal artery (GDA)</p> Signup and view all the answers

    Caudal pancreatic arteries supply which part of the pancreas?

    <p>Tail</p> Signup and view all the answers

    Which nodes receive lymphatics from the pancreas?

    <p>Celiac and superior mesenteric artery (SMA) nodes</p> Signup and view all the answers

    Which of the following is a common symptom of pancreatic pseudocysts?

    <p>Vague abdominal discomfort and early satiety</p> Signup and view all the answers

    What is the most appropriate initial management for pancreatic pseudocysts that are < 5 cm in size?

    <p>Expectant management for 3 months</p> Signup and view all the answers

    Pancreatic pseudocysts may need to be surgically intervened if:

    <p>Symptoms continue and the cyst is growing</p> Signup and view all the answers

    Which of the following is a complication associated with pancreatic pseudocysts?

    <p>Infection of the cyst and portal vein thrombosis</p> Signup and view all the answers

    What is the main cause of chronic pancreatitis?

    <p>Alcohol consumption</p> Signup and view all the answers

    Which diagnostic imaging modality is best for confirming chronic pancreatitis?

    <p>CT scan</p> Signup and view all the answers

    What is the mainstay of treatment for patients with chronic pancreatitis?

    <p>Pain control and nutritional support</p> Signup and view all the answers

    Which procedure is indicated for patients with chronic pancreatitis who have enlarged pancreatic ducts (> 6 mm) and a disease-free pancreatic head?

    <p>&quot;Core-out&quot; procedure with lateral pancreaticojejunostomy</p> Signup and view all the answers

    "Minimal change" chronic pancreatitis may be treated with:

    <p>&quot;Core-out&quot; procedure with lateral pancreaticojejunostomy</p> Signup and view all the answers

    "Jaundice workup" involves which initial imaging study?

    <p>&quot;Ultrasonography&quot;</p> Signup and view all the answers

    What is the most appropriate initial management for a pleural effusion caused by retroperitoneal leakage of pancreatic fluid?

    <p>Immediate thoracentesis followed by conservative treatment</p> Signup and view all the answers

    What is the main purpose of MRCP in the diagnosis of pancreatic cystic neoplasms?

    <p>To differentiate between serous and mucinous cystadenomas</p> Signup and view all the answers

    In a patient with suspected Munchausen's syndrome and absence of sulfonylureas, what is the next step in localization?

    <p>Somatostatin scintigraphy</p> Signup and view all the answers

    What is the preferred method for localization if a pancreatic neuroendocrine tumor (PNET) is not localized with triple phase CT scan or MRI?

    <p>Selective intra-arterial calcium injection with hepatic venous sampling for insulin</p> Signup and view all the answers

    What is the treatment approach for metastatic disease of a PNET?

    <p>Chemotherapy with 5FU and streptozocin</p> Signup and view all the answers

    Which diagnostic test is used to confirm Zollinger–Ellison syndrome (ZES)?

    <p>Fasting gastrin levels &gt; 1,000</p> Signup and view all the answers

    What is the most common site for finding gastrinomas?

    <p>Third portion of the duodenum</p> Signup and view all the answers

    What is the single best study for localizing a gastrinoma?

    <p>Somatostatin receptor scintigraphy (SRS)</p> Signup and view all the answers

    What is the recommended treatment for sporadic gastrinoma if the tumor size is less than 2 cm?

    <p>Surgical enucleation</p> Signup and view all the answers

    In MEN-1 patients with gastrinoma, what is the aim of medical therapy if the tumor size is less than 2 cm?

    <p>Medical therapy with diazoxide</p> Signup and view all the answers

    Which symptoms are associated with glucagonoma?

    <p>Depression, DVT, dermatitis</p> Signup and view all the answers

    What is the most malignant form of pancreatic neuroendocrine tumors?

    <p>Somatostatinoma</p> Signup and view all the answers

    What is the preferred method for localizing a VIPoma?

    <p>Somatostatin receptor scintigraphy (SRS)</p> Signup and view all the answers

    Which treatment approach is recommended for VIPoma?

    <p>Cholecystectomy with resection</p> Signup and view all the answers

    What activates trypsinogen to trypsin?

    <p>Enterokinase</p> Signup and view all the answers

    Which hormone primarily increases pancreatic enzymes?

    <p>CCK</p> Signup and view all the answers

    Which duct is the major pancreatic duct that merges with the common bile duct before entering the duodenum?

    <p>Duct of Wirsung</p> Signup and view all the answers

    What is the most common cause of acute pancreatitis in the United States?

    <p>Gallstones</p> Signup and view all the answers

    Which sign is characterized by flank ecchymosis and is associated with hemorrhagic pancreatitis?

    <p>Grey Turner sign</p> Signup and view all the answers

    What is the most important risk factor for necrotizing pancreatitis?

    <p>Obesity</p> Signup and view all the answers

    Which criteria includes age > 55, WBC > 16, glucose > 200, and AST > 250 as indicators of severe pancreatitis?

    <p>Ranson's criteria</p> Signup and view all the answers

    Which drug is considered the best for severe pancreatitis?

    <p>Imipenem</p> Signup and view all the answers

    What is the first-line treatment for infected necrosis in severe pancreatitis?

    <p>ICU care and early nutrition</p> Signup and view all the answers

    Which of the following is a high-risk feature for branch duct IPMN, indicating the need for surgical resection?

    <p>Thickened wall and mural nodules</p> Signup and view all the answers

    What is the most common symptom of pancreatic adenocarcinoma?

    <p>Jaundice</p> Signup and view all the answers

    What is the serum marker for pancreatic adenocarcinoma?

    <p>CA 19-9</p> Signup and view all the answers

    What is the most common site of metastasis for pancreatic adenocarcinoma?

    <p>Liver</p> Signup and view all the answers

    What is the first line of treatment for non-functional pancreatic neuroendocrine tumors?

    <p>Formal resection</p> Signup and view all the answers

    Which functional pancreatic neuroendocrine tumor commonly responds to treatment with octreotide?

    <p>Gastrinoma</p> Signup and view all the answers

    What is the most common functional pancreatic neuroendocrine tumor?

    <p>Gastrinoma</p> Signup and view all the answers

    What is the characteristic symptom of insulinoma?

    <p>Hypoglycemia</p> Signup and view all the answers

    Which enzyme marker is elevated in insulinoma?

    <p>$ ext{Insulin}$</p> Signup and view all the answers

    What is the first-line postoperative chemotherapy regimen for patients with pancreatic adenocarcinoma?

    <p>FOLFIRINOX (FOLinic acid, Fluorouracil, IRINotecan, OXaliplatnin)</p> Signup and view all the answers

    What is the most significant risk factor for necrotizing pancreatitis?

    <p>Chronic pancreatitis</p> Signup and view all the answers

    Which imaging study is used to differentiate dilated ducts due to chronic pancreatitis from carcinoma on the basis of its ability to detect vessel involvement?

    <p>MRCP (Magnetic Resonance Cholangiopancreatography)</p> Signup and view all the answers

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