Insulinoma Gatsrinom Glucagono Vipoma somatosta

a ma ti
Cell of B cells G cells.Not A cells. D2 cells. Evenly D cells.
origin and Body and present in Evenly distributed. Evenly
location in tail normal distributed And G cells. distribute
pancreas physiologi d
c state in
islet.
Location of Evenly Triangle Only in 90 % Body and Head Pan
tumour distributed (D1> pancreas tail >duodenu
pancreas) Body an Tail M/C, 10% in m> small
tail. colon,bronchus, intestine
adrenal, liver.
Clinical Whipple Pain 4 Ds, NME WDHA, Hypochlor
triad, abd,diarrh with isosmotic hy DM,
Painless ea relived itch,mild diarrhea not gall sto
by NG DM relived by steatorrhe
tube NG/fast, > 700 o
ml
% benign 90% benign 75% small 10% benign 75% benign 10%
% 10% D1 90% 25% malignant benign
malignant malignant 25% large malignant 90%malig
pancreatic nant
and liver
mx
% >50% 80% liver 70% mx Mx to liver
metastat mx / LN
at present
%sporadic 95% 75% 95% 95% sporadic 95%spora
% a/w sporadic sporadic sporadic 5% MEN1 dic
MEN1 5% MEN1 25% MEN1 5% MEN1 5% MEN1
When a/w Multiple and m/c in a/w
MEN malignant duodenum MEN,PHC,
, multiple, Von
90% LN Reckingha
mets at usen
present
and never
to liver
Biochemic i/g >0.3, <100 <100 pg/ml <200 pg/ml 10-25
al insulin>3uU pg/ml pg/ml
Normal /L gastrin
c-pep>0.2
prions>5
BHB<2.7
Diagnostic >1000pg/ >1000pg/m 200-2000 >160
ml with l pg/ml pg/ml
PH<2
Secretin
 stim >200
pg
increase
Size at Avg 1.5 cm Small size 5-10 cm Solitary and Solitary
presentati and >3cm and >
on difficult to 2cm
localize.
Can
present
anywhere
in
Abdomen
Localizatio EUS/ ASVS. EUS/SRS/A CT scan CT scan CT scan
n imaging No role of SV
SRS Transillumi
nation and
duodenoto
my. Entire
abdomen
exploratio
n
Medical rx PPI ro IV amino Electrolyte and INF-a
maintain acids fluid. Octrotide Octrotide
BAO<10 Octreotide. and steroids
mEq/hr. Anti-DVT .
DACARBAZI
NE
Surgery Enucleation If PPI fails. Complete Complet Whipples
Debulking, anatomic anatomic as Head is
gastrecto resection. resection. No involved
my role of
debulking of
mets