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. Cancerous

d) Onset of disease at 50 years 


Answer d - Free. See here for other questions and this question

Onset 50 years

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

These patients have increased risk of cancer

It is associated with SPINK 1 mutation

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

Endocrine cells of pancreas

Q) Delta cells in the pancreas secrete

a) Insulin

b) Glucagon

c) Somatostatin

d) Secretin

Free answer for all

Answer d

Somatostatin

Endocrine pancreas
Endocrine cells of pancreas

Pancreas- Endocrine functions

Beta cells form 65-80% of pancreatic endocrine cells and produce insulin

Alpha cells 12-20% and produce glucagon

Delta cells 3-10% and produce somatostatin

PP cells - Pancreatic polypeptide 1%

Somatostain is an inhibitory hormone and inhibits most of the things

 

Whipple’s triad

Q) Whipple's triad is seen in 

a) Insulinoma

b) Glucagonoma

c) VIPOma

d) Somatostatinoma

Answer 

a

Whipple's triad is seen in pancreatic insulinoma and consists of 

a) Symptoms of hypoglycemia

b) Fasting sugar less than 50 mg%

c) Relief of symptoms with administration of dextrose solution

  • Insulinoma is the most common functioning pancreatic neuroendocrine tumor
  • Symptoms are present for many years before diagnosis
  • Weight gain is common
  • Distribution of insulinomas is equal in body head and tail
  • Avg size of insulinoma is 1-1.5 cm

 

 

 

Beger Procedure for Chronic Pancreatitis

Q) True about Beger procedure for chronic pancreatitis

a) Posterior branch of gastro duodenal artery is preserved.

b) Beger procedure is  a pancreatic head mass resection that can be done for small pancreatic tumors.

c) Intra pancreatic, choledochal and ampullary structures are removed.

d) Neck of the pancreas is not  transacted

 

Answer a) Posterior branch of GDA is preserved

Beger procedure for chronic pancreatitis is mostly done in Europe. Hans Beger in 1972 in Germany introduced this  for chronic pancreatitis with inflammatory head mass. This is a complex procedure which removes head of the pancreas but leaves duodenum, a thin rim of pancreas around the medial aspect of duodenum and intrapancreatic bile duct intact.

The difference from  similar Frey's procedure is that in Beger procedure neck of the pancreas is transacted where as in Frey, neck of the pancreas is not cut.

This procedure is not recommended if there is suspicion of carcinoma  head of pancreas and Whipple is the procedure for that.

Posterior branch of GDA is preserved in Beger Procedure.

Reconstruction is at two places: Distal pancreas and rim of the pancreas at medial side of duodenum.

Free Questions on Pancreas