Most common symptom of periampullary carcinoma

Q Most common symptom in periampullary carcinoma

a) Pain 

b) Pruritis

c) Jaundice

d) Clay coloured stools

Answer

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

 

Heterotropic pancreas

Q ) True about heterotropic pancreas is

a) Most common site for heterotropic pancreas is stomach.

b) Most of these lesions present with pancreatitis

c) CT scan shows mucosal dimpled lesions

d) It can be easily differentiated from GIST and carcinoid tumors

Premium answer

 

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