Pancreas

Endocrine cells of pancreas

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Q) Delta cells in the pancreas secrete

a) Insulin

b) Glucagon

c) Somatostatin

d) Secretin

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%

Somatostatin is an inhibitory hormone and inhibits most of the things

Whipple’s triad

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Q) Whipple's triad is seen in which pathological condition?

a) Insulinoma

b) Glucagonoma

c) VIPOma

d) Somatostatinoma

 

Answer 

a) Insulinoma

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

Other Points

  • 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
  • Average size of insulinoma is 1-1.5 cm

Symptoms of Insulinoma

The neuroglycopenic symptoms of insulinoma included confusion, visual change, and unusual behavior

Sympathoadrenal symptoms may include palpitations, diaphoresis, and tremulousness.

Whipple's triad is just a part of Insulinoma and is not pathognomic of it. This entity may also be seen in other hyperinsulinemic conditions.

For endogenous Insulinoma, following tests are done

Proinsulin above 5.0 pmol/L

insulin above 3.0 pmol/L,

C-peptide above 0.2 nmol/L

all demonstrate endogenous hyperinsulinemia

In Memoriam: Allen O. Whipple, M.D

Most common cause of death in acute pancreatitis

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Q. Most Common Cause of death in early acute Pancreatitis is ( Free Questions on Pancreas) 
 a) Renal Failure
b) Cardiac failure
c) Respiratory Failure
d) Uncontrolled Coagulopathy

Ans

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.

EUS in pancreatic cancer

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Q) What is true about the role of EUS in Carcinoma head of pancreas.

a) It has a sensitivity of 50-60% in detecting lesions less than 3 cm in size

b) It has a  high negative predictive  value

c) Chronic pancreatitis can be easily differentiated from Carcinoma head of pancreas by EUS

d) Small caliber needles have low accuracy than high caliber needles in FNAC

www.mcqsurgery.com/pancreas

Beger Procedure for Chronic Pancreatitis

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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  transected

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 For Small tumors it can be used

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

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