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Pancreas Review. I am made in K cells and travel to the pancreass after meals to increase insulin release. GIP I target the biliopancreatic system after meals and increase pancreatic bicarb secretion and also the delivy of bile. CCK

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Pancreas Review

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Pancreas Review

I am made in K cells and travel to the pancreass after meals to increase insulin release.


I target the biliopancreatic system after meals and increase pancreatic bicarb secretion and also the delivy of bile.


I am mostly produced in the pancreas, and target the liver to increase glycogenolysis and gluconeogenesis. I am inhibited by somatostatin. I also go to fat and increase lipolysis and ketogenesis.


Similar to CCK, I increase panc and bile secretion. I can be used to help diagnose hypergastrinemia.


Stimulated by presence of CCK, I inhibit pancreatic secretion, and GB contraction, and slow down the foregut in the post-prandial state

Panc. PP

Bonus: How is PPP used clinically?

Tumor marker for APUDoma’s

Stimulated by intraluminal fat, I also slow down the foregut in the post-prandial state

Peptide YY

What is the name of the main pancreatic duct

The Duct of Wirsung

Mindless fact: Wirsung was murdered in Padua in 1643 over a fight about who really discovered the duct. Dr. Bartholin was also a co-discoverer.

What is the name of the small pancreatic duct

Duct of Santorini

Santorini was a Venetian anatomist and his star pupil was Vater. What did Vater name?

Where is the Supreme Artery of Kirk

Dorsal Pancreatic artery

Which pancreatic bud is connected to the bile duct


Which bud migrates posteriorly and left to fuse with the other

Ventral migrates towards dorsal

Which duct comes from the ventral bud


What does the ventral bud become

Uncinate and inferior head

The dorsal bud has the duct of wirsung and makes up the sup. Head, body, and tail

Which bud abnomally fuses and causes an annular pancreas?

The ventral bud migrates ant and post but fails to fuse

How does it present and what is common pre-existing co-morbidity

Bowel obstruction in newborn period , Down’s syndrome.

What is the treatment


What condition is caused by failure of ducts to fuse

Pancreatic divisum

Who do you treat and what is treatment

Recurrent attacks, ERCP/sphincterotomy/papillotomy, lap chole.

Which common meds are associated with pancreatitis

Proven: Azathioprine, Lasix, depakote, thiazides, tetracycline, sulfonamide, H2 blockers

Suspected: steroids, Tacrolimus, flagyl, 6-mp

What metabolic causes can cause pancreatitis

Hypertriglycidemia, and hypercalcemia

What surgical diseases may cause pancreatitis

Perforated peptic ulcer, crohn’s of duodenum

Which enzymes are responsible for

Acute pancreatitis


Pancreatic necrosis (in the presence of bile)

Phospholiapse A

Intrapancreatic hemorrhage


Bonus: How does PLA2 affect lungs during pancreatitis

By digesting pulmonary surfactant and causing ARDS

What signs are seen on a flat-plate for acute pancreatitis

Sentinel loops, colon cut-off, dilated duodenum

What is a sentinel loop

Adynamic dilated loop of SB with small focal area of inflammation related to panc. Associated ileus.

What signs are seen on a flat-plate for chronic pancreatitis


On CT?

Dilated panc. Duct, calcifications, parenchymal atrophy


Chain of lakes

What are the early ranson’s criteria

Age >55

WBC >18k




What are the late criteria?

HCT drop >10

+ fluid sequ by 4L

BUN up by 5 from baseline



pO2 <55

Which of the following are indications for necrosectomy?

>50% pancreatic necrosis by CT

Bile duct stricture

Refractory Shock for >3 days

Infected necrosis

What % of people with GB pancreatitis will recur within 8 weeks if GB not removed


What are the absolute indications for surgery in chronic pancreatitis?


Relative indications?

Refractory disabling pain

GI or biliary obstruction

Recurrent acute exacerbations

Splenic V thrombosis with portal HTN

r/o malignancy

What % of patients with acute pancreatitis will get a pseudocyst?


What % of patients with chronic pancreatitis will get a pseudocyst?


What % of patients with acute pancreatitis will get a persistant pseudocyst?


What is most common cause for children to get pseudocyst


What % of periampullary tumors come from:

The pancreas?






Ampulla itself?


What tumor marker is the most useful

CA 19-9 has the highest sens and spec.

Which genetic syndromes and genes assoc. with panc ca

BRCA 2, HNPCC, Peutz-Jeghers, MEN1, p-53

What is the most common benign neoplasm in the pancreas


What is the most common cystic lesion in the pancreas


Courvoisier lived in Switzerland in 1880’s and fought in Franco-Prussian (7-years war). Did internships with Lister and Bilroth

What rash do patients with glucagonoma get

Nec Mig Ery. Also anemia, glossitis, and weight loss (rem: all malignant)

What do patients with VIPomas get

WDHA (rem: 50% malignant)

What do patients with somatistatinomas get

Gallstones, DM, and steatorrhea (rem: all malignant)

What will the question mention in gastrinoma?

H. Pylori negative. (1/2 malig), never malign when in MEN 1 (10% of time)

Bonus: 2nd most common location of gastrinoma following pancreas

Duodenum. (submucosal) in triangle

Who am I?

Sunburst pattern on CT, rarely malignant

Serous cystadenoma ( Sunny and not Serious)

I am frequently malignant and have peripheral calcifications

Mucinous (M Malig)

I am premalignant and require excision with clear margins “fishmouth” duct with mucus pathogen.


The End !

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