18 - Pancreas 2026

Ventral anlage

The accessory duct of Santorini is derived from the dorsal anlage, if present

The main pancreatic duct of Wirsung is derived from the ___ anlage

Pancreas divisum

What is the most common congenital anomaly of the pancreas?

Annular pancreas

Which congenital anomaly of the pancreas is associated with proximal small intestinal obstruction?

Gallstones

What is the most common cause of acute pancreatitis?

Grey Turner sign

Flank ecchymosis in acute pancreatitis is known as what sign?

Cullen sign

Periumbilical ecchymosis in acute pancreatitis is also known as what sign?

Amylase and lipase (elevated 3x upper limit)

Contrast-enhanced CT may be used to diagnose acute pancreatitis if the above two criteria are not met

Acute pancreatitis may be diagnosed by these characteristic laboratory markers, which are:

Lipase

Between amylase and lipase, which is more specific for acute pancreatitis and remains elevated for a much longer period?

Abdominal CT scan

What is the diagnostic gold standard for acute pancreatitis?

Hypertriglyceridemia

Serum lipase is often more useful for acute pancreatitis because it is more specific

Serum amylase may be normal in acute pancreatitis due to ___

Alcohol

According to TIGAR-O classification, there is increasing incidence of chronic pancreatitis with duration of alcohol use

What is the most common cause of chronic pancreatitis? (Schwratz)

90%

Pancreatogenic diabetes can occur in chronic pancreatitis when ___% of the parenchyma is replaced by fibrosis

Pancreatitis (75%)

Trauma (25%)

What are the two most important causes of pancreatic pseudocyst?

Head/uncinate process

Masses at the head

Pancreatic adenocarcinoma most commonly arises in which part of the pancreas?

Pancreatic malignancy

What is the most common periampullary malignancy?

Head of pancreas

Tumors at the ___ of the pancreas will often present with obstructive jaundice and thus lead to earlier diagnosis

CA 19-9

What tumor marker is elevated in pancreatic cancer?

Contrast-enhanced computed tomography (CECT) of the pancreas (triple-phase: arterial, pancreatic, venous)

What is the most effective tool for diagnosis and staging of pancreatic cancer?

Whipple procedure (pancreaticoduodenectomy)

What surgical procedure is the only definitive and potentially curative treatment for periampullary carcinoma?

Nonfunctional tumors

What is the most common pancreatic endocrine tumor?

Gastrinomas

What is the most common islet cell tumor in patients with MEN1?

Insulinomas

What is the most common functional pancreatic endocrine tumor?

Symptomatic fasting hypoglycemia

Serum glucose <50 mg/dL

Relief of symptoms with glucose administration

What are the components of the Whipple's triad of insulinoma?

Simple enucleation

However, when the lesion is embedded deep in the pancreatic tissue or is close to the main pancreatic duct, enucleation should be avoided and formal pancreatic resection should be done

What is the surgical management of insulinomas?

WDHA: Watery Diarrhea, Hypokalemia, Achlorhydria

What are the components of the syndrome in VIPoma?

Glucagonoma

The presence of necrolytic migratory erythema (diabetes + dermatitis) points to the presence of this pancreatic pathology:

Octreotide (somatostatin analogue)

Symptoms of VIPoma may be treated with this drug:

Pancreatic polypeptide (PP)

What tumor marker is elevated in non-functioning islet cell tumors of the pancreas?