לבלב Flashcards
מהי הסיבה הכי שכיחה לפאנקריאטיטיס אקוטית
אבנים בכיס מרה
What are the main causes of acute pancreatitis
I GET SMASHED
I- idiopathic
G- gallstones
E- etanhol (alcohol)
T- trauma
S- steroids
M- mumps
A- autoimmune
S- scorpion sting/ spider sting
H- Hyperlipidemia / Calcemia
E- ERCP
D- Drugs
Which level of Renson for severity of pancreatitis is consider secere?
Renson > 3
(out of 10)
מהו הטיפול בפאנקריאטיטיס?
שמרני- צום, נוזלים, משככי כאבים חמצן וניטול
נעדיף הזנה אנטרלית פוסט פילורית תוך 24 שעות מהאשפוז
הזנה מוקדמת- מפחיתה סיבוכים וזיהומים
Tx for
* פאנקריאטיטיס קלה בגלל אבנים בכיס מרה
* פאנקריטיטיס קשה בגלל אבנים ביכיס מרה
- במצב קל- כריתת כיס מרה באשפוז
- במצב קשה- כריתה אלקטיבית לאחר 6 שבועות
מהו % החולים עם פאנקריאטיטיס חריפה שיפתחו נמק?
לרוב איזה חיידקים יהיו מעורבים?
20%
חיידקים גרם שליליים- e.coli, klabsiella, pseudomonas
כיצד נאבחן ונטפל ב-
pancreatic necrosis
Dgx
CT - אזורי היפופרפוזיה ( אזורים היפודנסיים)
Tx
אנטיובטיקה- Carbapenem- חודרת רקמה נמקית
+
ניקוז פרקטונאי / אנדוסקופי
קו שני
הטריה (נקרוסטומיה) פתוחה
מהו המבנה של פסואודוציסטה בלבלב ומתי מופיעה לרוב?
קולקציית נוזל מוקפת רקמת גרנולציה וקולגן (לא אפיתל)
חודש חודשיים לאחר פאנקריאטיטיס חריפה
A 45-year-old male with a history of chronic pancreatitis presents with abdominal discomfort and early satiety. On examination, there is mild abdominal tenderness. A CT scan reveals a well-defined 5 cm pseudocyst located in the tail of the pancreas. The patient is asymptomatic other than the mild discomfort and denies any fever, nausea, or significant pain.
What is the most appropriate next step in the management of this patient?
A) Surgical drainage with cystogastrostomy
B) Observation with serial imaging
C) Percutaneous drainage
D) Immediate endoscopic retrograde cholangiopancreatography (ERCP)
E) Resection of the cyst
Observation with serial imaging
Asymptomatic pancreatic pseudocysts less than 6 cm in size can be managed conservatively with observation. Many pseudocysts, especially smaller ones, regress spontaneously, particularly in the absence of symptoms. Only when pseudocysts are symptomatic, enlarging, or associated with complications (such as infection, hemorrhage, or obstruction) is intervention required .
A 58-year-old man presents with a history of severe acute pancreatitis one month ago. He now complains of abdominal pain, early satiety, and weight loss. CT scan reveals a 9 cm pancreatic pseudocyst in the head of the pancreas with compression of the adjacent duodenum. Endoscopic drainage is attempted but fails to improve the patient’s symptoms.
What is the next best step in management?
A) Continued observation
B) Percutaneous drainage
C) Surgical drainage with cystoduodenostomy
D) Resection of the pancreatic head
E) Endoscopic stenting of the cyst
urgical drainage with cystoduodenostomy
Large pseudocysts (>6 cm) that are symptomatic, causing obstruction, or fail to regress spontaneously after conservative management often require surgical intervention. In this case, the pseudocyst is compressing the duodenum, causing obstructive symptoms, making cystoduodenostomy (surgical drainage into the duodenum) the appropriate next step. Endoscopic and percutaneous drainage are not appropriate given the size and location of the pseudocyst and the failure of previous endoscopic attempts .
מהו הטיפול בפסואו-ציסט בלבלב?
Pseudocysts < 6 cm and asymptomatic can be managed with observation and follow-up imaging, as many will resolve spontaneously.
Pseudocysts >6 cm or those that persist beyond 6 weeks typically require intervention due to the higher risk of complications.
מתי נבצע ניקוז אנדוסקופי ומתי ניתוחי בפסואו-ציסט באינדיקציה ניתוחית?
- Endoscopic drainage is preferred for pseudocysts >6 cm that are adjacent to the stomach or duodenum, accessible, and without complications like infection or hemorrhage.
