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1. How does the pancreas develop?
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Correct answer:
The pancreas develops as a dorsal and a ventral bud from the duodenum. The ventral bud rotates posteriorly, thus enclosing the superior mesenteric vessels; it forms the major part of the head of the pancreas and its duct becomes the main duct of Wirsung, which in the great majority of cases has a shared opening with the common bile duct in the ampulla of Vater. The larger dorsal bud becomes the body and tail and its duct becomes the accessory duct of Santorini.
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2. What are the two main congenital abnormalities of the pancreas?
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Annular pancreas; heterotopic pancreas.
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3. What is an annular pancreas?
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Correct answer:
The two developmental buds may envelop the second part of the duodenum, producing this rare form of duodenal extrinsic obstruction.
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4. What is a heterotopic pancreas?
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Correct answer:
This is produced by an accessory budding from the primitive foregut. A nodule of pancreatic tissue may be found in the stomach, duodenum or jejunum. This produces obstructive or dyspeptic symptoms.
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5. What are the 12 causes of acute pancreatitis?
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Correct answer:
(1) Hypothermia.
(2) Hypercalcaemia.
(3) Hyperlipidaemia.
(4) Postoperative.
(5) Alcohol.
(6) Gallstones.
(7) Endoscopic retrograde cholangiopancreatography
(8) Drugs.
(9) Carcinoma of the pancreas.
(10) Infection.
(11) Trauma.
(12) Vascular.
The two most common causes are gallstones and alcohol.
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6. How commonly are gallstones associated with acute pancreatitis?
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Correct answer:
Gallstones are present in half the cases in the UK, and indeed small gallstones can be recovered from the faeces of many patients with acute pancreatitis.
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7. How commonly is alcohol associated with acute pancreatitis?
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Correct answer:
The majority of non-gallstone pancreatitis is alcohol related. This is particularly common in France and North America. Alcohol is also the commonest cause of recurrent pancreatitis. The mechanism is unclear, and it may follow either chronic alcohol abuse or binge drinking.
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8. In which parts of the world does alcohol have a particular association with acute pancreatitis?
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Correct answer:
France and North America.
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9. With which operations is acute pancreatitis associated postoperatively?
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Correct answer:
Particularly after cardiopulmonary bypass or damage to the pancreas during mobilization of the duodenum at partial gastrectomy or splenectomy.
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10. Why is acute pancreatitis associated with endoscopic retrograde cholangiopancreatography?
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Correct answer:
Particularly if pancreatography was performed and when there was difficulty cannulating the papilla with subsequent oedema and obstruction.
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11. Which infections are associated with acute pancreatitis?
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Correct answer:
Mumps, cytomegalovirus or coxsackie infection.
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12. What type of trauma is associated with acute pancreatitis?
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Particularly blunt trauma or crush injury.
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13. Which drugs are associated with acute pancreatitis?
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Correct answer:
Sodium valproate; corticosteroids.
