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Chapter 33: Pancreas

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The percentage of patients who will have an occurrence of a replaced right hepatic artery is

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A. 1–2%

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B. 5–10%

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C. 15–20%

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D. 20–25%

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Answer: C

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In 15 to 20% of patients, the right hepatic artery will arise from the superior mesenteric artery and travel upward toward the liver along the posterior aspect of the head of the pancreas (referred to as a replaced right hepatic artery). It is important to look for this variation on preoperative computed tomographic (CT) scans and in the operating room (OR) so the replaced hepatic artery is recognized and injury is avoided. (See Schwartz 10th ed., p. 1345.)

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The most common complication of chronic pancreatitis is

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A. Pseudocysts

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B. Duct strictures and/or stones

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C. Pancreatic necrosis

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D. Duodenal obstruction

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Answer: A

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A chronic collection of pancreatic fluid surrounded by a nonepithelialized wall of granulation tissue and fibrosis is referred to as a pseudocyst. Pseudocysts occur in up to 10% of patients with acute pancreatitis, and in 20 to 38% of patients with chronic pancreatitis, and thus, they comprise the most common complication of chronic pancreatitis. (See Schwartz 10th ed., pp. 1375–1376.)

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Insulinomas associated with the multiple endocrine neoplasia (MEN)1 syndrome

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A. Do not usually require resection

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B. Are sporadic in nature

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C. Have a lower rate of recurrence

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D. Are more likely to be malignant

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Answer: B

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Approximately 90% of insulinomas are sporadic, and 10% are associated with the multiple endocrine neoplasia (MEN)1 syndrome. Insulinomas associated with the MEN1 syndrome are more likely to be multifocal and have a higher rate of recurrence. (See Schwartz 10th ed., p. 1391.)

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A pancreatic cystic neoplasms that is <3 cm, has atypical cells present, and has a solid component

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A. Requires a repeat CT scan in 3 to 6 months

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B. Requires a repeat CT scan in 1 year

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C. Requires continued observation

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D. Requires resection

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Answer: D

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See Figure 33-1. (See Schwartz 10th ed., Figure 33-75, p. 1409.)

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