Last Minute Flashcards
Whipple procedure
- Dx lap, then upper midline laparotomy
- Enter lesser sac and start retropancreatic tunnel over SMV
- Kocher, palpate course of SMA
- Cholecystectomy, portal dissection, identify/ligate GDA (can see portal vein)
- Complete retro pancreatic tunnel
- Divide:
a. CHD
b. Stomach
c. Jejunum
d. Pancreatic neck - send margin for Frozen - Reconstruct
a. PJ - 5-0 PDS; duct to mucosa
b. HJ - 5-0 PDS
c. GJ - 3-0 PDS; 2 layer - Leave closed suction drains
a. Drain amylase on days 1, 3
i. Remove if drain output <30 cc/day
ii. Normal amylase levels
No clinical signs of postoperative pancreatic fistula
brain death exam
Brain Death examination: (AAN 2010 guidelines)
- Ensure pt meets criteria
○ Coma secondary to a known cause
○ SBP > 100 (can use pressors)
○ Absence of CNS depressing drugs
○ Core tempt > 36C
○ Absence of spontaneous respirations
- Check reflexes and response to noxious stimuli
Nonreactive pupils
Absent corneal, occulocephalic, occulovestibular
Absent cough/gag
Absent motor to noxious stimuli in all 4 limbs
Absence of facial motor at supraorbital and TMJ noxious stimuli
- Apnea test
○ Confirms absence of spontaneous
○ PCO2 > 60mmHg or >20 increase in baseline
2nd physician examinatio
Adrenal mass Workup
Biochemical workup for an adrenal mass:
- CBC
- CMP
- 1mg low-dose dexamethasone suppression test
○ <1.8 = normal (Coritsol)
○ 24 hr urinary cortisol or Midnight salivary cortisol can be used to determine excess cortisol
- Plasma renin/serum aldosterone
- Plasma metanephrines
○ Higher false positive
○ Can be confirmed with 24 hr urinary metanephrines
- DHEA-sulfate
○ Can be increased due to more sex steroid production
- ACTH
○ Suppressed with adrenal source
MEN I
Parathyroid hyperplasia
PNET (Gastrinoma 80%)
Pituitary adenoma (prolactinoma)
MEN IIA
MEN IIB
IIA:
MTC
Pheo
Para hyperplasia
IIB:
MTC
Pheo
ganglioneuromas, marfanoid
