๐ท๐๐๐๐๐๐๐๐๐ ๐ช๐๐๐๐๐ Flashcards
What is the anatomical position of the pancreas?
A retroperitoneal organ anterior to the 1st lumbar vertebrae
What are the typical dimensions of the pancreas?
Measures between 10-20cm long & weighs 75-125gm
What are the four anatomical parts of the pancreas?
Head neck body & tail
What is the anatomical position of the pancreatic head?
To the right of the midline within the C-loop of the duodenum anterior to the vena cava
What arteries supply the pancreas?
Splenic artery (neck body & tail), superior & inferior pancreaticoduodenal arteries
What are the main veins draining the pancreas?
Superior pancreaticoduodenal vein, superior mesenteric vein
Where do the lymphatics of the body and tail of the pancreas drain?
Into the splenic hilar glands
What are the two main functional categories of the pancreas?
Exocrine and endocrine functions
What are the three main digestive enzymes produced by the pancreas?
Lipase peptidases and amylase
What are the three main hormones produced by the pancreas?
Insulin glucagon and somatostatin
What is the second most common pancreatic cancer?
Cystic neoplasm of the pancreas
What is the most common cystic neoplasm of the pancreas?
Mucinous cystic neoplasm
What is characteristic about mucinous cystic neoplasm demographics?
Frequently seen in young women and rarely affects men
What hormonal staining is characteristic of mucinous cystic neoplasm?
Staining for estrogen & progesterone
What is the typical presentation of serous cystic neoplasm?
Usually affects head of pancreas causing vague abdominal pain & less jaundice
What is the most common type of pancreatic cancer?
Adenocarcinoma
What is the 5-year survival rate for pancreatic adenocarcinoma?
<5% in 5 years
What is the male to female ratio in pancreatic adenocarcinoma?
M:F is 13:1
What is the peak age incidence for pancreatic adenocarcinoma?
65-75 years
List five risk factors for pancreatic adenocarcinoma
Smoking obesity diabetes chronic pancreatitis hereditary factors
What tumor suppressor genes are involved in pancreatic cancer?
PDX1 KRAS2 CDKN2A/p16 p53 DPCA
What is the first constant symptom of pancreatic cancer?
Anorexia & weight loss
What is Courvoisierโs law?
In a patient with jaundice if the gall bladder is palpable it is not due to gallstone
Name 2 psychiatric manifestations of pancreatic cancer
Depression & Paranoia
What imaging is preferred over CT in pancreatic cancer?
MRI is preferred over CT in pancreatic cancer
What does ERCP stand for and what is its use?
Endoscopic Retrograde Cholangiopancreatography - evaluation of jaundiced patient for biopsy & stent
What tumor markers are used in pancreatic cancer?
CA 19-9 , CEA & Pancreatic Oncofetal Antigen
What is the pre-op fluid expansion requirement?
3-5L of crystalloids in 24 hrs
What are the main surgical options for pancreatic cancer?
โฆ๏ธ Open
โฆ๏ธ Laparoscopic/robotic assisted (Whipple operation or pancreatico-duodenectomy)
State 2 indications for Whipple Operation/Pancreatico-duodenectomy
โฆ๏ธPancreatic head Lesion
โฆ๏ธPylorus preserving pancreatico-duodenectomy
List five complications of pancreatic resection
Hemorrhage
Renal failure
Pancreatic fistula
Intra-abdominal abscess
Delayed gastric emptying
What chemotherapy agents are used in pancreatic cancer?
Gemcitabine/capecitabine and 5FU with radiotherapy
When is radiotherapy indicated in pancreatic cancer?
For intractable pain
What does EUS stand for and what is its role?
Endoscopic Ultrasound - used for imaging and staging
What is the significance of Sister Mary Joseph node?
Itโs a sign of metastatic spread typically found at the umbilicus
What metabolic complications can occur in pancreatic cancer?
hyperglycemia
How is hypoprothrombanemia corrected?
By administration of vitamin K
What is the purpose of cholecystjejunal anastomosis?
Relieves jaundice & pruritus
What imaging helps determine the level of blockage?
Contrast enhanced multi-sliced CT
What is the purpose of barium studies?
Shows pancreatic augmentation & narrowing of 1st-3rd parts of the duodenum
In what condition is palliative surgery considered?
If the tumour is obstructive
Name three types of palliative procedures
Endoprosthesis
Chole-cystjejunal anastomosis
Entero-enteroanastomosis
Where do pancreaticoduodenal lymph nodes drain?
Into the superior mesenteric vein
Clinical features of Pancreatic Ca
โCOURAGEโ:
C โ Cachexia (weight loss)
O โ Obstructive jaundice
U โ Upper abdominal pain (radiating to the back)
R โ Recent-onset diabetes (hyperglycemia)
A โ Anorexia, Abdominal tenderness, Ascites
G โ GI symptoms (nausea, vomiting, steatorrhea)
E โ Enlarged gallbladder (Courvoisierโs law) & Liver
State 5 investigations of Pancreatic Ca
โฆ๏ธAbdominal USS
โฆ๏ธ ERCP (Endoscopic retrograde cholangio-pancreatography)
โฆ๏ธ CT
โฆ๏ธ MRI (preferred over CT)
โฆ๏ธ Barium Studies (shows reverse 3 sign)
โฆ๏ธ LFT (in jaundiced patients)
โฆ๏ธ Tumour markers (CA 19-9, CEA, pancreatic oncofetal antigen)
What are the pre-op preparations for pancreatic ca?
โฆ๏ธRehydration
โฆ๏ธHyperalimentation (provision of excessive nutrients through artificial means)
โฆ๏ธCorrection of anemia
โฆ๏ธHypoprothrombinaemia correction by administration of vitamin K
โฆ๏ธProphylactic broad spectrum antibiotics
