Pancreatic protocol CT

Q) All are true about pancreatic protocol CT except (AIIMS 2012) 

a) > 90% unresectable lesions picked up by CT

b) Dual phase CT with cuts taken at 40 secs and 70 secs

c) Liver metastasis detected in early arterial phase

d)

Answer is free for all 

c

Pancreatic protocol CT involves  imaging  at  the  pancreatic  phase (i.e.,  approximately  45  seconds  after  contrast  administration)  and  at  the  portal  venous  phase  (i.e.,  approximately 70  seconds  after  contrast  administration). It is useful for detection of adenocarcinoma of pancreas. 

Metastatic lesions are seen in  the  portal  venous  phase,  because  the  lesions  are  not  typically  well  vascularized.

  Arterial  phase images  are  principally  used  to  distinguish  metastatic  disease from  benign  vascular  lesions,  such  as  hemangiomas,  or  to  better define  the  arterial  anatomy  of  the  liver.

Non contrast phase used for  Read More ...

Severe Acute Pancreatitis

Q)  Ideal time for CECT in severe acute pancreatitis is
A. After 72 hours
B. After 48 hours
C. 24 hours
D. At admission

Answer for premium members

Mild acute pancreatitis 

  1. enlargement of the pancreas with loss of definition of the borders of the pancreas. 
  2.  Thickening of the right or left anterior pararenal fascia 

Severe Acute pancreatitis 

 Main determinant of clinical outcome is the degree of systemic organ disturbance, particularly during the early hours and days after admission to hospital

More than half of all deaths in AP occur within the first 2 weeks of illness  and are usually a consequence
of multiple organ failure

The revised Atlanta Classification 
3  grades of severity of pancreatitis:

Mild AP—characterized by the absence of organ failure or local
complications

Moderately severe AP—defined by...................read on 

 

Hereditary Pancreatic Cancer

Q. All of the following predisposing syndromes for pancreatic adenocarcinoma are AD except
A. PJS (Peutz Jeghers) 
B. CFTR (Cystic fibrosis) 
C. HNPCC
D. FAMMM

Answer for premium members

Several hereditary cancer syndromes (e.g., Peutz-Jeghers syndrome, familial atypical mole and multiple melanoma syndrome, hereditary breast and ovarian cancer syndrome) are known to be associated with increased risk of pancreatic cancer

Read on Q24

Chronic pancreatitis enzymes

Q . All are true regarding enzyme supplementation in chronic pancreatitis except 

a) Lipase to be given 30000U before or after meal

b) H2 blocker is mandatory with enteric coated tablets

c) Main cause of failure is inadequate dosage

d) In cases of failure of enzyme replacement feeding of medium chain Triglycerides are  helpful


Ans

Indications of enzyme supplementation are -

  1. Weight loss, steatorrhea (15g/day ) or both
  2. Dyspepsia, Diarrhoea, bloating, malabsorption of proteins  and carbohydrates
  3. Pain abdomen

Read on for ans Q 23 

Islet cells

Q  Regarding islet cell of pancreas true is (AIIMS, JIPMER) 

a) Cells in descending order of frequency is B,D,A,F

b) B cells are more common in the periphery of islets

c ) Peri islet acinar cells same as acinar cells else where

d) Portal flow from islet to acinar cell helps to control secretions

Answer 

ERCP in pancreatitis

Q) All are true about ERCP in pancreatitis except

a) Not useful in patient with multiple strictures and stones

b) Ductal stenting associated with changes of c/c pancreatitis in 50%

c) In pts with pancreas divisum minor duct sphincterotomy causes significant pain relief irrespective of size of duct

d) Pain relief with endoscopic intervention occurs irrespective of relief of ductal pressure/ decrease in duct size


Answer for premium members  ( Please log in to see) 

Pancreatic  ductal  obstruction  by  fibrotic  stenoses  and/or  calculi are  the  most  frequent  indications  for  endoscopic  therapy.

Multiple strictures and stones are not amenable for endoscopic therapy ....................

Tropical Pancreatitis

Q) All are true about tropical pancreatitis except?

a. Associated with Tapioca.
b. Patients have  large stones with fibrosis.
c. It is Pre Cancerous

d) Onset of disease at 50 years 


  Free. See here for answers to other  questions and this question

Answer -d )Onset is at young age

Tropical pancreatitis

is an  idiopathic disease which begins in teens.  It has a high association with diabetes and Pancreatic duct calculi. It is common in South India, Asia, Africa and central America.

 

Etiology 

Malnutrition 

Cassava

Hydrocarbons exposure

It is associated with SPINK 1 mutation


It is pre cancerous

IPSG data shows the cumulative risk of Pancreatic Cancer  in patients with Chronic Pancreatitis  (predominantly of alcoholic aetiology) was reported as 1.8 % and 4 % at 10 and 20 years respectively. This risk was reported to be independent of age, sex and type of pancreatitis.

The link between CP and PC is clearer in certain subtypes of CP like tropical pancreatitis and hereditary pancreatitis.

 Augustine et al. reported a 8.3 % incidence of pancreatic cancer in patients with tropical pancreatitis, which is much higher than western figures.

Ref 

Pancreatic Cancer in Chronic Pancreatitis


Clinical Picture of tropical pancreatitis

a child, adolescent or young adult , recurrent upper abdominal pain, diabetes mellitus,  malnutrition, nutrient deficiencies, nutritional edema, cyanotic hue of the lips, parotid enlargement and pancreatic calculi on plain abdominal X ray  

Ref https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742869/pdf/v079p00606.pdf

 

Survival after pancreatic resection in Ca head of Pancreas

Q) Median survival after surgery and chemotherapy in Ca Head of Pancreas

a) 12 months

b) 22 months

c) 32 months

d) 44 months

Answer for premium members

This is an interesting question because this is one tumor in which breakthrough has not been achieved in the last 70 years. Pancreatic cancer remains one of the deadliest cancers of the GI tract and whipple's surgery continues to have high morbidity.

We discuss the role and response of chemotherapy also