Pancreas DSA Flashcards
What kind of cancer is pancreatic head cancer
Normally adenocarcinoma and they can invade the bile duct=jaundice
Pancreatic head cancers cause pain how
They invade the nerves
What is the best treatment of pancreatic head cancer
Whipple procedure, removing head of pancreas, duodenum, and intra-pancreatic bile duct
Whipple procedure is most positive when?
When the whole cancer can be excised(ie it hasn’t spread to arteries or lymph nodes
Survival rates
With lymph spread-10% at 5 yrs
Inguinal hernias
Happen more in males and if the processus vaginalis doesn’t obliterate in development there will be a patent hernia
What forms the inguinal ligament
The external oblique as it passes under the superficial inguinal canal
What forms the cremaster muscle
The internal oblique
Transversalis fascia forms what
The back of the inguinal canal and internal deep ring
Hesselbachs triangle
Formed by the lateral rectus sheath, inf epigastric vessels, inguinal ligament
This is where direct hernias go through
Indirect hernias
Lateral to the epigastric vessels and follows through the internal and superficial inguinal ring in the the spermatic cord
Hernia repair must be careful of what nerves
Iliohypogastric, ilioinguinal, genitofemoral nerves
What is a hernia that is stuck and will not go back even on exam
Incarcerated hernia- may lose blood supply die and perforate
What is a hernia with ischemic/necrotic bowel
Strangulated hernia- makes it an emergency
Upper gastro bleeds present how and are where
Either hematemesis bright red blood, or coffee grounds emesis/stool
Must be proximal to the ligament of treitz ie duodenum
What are causes of upper gastro bleeds
Gastric/duodenal ulcers
Esoph/gastr/duodenitis
Portal hypertension(causing esophageal varicies)
PUD
Pain in the RUQ or epigastric region
H pylori and NSAIDs
Dx via upper endoscopy
Treatment of PUD
Proton pump inhibitors and H pylori treatment
Or stop NSAIDs
Complications of PUD
Either perforations on the anterior duodenum
Or erosion into the the gastroduodenal artery causing UGI hemorrhage
Portal HTN
Can present with Caput Medusae, hemorrhoids or esophageal varicies
Porto-systemic collateralization
4 areas
Esoph-azygous
Periumbilical and superficial epigastric (caput medusae)
Mid and inferior rectal veins
Bare area of liver or post veins in retro-peritoneal viscera
