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Alimentary System > Lecture 21 Surgery of Pancreatic Disorders > Flashcards

Lecture 21 Surgery of Pancreatic Disorders Flashcards

1
Q

What are the presentation of pancreatic cancer

A
  • Obstructive jaundice
  • Diabetes
  • Abdominal pain / Back pain
  • Anorexia
  • Vomiting
  • Weight loss
  • Recurrent bouts pancreatitis
  • Incidental finding
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2
Q

Aetiology of Pancreatic cancer

A 
Uknown
Smoking
Chronic pancreatitis
Hereditary
Periampullary cancer is a feature of FAP
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3
Q

Investigation of pancreatic cancer

A

Blood test
CXR
Tumour markers

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4
Q

What is the name of the tumour marker for pancreatic cancer

A

CA19-9

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5
Q

Imagine and Invasive investigations used for pancreatic cancer

A 
USS
ERCP
CT
MRCP
Laparoscopy
Peritoneal cytology
EUS + FNA
PET
Percutaneous need biopsy
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6
Q

What type of surgeries can be performed for pancreatic cancer

A

Kausch-Whipple

PPPD

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7
Q

Describe the Kausch Whipple

A
  • Half of pancreas and stomach removed

* Whole duodenum resected

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8
Q

Describe PPPD

A
  • Modification of Whipple

* All stomach is intact and pylorus is preserved

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9
Q

What are the classifications of acute pancreatitis

A

Mild AP

Severe AP

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10
Q

Describe mild AP

A

Associated with minimal organ dysfunction and uneventful recovery

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11
Q

Describe Severe AP

A

Associated with organ failure or local complication (lung, kidneys etc.)

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12
Q

What are local complications of severe AP

A

Acute fluid collections

  • Pseudocyst
  • Pancreatic abscess
  • Pancreatic necrosis
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13
Q

Aetiology of acute pancreatitis

A 
Gallstones
Alcohol
Drugs
Virus
Trauma
Tumours
ErCP
Lipid abnormalities
Ischaemia 
Idiopathic
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14
Q

symptoms of acute pancreatitis

A
  • Abdominal pain
  • Nausea
  • Vomiting
  • Collapse
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15
Q

Signs of acute pancreatitis

A
  • Pyrexia
  • Dehydration
  • Abdominal tenderness
  • Circulatory failure
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16
Q

What is the modified Glasgow/PANCREAS score

A 
PaO2
Age
Neutrophils
Calcium
Renal function
Enzymes
Albumin
Sugar (glucose)
17
Q

How is Cholelithiasis manages

A

ERCP & ES, cholecystectomy

18
Q

How is the factor of alcohol managed

A

Abstinence and counselling

19
Q

How is ischaemia managed

A

Careful support and correcting cause

20
Q

How is malignancy managed

A

Resection or bypass

21
Q

How is hyperlipidaemia managed

A

Diet, lipid lowering drugs

22
Q

Aetiology of chronic pancreatitis

A 
Obstruction of main pancreatic duct
Autoimmune-IgG4
Toxin
Idiopathic
Genetic 
Environmental
Recurrent injuries
23
Q

Name the genes responsible for chronic pancreatic cancer

A

– Autosomal dominant (Condon 29 and 122)
– Autosomal recessive/modifier genes
• (CFTR, SPINK1, Codon A

24
Q

Clinical Features of chronic pancreatitis

A 
Pain
Pancreatic exocrine insufficiency
Diabetes 
Jaundice
Duodenal obstruction
Upper GI haemorrhage
25
Q

Investigations for chronic pancreatitis

A 
History
CT scan/X-ray (calcification)
ERCP/MRCP
Faecal/serum enzymes (elastase)
Pancreolauryl test
26
Q

Management of Chronic Pancreatitis

A 
Counselling
•	  Abstinence from alcohol
•	  Management of acute attacks
•	  Analgesia
•	 ? Interventional methods of analgesia
•	  Avoid high fat, high protein diet
•	  Pancreatic supplementation controversial for pain
•	  Anti-oxidant therapy
Steatorrhoea:
•	Reduce fat intake
•	Pancreatic supplementation
27
Q

When is surgery an intervention for chronic pancreatitis

A

When there is a suspicion of a malignancy

28
Q

Complications of surgery

A
  • Pancreatic duct stenosis
  • Cyst / pseudocysts- Drainage
  • Biliary tract obstruction
  • Splenic vein thrombosis / gastric varices
  • Portal vein compression / mesenteric vein thrombosis
  • Duodenal stenosis-ERCP
  • Colonic stricture
29
Q

Treatment for chronic pancreatitis

A 
Endoscopic PD sphincetortomy, dilation and lithotripsy
Management of chronic pseudocyst
•	CBD stenting or bypass
•	Thoracoscopic
•		Splanchnectomy
•	Caeliac plexus block- Caeliac plexus block- to minimize pain by CT/EUS/Fluoroscopy using alcohol
–	CT guided
–	EUS guided
–	Fluoroscopy guided
•	Classical trans-crual approach
•	Trans-aortic techniques
30
Q

Surgery techniques for chronic pancreatitis

A 
•	Drainage:
–	Pancreatic duct sphincteroplasty
–	Puestow (Rochelle modification)
•	Resection:
–	DPPHR (Beger)
–	PPPD (Duodenum preserving pancreatic head resection)
–	Whipple’s pancreatico-duodenectomy
–	Frey procedure 
–	Spleen-preserving distal pancreatectomy
–	Central pancreatectomy
31
Q

What does MCN stand for

A

Mucinous Neoplasia

32
Q

What are the 2 types of IPMN

A

Main duct

Branch Duct

33
Q

Describe MD-IPMN High risk stigmata

A

MPD>10mm

Enhanced solid component

34
Q

Describe worrisome features of MD-IPMN

A

5-9mm
Non-enhanced mural nodule
Abrupt change in MPD
LNs

35
Q

Describe MCN High risk stigmata

A

> 1cm with enhanced solid component

MPD>1cm

36
Q

Describe worrisome features of McN

A

> 3cm
Enhanced cyst wall
Non-enhanced nodules

37
Q

Methods of resection for MCN

A
  • Pancreatectomy + LN’s
  • Focal and LN or spleen sparing:
  • Laparoscopic
  • Robotic
  • Multifocal BD-IPMN: total pancreatectomy

Alimentary System (39 decks)

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