- Surgical drainage is indicated when endoscopic drainage fails, the pseudocyst is complicated (e.g., infection, obstruction), or it’s in a location inaccessible by endoscopy.
ניקוז ניתוחי = ציסטגסטרוסטומיה / ציסטדאודנוסטומיה
Epigastric pain with jaundice and new onset of DM should raise a suspect of?
How we Dgx?
Chronic pancriatitis
Dgx- ERCP. most common reason - alcohol (80%)
Which pancreatic cysts has starburst appearance with multiple small cysts?
Serous cystic neoplasm
הסתיידות מרכזית השולחת ספטות רדיאליות
Which pancreatic cysts is a/w eggshell apperance and calcification?
Mucinous cystic neoplasm
Tx for mucinous cystic neoplasm?
pancreatectomy of involve part
consider adjvant therapy (if malignant)
what is the lesion a/w cytic enlargment of wirsong duct with metaplasia and mucous secretion?
Main duct IPMN
Dgx- CT
Which cyst are a/w mucin production and high levels of CEA?
Mucinous cysts neoplasm
+
IPMN (intraductal mucnious neoplasm)
CEA is going with mucinous secreted lesions
Which pancreatic cysts are a/w high amylase levels?
- psuedo-cysts
- IPMN
in IPMN- everything is high, so if CEA low = must be psuedo-cysts
in IPMN, what are the indication of resection of involved part?
Whippel procedre- pancreaticodudunectomy
- symptomatic
- Cysts > 3 cm
- high risk for malignancy jaundice, solid , wirsong > 1 cm, 15% cystd as side brance)
- main duct IPMN
A 55-year-old woman presents with vague abdominal discomfort. She has no history of pancreatitis or abdominal trauma. A CT scan shows a solitary, thin-walled cyst in the body of the pancreas, measuring 4.5 cm. The cyst fluid analysis reveals high CEA levels and low amylase levels.
What is the most appropriate next step in management?
A) Observation and follow-up imaging
B) Surgical resection
C) Endoscopic drainage
D) Percutaneous biopsy
E) Chemotherapy
Surgical resection
This patient has a mucinous cystic neoplasm (MCN), which is characterized by a solitary cyst, high CEA, and low amylase. Due to its malignant potential, the appropriate management is surgical resection, especially when the cyst is >4 cm.
A 65-year-old woman presents with an incidental finding of a pancreatic cyst on CT during evaluation for gallbladder disease. The cyst measures 3 cm and is located in the head of the pancreas. The cyst fluid analysis shows low CEA levels and low amylase. The CT shows multiple small cysts with central calcifications.
What is the most likely diagnosis?
A) Pancreatic pseudocyst
B) Intraductal papillary mucinous neoplasm (IPMN)
C) Mucinous cystic neoplasm (MCN)
D) Serous cystic neoplasm (SCN)
E) Pancreatic adenocarcinoma
** Serous cystic neoplasm (SCN)**
This patient has a serous cystic neoplasm, characterized by low CEA, low amylase, and a “starburst” calcification pattern. SCNs are usually benign, and treatment is often unnecessary unless symptomatic.
A 70-year-old man presents with painless jaundice. A CT scan shows dilation of the main pancreatic duct and multiple cystic lesions within the head of the pancreas. The fluid analysis shows high CEA and high amylase levels.
What is the most appropriate management?
A) Observation with serial imaging
B) Endoscopic drainage
C) Surgical resection
D) Chemotherapy
E) Percutaneous aspiration
Surgical resection
This patient likely has a main duct intraductal papillary mucinous neoplasm (IPMN), characterized by ductal dilation and high CEA and amylase levels. Main duct IPMNs carry a high risk of malignancy, so surgical resection is the appropriate treatment.
A 48-year-old male with a history of alcohol-induced acute pancreatitis presents with worsening abdominal discomfort. A CT scan reveals a 6 cm fluid-filled collection in the tail of the pancreas. Fluid analysis shows high amylase and low CEA.
What is the most likely diagnosis?
A) Serous cystic neoplasm
B) Mucinous cystic neoplasm
C) Pancreatic pseudocyst
D) Main duct IPMN
E) Pancreatic adenocarcinoma
Pancreatic pseudocyst
This patient’s history of pancreatitis and the findings of a fluid-filled cyst with high amylase and low CEA are consistent with a pancreatic pseudocyst. Pseudocysts are typically managed conservatively unless symptomatic or complicated.
