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Abdominal Pathology > Lesson 3B (Part 1) > Flashcards

Lesson 3B (Part 1) Flashcards

1
Q

Types of neoplasms of the pancreas? (4)

A
  1. Periampullary
  2. Cystic
    - simple
    - serous cystic
    - mucinous intraductal
  3. Pseudopapillary
  4. Endocrine, lipoma and mets
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2
Q

What are examples of periampullary neoplasms? (4)

A
  1. Pancreatic ductal adenocarcinoma
    - 66%
  2. Ampullary carcinoma
    - 15-25%
  3. Duodenal carcinoma
    - 10%
  4. Distal cholangiocarcinoma
    - 10%
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3
Q

What is the survival rate like for periampullary neoplasms?

A

Poor

- difficult to resect

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4
Q

What is the most common presentation of periampullary neoplasms?

A

Jaundice

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5
Q

How is periampullary neoplasms managed?

A

With Whipples Procedure

  • pancreaticoduodenectomy
  • depending on stage at time of diagnosis ***
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6
Q

What is the most common primary pancreatic neoplasm?

A

Pancreatic ductal adenocarcinoma

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7
Q

What is the 4th most common cause of cancer death?

A

Pancreatic ductal adenocarcinoma

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8
Q

What is the percent of pancreatic ductal adenocarcinoma malignancies?

A

85-90%

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9
Q

What can detect advanced diseases? (2)

A
  1. US

2. CT

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10
Q

What is the cure for pancreatic ductal adenocarcinoma?

A

Its rare

- 5 yr survival rate is 2-5%

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11
Q

What are the risk factors for ductal adenocarcinoma? (8)

A
  1. Slight male predominence
  2. 60-80 yrs of age
  3. Smoking
  4. Obesity
  5. Chronic pancreatitis
  6. Diabetes
  7. Cirrhosis
  8. Family history of pancreatic CA
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12
Q

What are classic symptoms of ductal adenocarcinoma? (3)

A
  1. Jaundice
  2. Pain
  3. Weight loss
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13
Q

What is ductal adenocarcinoma associated with? (5)

A
  1. Increased bilirubin and ALP
  2. Urine is dark
  3. Stools are pale
  4. Pruritis
    - itchy and uncomfortable sensation of the skin
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14
Q

What is the % of cancers that originate from the head of the pancreas?

A

60-70%

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15
Q

What is the % of cancers that originate from the body and tail of the pancreas?

A

25-35%

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16
Q

What are sonographic signs of ductal/periampullar adenocarcinoma?

A
  1. Double- duct sign
    - CBD and pancreatic duct dilation
  2. Solid mass in the pancreatic head region
  3. Variable echotexture
    - can lead to Courvoisier GB
17
Q

Courvoisier GB

A

Enlarged palpable gallbladder in a patient with carcinoma of the head of the pancreas
- dilated CBD

18
Q

What is Courvoisier GB associated with?

A

Jaundice

- due to obstruction of the CBD (mass is pushing on it)

19
Q

What needs to be determined for the treatment/prognosis of duct adenocarcinomas?

A

If patient can have tumour removed aka resected

20
Q

When is a tumour unresectable? (4)

A
  1. Tumor larger than 2 cm
  2. Extracapsular extension
  3. Lymphadenopathy
  4. Metastatic disease
21
Q

How do you determine the chance for resection for ductal adenocarcinoma?

A

Vascular invasion

22
Q

What are critical vessels that can have a relationship of a tumour mass that is associated with ductal adenocarcinoma? (5)

A
  1. MPV
  2. SMV
  3. SV
  4. LRV
  5. IVC
23
Q

What are useful modalities for staging ductal adenocarcinomas? (3)

A
  1. CT
  2. MRI
  3. Endoscopy
24
Q

Whipples procedure

A

Is an operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct

25
Q

What is not being invaded on during the whipples prodceude? (4)

A
  1. SMA
  2. IVC
  3. AO
  4. CA
26
Q

What i the result of the whipples procedure?

A

Surgical anastomosis of the CHD and remaining pancreas and stomach to the jejunem

27
Q

What happens after the whipples procedure?

A

Hepatic function decreases

28
Q

What are symptoms of decrease in hepatic function? (4)

A
  1. Fatigue
  2. Anorexia
  3. Bruising due to loss of clotting factors
  4. Increased mortality rate in the centers that do not do a lot of these procedures
29
Q

What kind of surgery is the whipples procedure?

A

Long and complex

- experienced surgeons have the best outcome for their patients

Abdominal Pathology (49 decks)

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