Curbside Consultation of the Pancreas

Scott Tenner, MD, MPH, serves as Director of Medical Education and Research at Maimonides Medical Center, New York. He also serves as an Associate Professor of Medicine at the State University of New York. Dr. Tenner received his doctorate in medicine, his master’s in cell biology, and his master’s in public health at The George Washington University, Washington, DC. He completed his training in gastroenterology and endoscopy at Brigham and Women’s Hospital, Harvard Medical School, Boston. Board certified in both medicine and gastroenterology, he has served as President for the New York Society for Gastrointestinal Endoscopy and currently serves as a Governor and Chair of the National Affairs Committee for the American College of Gastroenterology. Actively involved in teaching and research, Dr. Tenner has authored more than 200 abstracts, papers, chapters, and books. With a focus on diseases of the pancreas, Dr. Tenner is a member of the Research Committee for the American College of Gastroenterology and often serves as a speaker, reviewer, and moderator in subjects of pancreatic disease at national scientific meetings. Despite a busy academic career, Dr. Tenner maintains a busy private practice. He serves as Director of the Brooklyn Gastroenterology and Endoscopy Associates and the Greater New York Endoscopy Surgical Center.Alphonso Brown, MD, MS Clin Epi, is currently a staff physician at The Beth Israel Deaconess Medical Center, a Harvard teaching hospital. He also holds a teaching appointment at Harvard Medical School. He spends his time between patient care duties and the conduct of translational research.Frank G. Gress, MD, is Professor of Medicine and Chief, Division of Gastroenterology and Hepatology at the State University of New York (SUNY), College of Medicine and Downstate Medical Center in Brooklyn, NY. Previously, Dr. Gress was Associate Professor of Medicine at Duke University, Durham, NC and served as Clinical Chief for the Gastroenterology Section at the Durham VA Medical Center.Dr. Gress completed his medical school training at the Mount Sinai School of Medicine in New York, NY; residency in internal medicine at Montefiore Medical Center, Bronx, NY; and his gastroenterology fellowship at the Brooklyn Hospital Center and Methodist Hospital affiliated with SUNY, Health Sciences Center, Brooklyn, NY. After finishing his gastroenterology fellowship, Dr. Gress was awarded the American Society for Gastrointestinal Endoscopy Advanced Endoscopy Scholarship, which was established to support training in advanced therapeutic endoscopy, and he subsequently completed an advanced therapeutic endoscopy fellowship at the Division of Gastroenterology and Hepatology at Indiana University Medical Center in Indianapolis where he trained in the emerging field of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography.Dr. Gress has published more than 80 articles on original research in highly respected peer-review journals and contributed more than 25 chapters to numerous textbooks on such subjects as clinical gastroenterology, rectal cancer, pancreatitis, pancreatic cancer, advanced endoscopy, training simulators for endoscopy, and the clinical applications of endoscopic ultrasound to name a few. He also lectures regularly at regional and national meetings on these subjects. He also co-authored the textbook Endoscopic Ultrasonography, now in its second edition.

"The book is surprisingly well-illustrated given its size and conciseness. The authors are to be complimented on putting together such an excellent book which nicely addresses many common clinical scenarios. I recommend this book to the busy clinician or trainee who needs to have a book that will supply quick information." — Priya Jamidar, MD, FACG, FASGE, Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, Journal of Clinical Gastroenterology"Among the great features of this book is the way it provides helpful information in very short chapters on well selected, relevant topics. It is an interesting, quick read by authors who are respected experts in the field. The answers are short and relatively basic… this is an exceptionally interesting book for students, clinicians, and researchers who deal with pancreatic