INI CET GI 10-20% of all questions are from pancreas.

Acute and Chronic pancreatitis, carcinoma, pseudocysts, cystic diseases of pancreas; all constitutes important questions.

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Pancreatic Carcinoma

Pancreatitis

Q1. Which of the following is least associated with development of cancer of pancreas?

a) Smoking

b) BRCA 2 gene mutation

c) Lynch Syndrome

d) Diabetes Mellitus

Ans

1.d

In adenocarcinoma of pancreas both environmental and genetic factors play a causative role. The most commonly associated risk factor for adenocarcinoma of the pancreas is smoking. The incidence of adenocarcinoma of the pancreas is directly related to the number of pack years smoked. Diabetes Mellitus and Chronic pancreatitis are somewhat doubtful etiological factors.

Somatic genetic drivers of PDAC

mutations of
a) KRAS (90%)

b) TP53 (75%)

c) SMAD4 (55%)

d) CDKN2A (80%)

Hereditary cases of PDAC are associated with several, wellestablished susceptibility genes, including BRCA2, ATM,
BRCA1, PALB2, CDKN2A, STK11, PRSS1, and SPINK1

Diabetes does not have a direct causative role in carcinoma pancreas

Blumgart New 7th edition page 845

Q2. Not true regarding blood supply of pancreas?

a) Pancreas receives blood supply from coeliac trunk and superior mesenteric artery.

b) Body and tail of pancreas is supplied by Splenic artery

c) Posterior superior pancreaticoduodenal artery is a branch of Superior mesenteric artery.

d) All major pancreatic arteries lie posterior to pancreatic ducts

Ans 2. c

Anterior and Posterior Superior Pancreaticoduodenal artery & vessels are derived from coeliac artery.

Anteior and Posterior Inferior pancreaticoduodenal artery & 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 (Postero Superior Pancreaticodeuocenal Artery) 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

Q3. Most Common Cause of death in early acute Pancreatitis is

a) Renal Failure

b) Cardiac failure

c) Respiratory Failure

d) Uncontrolled Coagulopathy

Ans

Q4. All of the following have been used in management of Acute Pancreatitis except

a) Interleukin-10

b) Gabexate

c) Somatostatin

d) Peritoneal dialysis

Ans

Q5. 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

Ans

Q6. Nealon's classification is used for

a) Acute pancreatitis

b) chronic pancreatitis

c) pseudocyst pancreas

d) alcoholic pancreatitis

Ans

PANCREAS MCQ ANSWERS

Note the Superior Pancreaticoduodenal artery coming off the coeliac artery.The Inferior Pancreaticoduodenal arteries are branches of Superior Mesenteric artery and both form an important anastomotic area in the C loop in the duodenum

In Beger's Pancreatectomy posterior Superior Pancreaticodeuodenal artery has to be preserved

3. 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.

4. 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

5. 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.

6.c

Nealon classification describes the relationship of pseudocyst pancreas with the pancreatic duct

Pancreas Questions 6-10 P Questions 11-15 Endocrine Pancreas