Pancreas Flashcards
55 M h/o chron and, MRCP w large mass at HOP with distal ductal dilation >7cm , EUS no malignanxy. Procedure/Tx?
Beger - duod preserving pancreatic head resection
Distal pancreatectomy - consideration of vasculature
Control splenic artery/vein
If IMV enters SV LATERAL to target lesion = ligate
If IMV enters SMV medial to target, can be spared
Auto immune Panc Dx
- high IgG concentration
- associated AI dz
- strictures of the PD
For lymphplasmacytic SP do ERCP
50 M infected panc s/p perc drain placement, upsize drain with 72 hours fever, inc fever and Leuko, next best step?
Endoscopic necrosectomy
True re: management of pancreatic mucinous neoplasms?
Where is it usually located and how does that change operative mgmt?
mucinous cystic neoplasms found in the tail of the pancreas, allowing spleen preseving distal panc
Panc necrosis with sepsis/HDU, tx?
IR drain
Whipple steps
- explore peritoneum
- Right colon mobilizes (CattellBraash) exposing SMV
- Kocher at level of aorta with attentionto lymph nodes and great vessels
- transverse meso seperated off the head of pancreas
- lesser sac entered through gastrocolic
- Ligate right gastroepiploic at DMV to allow SMV to be dissected away from the neck of panc
- Once SMV dissection and HOP mobilizrd, the GB removed and Common hepatic duct dissected.
ETC
ERCP cystic lesion communicating w branch duct in 74 F w jaundice. High CEA and Amylase. Dx?
Branch duct IDPN
sterile or infected panc necrosis?
CT guided perc needle asp w gram stain and culture
MC etiology cystic lesion of pancreas
acute pancreatitis
48 F w panc necrosis s/p VARD on POD5, hematemesis, definitive mgmt?
CT mesenteric angiogram w embolization
64 M painless jaundice and 10 lb w/l, 1 cm periampullary adeno with spread to duod SM w/o mets dz. Mgmt?
whipple
68 M abdo pain and weight loss with 4 cm panc cyst communicating with dilated main panc duct. What would the analysis of cystic fluid show?
high viscosity
high CEA
high amylase
Intraductal pap mucinous neoplasm IPMN
h/o panc, 3 mos later, CT w 6cm area with enhancing wall and pockets of air. In additon to Abx, next step in mgmt
panc abscess needs endoscopic drainage
h/o panc 6 weeks ago now w early satiety. CT wouls show what?
A homogenous well circumscribed round fluid collection with a hyper dense capsule – pseudocyst
65 M with constitutional sis, 6 cm pan head mass and LAD
primary panc lymphoma - ususally B cell
64 M h/o UC, pain radiating back with normal labs, panc head mass and elevated IgG. Management?
AI panc – needs biopsy
Exposure of which vessels during distal panc?
Splenic artery and vein
technique for open panc debridement
bluntly with finger dissection
ETOH hx w greasy stool
Exocrine panc insufficiency - - high carbs low fat diet with enzymes
61 F with 2cm panc mass with EUS showing 8mm panc duct. Mgmt?
IPMN – anatomic resection with negative margins
ATL criteria of Panc, panc necrosis def?
interstial fat tissue death with vessel damage affecting acing, islet and ductal cells
Grade 3 panc injury; what blood vessel
distal panc, splenic artery supplies the body and tail of the panc
35 M benign adenoma, does not want Whipple. Mgmt?
transduodenal excision of tumor
CT w left sided psudocyst in the retroperitoneum. Mgmt?
Roux en Y cyst Jejunostomy
Principle resection Whipple
Esablish plane between panc neck and PV before resection
Intervention for panc pseudocyst?
> 6 cm after 6 weeks obs
Imaging finding of abutment of less that 180 degrees of SMA, considered?
borderline resectable disease
