PGY 101: Chapters 53 & 54

Lisa Spiguel, MD

True or False: The most common cause of chronic pancreatitis in the US is related to gallstones.

Which of the below proteins have been shown to be involved in the etiology of chronic pancreatitis?

1. SPINK-1 – Pancreatic secretory trypsin inhibitor

2. CFTR – Cystic fibrosis transmembrane conductance regulator

3. C-Kit – Tyrosine kinase inhibitor4. A & B5. All of the above

True or False: Only 30% of acinar function must be lost prior to symptoms of steatorrhea appear.

Which of the following below is the most common complication of chronic pancreatitis?

1. Pain2. Pseudocyst3. Pseudoaneurysm4. Mesenteric Venous Thrombosis

A 55 yo man with a PMH of chronic pancreatitis presents to your clinic with complaints of abdominal discomfort, increased abdominal girth, and decreased appetite. On physical exam you not a non-pulsatile fullness in his epigastrium without signs of peritonitis. His CT scan is shown to the right. What is his diagnosis?

1.Splenic artery aneurysm2.Splenic vein Thrombosis3.Pancreatic adenocarcinoma4.Pancreatic pseudocyst

True or False: Chronic pancreatitis is a risk factor for pancreatic adenocarcinoma, being proportionate with duration of diagnosis.

A 62 yo male with chronic alcoholic pancreatitis presents to your clinic. He has been suffering with abdominal pain, steatorrhea, and weight loss for almost 3 years. He has seen multiple physicians with no help. He is on an extensive narcotic regimen and pancreatic enzyme replacement without success. You order a CT pancreatic protocol which is demonstrated below. Which surgical procedure would you offer this man?

1. Whipple2. Distal pancreatectomy3. Central pancreatectomy4. Peustow procedure

A 62 yo male with chronic alcoholic pancreatitis presents to your clinic. He has been suffering with abdominal pain, steatorrhea, and weight loss for almost 3 years. He has seen multiple physicians with no help. He is on an extensive narcotic regimen and pancreatic enzyme replacement without success. You order a CT pancreatic protocol which is demonstrated below. However it also demonstrates excessive chronic pancreatitic changes in the pancreatic head. Which surgical procedure would you offer this man?

1. Whipple2. Distal pancreatectomy3. Frey procedure4. Peustow procedure

Puestow

Frey

Whipple

Frye

Beger

Distal Pancreatectomy

55 yo male presents to his PCP with a 2 month history of some mild upper abdominal pain, and new onset yellowing of the skin. His PCP orders a CT abdomen and pelvis below. What is your diagnosis?

1. Choledocholithiasis2. Pseudoaneurysm3. Pancreatic adenocarcinoma4. Chronic Pancreatitis

Which of the following below is not a risk factor for pancreatic cancer?

1. Tobacco2. Age3. BRCA 2+ carrier4. High fiber diet

True of False: 20 % of pancreatic cancer are caused by Familial predisposition syndromes.

Which of the below genes is not associated with pancreatic cancer?

1. BRCA 22. PRSSl3. STKll4. VEGF

Which of the below Oncogenes has be found to be altered in patients with pancreatic adenocarcinoma?

1. P532. DPC43. BRCA 24. K-ras

Which of the tumor markers below is elevated in pancreatic adenocarcinoma?

1. CA 1252. CA 19-93. CEA4. AFP

55 yo male presents to his PCP with a 2 month history of some mild upper abdominal pain, his PCP orders a CT abdomen pelvis as demonstrated below. What is the best surgical treatment option?

1. Pancreaticoduodenectomy2. Splenectomy3. Central pancreatectomy4. Distal pancreatectomy

55 yo male presents to his PCP with a 2 month history of some mild upper abdominal pain, his PCP orders a CT abdomen pelvis as demonstrated below. What is the best surgical treatment option?

1. Pancreaticoduodenectomy2. Splenectomy3. Central pancreatectomy4. Distal pancreatectomy

Distal PancreatectomyWhipple

A 64 yo male is recently diagnosed with pancreatic adenocarcinoma after a work up of back pain and new onset jaundice. His CT is demonstrated below. What is your definitive plan?

1. Pancreaticoduodenectomy followed by Adjuvant chemo-XRT

2. Neoadjuvant chemo-XRT followed by plan for pancreaticoduodenectomy if clinical response

3. This patient is a non-surgical candidate

4. Pancreaticoduodenectomy alone without adjuvant therapy

Which of the below is not a contraindication to pancreatic resection?

1. Encroachment of the celiac plexus2. Encasement of superior mesenteric

vessels3. Abutting the portal vein4. All of the above are

contraindications

5 yr survival rates for resectable pancreatic adenocarcinoma are?

1. 5-10%2. 10-15%3. 15-20%4. 20-25%

57 yo male underwent an EGD for chronic abdominal pain that was not alleviated by antacids. Once the gastroenterologist entered the 2nd portion of the duodenum, he encountered the image below. What is your most likely diagnosis?

1. Mucinous cystadenoma2. Serous cystadenoma3. Intraductal papillary mucinous neoplasm4. Ampullary adenocarcinoma

True or False: Intraductal papillary mucinous neoplasms contain ovarian-type stroma, unlike mucinous cystadenomas

Which of the following is not an indication for Branch-duct type IPMN resection?

1. Connection with main duct2. Mural nodule3. Greater than 3 cm4. Location in the distal body

True of False: All Serous Cystadenomas are benign and do not require resection.