Q1. Which of the following is not true regarding blood supply of pancreas?
a) It receives blood supply from coeliac trunk and superior mesenteric artery.
b) Body and tail of pancreas is supplied by Splenic artery
c) Postero superior pancreaticoduodenal artery is a branch of Superior mesenteric artery.
d) All major pancreatic arteries lie posterior to pancreatic ducts.
Q2. Most Common Cause of death in early acute Pancreatitis is
a) Renal Failure
b) Cardiac failure
c) Respiratory Failure
d) Uncontrolled Coagulopathy
Q3. All of the following have been used in management of Acute Pancreatitis except
a) Interleukin-10
b) Gabexate
c) Somatostatin
d) Peritoneal dialysis
Q4. Which of the following is not true for ectopic pancreas
a) stomach and duodenum are the most common site
b) Ectopic pancreas appears as a submucosal irregular nodule in the wall
c) Islet tissue is present in all the organs where ectopic pancreas is present.
d) Ulceration, bleeding and obstruction are the most common symptoms
Q5. Nealon's classification is used for
a) Acute pancreatitis
b) chronic pancreatitis
c) pseudocyst pancreas
d) alcoholic pancreatitis
Answers
1. c
Anterior and Posterior superior Pancreatic vessels are derived from coeliac artery.
Anteior and posterior Inferior pancreatic vessels are derived from Superior Mesenteric artery.
Splenic artery supplies the body and tail of pancreas. Dorsal pancreatic artery usually arises from the splenic artery, near its origin from the celiac trunk. A right branch of the dorsal pancreatic artery supplies the head of the pancreas and usually joins the posterior arcade.
The gastroduodenal artery gives origin to the supraduodenal, retroduodenal, and posterior
superior pancreaticoduodenal (PSPD) arteries. The gastroduodenal artery ends by dividing into the right gastroepiploic and anterior superior pancreaticoduodenal (ASPD) arteries.
PSPD is a branch of gastroduodenal and not Superior mesenteric artery
The anterior inferior pancreaticoduodenal artery arises from the SMA at or above the inferior margin of the pancreatic neck.
Mastery of Surgery Page 1232 5th edition
2. c
Respiratory failure is the cause of death in the early phase (7 days). The pulmonary manifestations of pancreatitis include atelectasis and acute lung injury.
where as infective complications are the cause of death in late phase.
3. a
Peritoneal dialysis, Gabexate, lexipafant (Anti PAF factor) Somatostatin all have been used in management of acute pancreatitis but have been found to be of no proven value .
IL 10 is raised in pancreatitis and has no role as treatment modality
4. c
Ectopic pancreas is most commonly seen as a submucosal nodule in the wall of stomach, duodenum, ileum, colon, gall bladder, meckel's diverticulum and mesentary.
Islet tissue is present only in the wall of stomach and duodenum not in other organs.
Ulceration , bleeding and obstruction (Ectopic pancreas can form a lead point of intussusception).
Sabiston Surgery 18th edition page 1592.
5.c
Nealon classification describes the relationship of pseudocyst pancreas with the pancreatic duct
