PANCREAS Flashcards
pancreatic lymphoma
The clinical presentation of patients with is often nonspecific, consisting of weight loss, nausea, vomiting, and abdominal pain. B-type lymphoma symptoms such as fever and night sweats may be present.
BUT NOT jaundice radiating back pain
CT images can suggest the diagnosis of pancreatic lymphoma by the presence of a bulky pancreatic mass with surrounding lymphadenopathy. CT evidence of a bulky pancreatic mass in the absence of weight loss, back pain, and extrahepatic biliary obstruction (normal bilirubin associated with an elevated lactate dehydrogenase) should cause one to consider lymphoma in the differential diagnosis.
Percutaneous or endoscopic ultrasound (EUS)-guided biopsy will confirm the diagnosis in most cases. If the diagnosis cannot be confirmed preoperatively, laparoscopic exploration and biopsy are indicated.
There is no role for resection in the management of pancreatic lymphoma (choice A, B, and C). Endoscopic stenting to relieve jaundice followed by chemotherapy is the standard treatment (choice E), and long-term remission is often achieved.
Treatment of pancreatic lymphoma traditionally has involved cytotoxic chemotherapy (choice D). The most common chemotherapy regimens include cyclophosphamide, doxorubicin (adriamycin), vincristine, and prednisone (CHOP).
Bottom Line: Pancreatic lymphoma may present similar to pancreatic adenocarcinoma but is treated with chemotherapy alone. Relief of biliary obstruction is accomplished with endoscopic stenting.
somatostatinoma syndrome
is the least common of the five generally accepted functional pancreatic endocrine neoplasia syndromes,
occurring in less than 1 in 40 million people.
The somatostatinoma syndrome is nonspecific, much more difficult to recognize, and exceedingly rare.
The clinical features are nonspecific including
steatorrhea,
diabetes,
hypochlorhydria,
cholelithiasis.
Most somatostatinomas are located
pancreatic head
or
periampullary region.
somatostatinoma - difficult to dx presentation
with difficult to manage (head tumor) location
“som”e enocrine tumors need whipples if you are going to make the head of the pancrease into swiss cheese
VIPoma location
distal pancreas
VIP = back of the bus = good treatement with distal panc as option
Glucagonoma are mostly located
distal pancreas
Glucagonoma = must have sat on glu = stuck to the tail =
Insulinoma are located
I nsulinoma = E verywhere
VIPoma is located where
VIP in the back of the bus
Glucaconoma are located where
glued on to the tail
compare Decompression of the obstructed biliary tract with endoscopic vs percutaneous-transhepatic
However, an endoscopic approach yields better results with fewer associated complications
The percutaneous-transhepatic approach to duct decompression is usually reserved for patients in whom, for technical reasons, a stent cannot be placed endoscopically.
compare Decompression of the obstructed biliary tract with plastic vs metal stents
metal stents give more complete and long-lasting relief of jaundice
Plastic stents can become obstructed by tumor or debris and, as a result, must be changed every 2 to 3 months.
Pancreatic head tumors can extend into what part of duodenum
second portion of the duodenum
Pancreatic body tumors can extend into what part of duodenum
invade the third or fourth portion of the duodenum and also cause obstruction.
duodenal obstruction from pancreatic cancer is managemed how
palliated by endoscopic placement of expandable endoluminal metal stents into the duodenum.
For lesions that are not amenable to stents, surgical gastrojejunostomy may be required
more advanced findings that may not need a staging laparoscopy for pancreatic cancer
large liver lesions (these can by biopsied percutaneously)
marked hypoalbuminemia
significant increases in the CA19-9 level,
..severe back or abdominal pain ; or marked weight loss…
for pancreatic cancer what generally considered to be a sign of unresectability findings (what is vascular exception)
Pancreatic cancer is considered unresectable with
any metastases,
extension into the retroperitoneum
or hepatoduodenal ligament,
involvement of major arterial structures, or involvement of nodal or neural structures around the celiac or superior mesenteric arteries.
Isolated involvement of the SMV or portal vein can be resected in selected patients.