diseases." — Patrick Mosler, MD, PhD, University of Kentucky College of Medicine, Doody Enterprises, Inc."Summary tables and figures are listed for the vast majority of topics, which are particularly helpful to highlight the reading material. Overall, the material reviewed is extremely accurate, up to date, and easy to read. Curbside Consultation of the Pancreas: 49 Clinical Questions does carve out its own niche as compared with existing books and texts on the pancreas…a well recommended book to anyone looking for a user-friendly resource for pancreatic and biliary disease written in a practical and clinically oriented format. Moreover, the layout and high use of images, charts, and tables makes the book an enjoyable source of medical information that is sure to be used repeatedly in everyday practice." — Daniel Cornett & Patrick Pfau, Division of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinics, Madison, WI, Gastroenterology

• Contents Dedication About the Editors Contributing Authors Section I: ACUTE PANCREATITIS Question 1 How Much Fluid Should Be Given During the Initial Management of Acute Pancreatitis? Nison Badalov, MD and Scott Tenner, MD, MPH Question 2 Should I Check a C-Reactive Protein During All Admissions for Pancreatitis? Nison Badalov, MD and Scott Tenner, MD, MPH Question 3 When Should I Consider Performing a Computed Tomography of the Abdomen in Patients With Acute Pancreatitis? Nison Badalov, MD and Scott Tenner, MD, MPH Question 4 When Would You Use Antibiotics in Acute Pancreatitis, and Which Antibiotics Would You Use? Nison Badalov, MD and Scott Tenner, MD, MPH Question 5 What Can Be Done to Minimize Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis? Nison Badalov, MD and Scott Tenner, MD, MPH Question 6 What Is the Best Approach to Nutrition in Acute Pancreatitis? Shishir K. Maithel, MD and Charles M. Vollmer, Jr, MD Question 7 When Should Gallstones Be Considered the Etiology of Acute Pancreatitis? Nison Badalov, MD and Scott Tenner, MD, MPH Question 8 When Should an Endoscopic Retrograde Cholangiopancreatography Be Performed in Acute Gallstone Pancreatitis? Nison Badalov, MD and Scott Tenner, MD, MPH Question 9 My Patient Had a Single Episode of Uncomplicated Gallstone Pancreatitis. Should He Have a Cholecystectomy, and, if so, When? Nison Badalov, MD and Scott Tenner, MD, MPH Question 10 Should a Cholecystectomy Be Performed on Patients With Acute Pancreatitis, No Gallstones, but Sludge in the Gallbladder? Benjamin E. Young II, MD Question 11 When Would You Perform Surgery in Acute Pancreatitis? Nison Badalov, MD and Scott Tenner, MD, MPH Question 12 What Should Be the Sequence of Investigations for a Patient With Recurrent, Unexplained Acute Pancreatitis? Nison Badalov, MD and Scott Tenner, MD, MPH Question 13 How Is Hypertriglyceridemia Treated When Suspected in Causing Acute Pancreatitis? Susan Ramdhaney, MD and Scott Tenner, MD, MPH Question 14 My Patient With Crohn's Disease Developed Pancreatitis on Imuran. Can He Take 6-MP? Nison Badalov, MD and Scott Tenner, MD, MPH Question 15 My Patient With Acute Pancreatitis Has a Computed Tomography Scan With Thrombosis of the Splenic Vein. Is It Safe to Anticoagulate Him? Susan Ramdhaney, MD and Alphonso Brown, MD, MS Clin Epi Section II: CHRONIC PANCREATITIS Question 16 How Is the Diagnosis of Chronic Pancreatitis Established? Jonathan Ari Erber, MD and Frank G. Gress, MD Question 17 What Is the Best Method of Treating Pain in Patients With Chronic Pancreatitis? Kumaravel Perumalsamy, MD and Scott Tenner, MD, MPH Question 18 Is There a Role of Pancreatic Enzymes to Treat Pain in Patients With Chronic Pancreatitis? Sagar Garud, MD, MS and Alphonso Brown, MD, MS Clin Epi Question 19 What Is the Pathophysiology of Alcohol-Induced Injury to the Pancreas? Nison Badalov, MD and Scott Tenner, MD, MPH Question 20 When Should One Suspect Autoimmune Pancreatitis as a Cause of Acute or Chronic Pancreatitis? Jonathan Ari Erber, MD and William Franklin Erber, MD Question 21 What Are the Complications of Chronic Pancreatitis? Jonathan Ari Erber, MD and Frank G. Gress, MD Section III: CYSTIC PANCREATIC LESIONS Question 22 My Patient Is a Middle-Aged Woman With an Asymptomatic 5-cm Fluid-Filled Cyst in the Tail of the Pancreas, Found Incidentally on