Pearls from the Pancreas
Superior mesenteric vein
What is the name of the pathologic classification of thyroid nodules which help guides risk of malignancy and treatment?
Bethesda classification
Name of interventional radiologic procedure to induce liver hypertrophy on Contralateral side
Portal vein embolization
This triad seen in a functional neuroendocrine tumor of the pancreas causes symptoms of weakness and confusion, glucose <70, and documentation during a spontaneous symptomatic episode
Whipple’s triad insulinoma
Gastrojejunostomy
In the evaluation of a thyroid nodule, this ultrasound guided procedure is the gold standard initial test to determine whether a nodule is benign or malignant
FNA (Fine needle aspiration)
What is the name of this complication after pancreaticoduodenectomy that is often associated with nausea/bloating/regurgitation which may be aggravated by an underlying pancreatic leak?
Delayed Gastric Emptying
Approximately 25% of Medullary thyroid cancer have a germline mutation in this protooncogene
RET
total hepatic vascular isolation
What is the specific radionucleotide tag used for PET scans for Neuroendocrine tumors?
PET-DOTATATE
This procedure is done in patients with an obstructing rectal mass in the setting of metastatic disease
Diverting loop colostomy
This physiologic reflex known as inhibitory sympathetic reflex in which mechanical manipulation of the bowel leads to a temporary cessation of peristalsis is the primary cause of this postop complication
Postoperative Ileus
Takeoff of the left renal vein
What test do you send from a FNA of a lymph node you are worried about thyroid cancer?
thyroglobulin
What is the functional liver remnant required for someone who has a background of cirrhosis?
40%
What is the Ki67 proliferation rate in a Grade 2 neuroendocrine tumor?
How do you manage bleeding in an unresectable gastric cancer patient?
Palliative SBRT (Short course radiation, 5 fractions)
Cystic duct
Cystic artery
In a patient with obstructive jaundice from a pancreatic head mass, what type of stent should you place if you anticipate neoadjuvant chemotherapy?
What is an indication for Radioactive iodine after total thyroidectomy? (Most answers get points)
1.) Tumor size >4cm
2.)Differentiated high grade carcinoma
3.)Cervical nodal metastasis (consider for any, highly recommended >5)
4.) Postoperative unstimulated Tg >10ng/mL
5.) Vascular invasion
These make up the boundaries of the Gastrinoma triangle (Passaro Triangle) where 90% of gastrinomas are found
1.) Confluence of cystic duct and common bile duct
2.) Second and third portion of the duodenum inferiorly
3.) Neck of the pancreas medially
What procedure can you perform to help alleviate severe abdominal pain either from chronic pancreatitis vs. locally advanced pancreatic cancer?
Celiac plexus block
This nerve coursing along the surface of the thyroid gland near the inferior thyroid artery is at risk during thyroidectomy and its injury results in hoarseness
recurrent laryngeal nerve
Name the guidelines often used to help differentiate when to operate on an IPMN?
Kyoto Guidelines
Thyroid lymphoma
Name the two drug regimen for locally advanced HCC that has been deemed unresectable and not a candidate for transplant
Atezolizumab
Bevacizumab
First line therapy for Neuroendocrine tumors who are SSTR positive and Ki67>10% with significant clinical tumor burden where a somatostatin analogue is chelated to a radionuclide (Lu-177) which caused DNA damage and cell death
Peptide Receptor Radionuclide Therapy
Management of a malignant small bowel obstruction in the setting of PCI of 29?
Conservative measurement
Goals of Care Discussion
PEG tube
This Vascular landmark located posterior to the neck of the pancreas Is formed by the union of the superior mesenteric vein and splenic vein
Portal vein