Abdominal Computed Tomography Scanning. What to Do Next? Nison Badalov, MD and Scott Tenner, MD, MPH Question 23 What Is the Best Approach to a Cystic Lesion in the Tail vs Head of the Pancreas When the Diagnosis Cannot Be Clearly Established? Nison Badalov, MD and Scott Tenner, MD, MPH Question 24 Endoscopic Ultrasound-Guided Fine Needle Aspiration of a Pancreatic Cyst in This Patient Yielded Fluid With an Amylase of 4500 and a Carcinoembryonic Antigen of 20. Is This Normal? Ilan Aharoni, MD and Scott Tenner, MD, MPH Question 25 Why Is It Important to Distinguish Serous Cystadenoma and Mucinous Cystadenoma? Hani Abdallah, MD and Alphonso Brown, MD, MS Clin Epi Question 26 My Hospital Does Not Have an Endoscopic Ultrasonographer. Is It Safe for Me to Use Computed Tomography-Guided Fine Needle Aspiration for a Pancreatic Lesion? Richard O'Farrell, MD Question 27 How Does One Manage Pseudocysts? Nison Badalov, MD and Scott Tenner, MD, MPH Question 28 How Do I Determine When a Pseudocyst Has Become Infected? How Do I Manage This? Nison Badalov, MD and Robin Baradarian, MD, FACG Question 29 My Patient Has a Large Pancreatic Cyst. Should I Involve a Surgeon in the Evaluation and Management of This Situation? John D. Christein, MD Question 30 When Should Endoscopic Therapy of the Pseudocyst and/or Organized Necrosis in Acute Pancreatitis Be Applied? Nison Badalov, MD and Robin Baradarian, MD, FACG Section IV: PANCREATIC CANCER Question 31 What Are the Risk Factors for the Development of Pancreatitic Cancer? Nison Badalov, MD and Robin Baradarian, MD, FACG Question 32 What Is the Best Approach to Staging Pancreatic Cancer? Nison Badalov, MD and Robin Baradarian, MD, FACG Question 33 What Are the Treatment Options for Early and Locally Advanced Pancreatic Cancer? Paul S. Sepe, MD Section V: OTHER PANCREATIC NEOPLASMS Question 34 In a Patient With Recurrent Hypoglycemia, How Does One Evaluate for an Insulinoma? Susan Ramdhaney, MD and Alphonso Brown, MD, MS Clin Epi Question 35 My Patient Has Chronic Diarrhea and Extensive Work-Up Has Been Negative. How to Establish a Diagnosis in a Patient Suspected of Having VIPoma? Jack P. Braha, DO; Robin Baradarian, MD, FACG; and Nison Badalov, MD Question 36 My Patient Has Reflux Esophagitis in Spite of Daily Omeprazole. His Serum Gastrin on Omeprazole Is 750. What Is the Next Step in Evaluation for Gastrinoma? Susan Truong, HMS III and Alphonso Brown, MD, MS Clin Epi Question 37 What Masses Mimic Pancreatic Cancer? Susan Truong, HMS III and Alphonso Brown, MD, MS Clin Epi Section VI: BILIARY Question 38 What Is the Role of Cholangiopancreatoscopy in Pancreaticobiliary Disease? Greg Guthrie, MD and Young Lee, MD Question 39 My Patient Had a Magnetic Resonance Cholangiopancreatography to Evaluate for Common Bile Duct Stones, but the Reading Includes a \u0022Double Duct Sign.\u0022 What Does This Mean? Does It Need Endoscopic Retrograde Cholangiopancreatography? Hui Hing (Jack) Tin, MD and Jai Mirchandani, MD Question 40 How Should I Discuss the Risks of Post-Procedure Pancreatitis With a Patient Whom I Am Consenting for Endoscopic Retrograde Cholangiopancreatography? Do I Really Have to Tell Him He Could Die? Susan Ramdhaney, MD and Alphonso Brown, MD, MS Clin Epi Question 41 In a Patient With Gallstone Pancreatitis, When Should an Endoscopic Retrograde Cholangiopancreatography and/or Magnetic Resonance Cholangiopancreatography Be Performed Preoperatively? Nison Badalov, MD and Robin Baradarian, MD, FACG Question 42 I Have a Patient With Suspected Primary Sclerosing Cholangitis. What Do I Need to Know and How Do I Establish the Diagnosis? Ronald Concha-Parra, MD and Frank G. Gress, MD Question 43 Caroli's Disease, What Do I Need to Know? Mustafa A. Tiewala, MD and Frank G. Gress, MD Question 44 Choledochal Cyst, What to Do? Watch, Ignore, or Operate? Yuriy Tsirlin, MD and Frank G. Gress, MD Question 45 What to Do in a Patient Suspected of Having Cholangiocarcinoma? Hui Hing (Jack) Tin, MD and Robin Baradarian, MD, FACG Question 46 How Often Should I Perform Endoscopic Retrograde Cholangiopancreatography in Order to Retain an Adequate Level of Skill? Susan Ramdhaney, MD and Alphonso Brown, MD, MS Clin Epi Section VII: MISCELLANEOUS Question 47 What Is the Best Approach to the Patient With S