Pancreatic Surgery Flashcards
What are the 3 anatomical parts of the pancreas? What are their blood supplies?
- right lobe - cranial and caudal pancreaticduodenal arteries
- left lobe - splenic artery
- body - hepatic artery
What are the differences in the pancreatic ducts in dogs and cats?
DOGS = have an accessory duct communicating with the minor duodenal papilla and a pancreatic duct communicating with the major duodenal papilla
CATS = have a single duct that fuses with the bile duct at the major duodenal papilla
What are the 2 functions of the pancreas?
- 98% EXOCRINE - acinar digestive enzymes
- ENDOCRINE - Islets of Langerhans secrete glucagon, insulin, somatostatin, and pancreatic polypeptide
What are the 2 major techniques for biopsying the pancreas? What is the best area for diffuse disease?
- guillotine - isolate an area of parenchyma at the periphery and ligate st the base of tissue
- lobar dissection - dissect small groups of lobules from surrounding tissues and ligate at the base of dissected tissue
right distal limb - protects nearby structures
What are the 2 major indications for partial pancreatectomies? How is it done?
- tumor removal
- biopsy of large lesions
incise the capsule, then dissect between lobules with blunt dissection and ligate vessels
In what 3 situations are total pancreatectomies recommended? How are they done?
- acute trauma with loss of perfusion
- severe, chronic fibrosis
- intractable pancreatitis
in conjunction with R&A of proximal duodenum, cholecystojejunostomy, and ligation of the common bile duct —> POOR PROGNOSIS, NOT COMMONLY PERFORMED
What are pancreatic pseudocysts? In what patients are they most common? How are they diagnosed?
collections of pancreatic secretions and debris in non-epithelialized sac
middle-aged to older dogs»_space;> cats
ultrasound AND cytology
What are the 3 treatment options of pseudocysts? What must be included?
- US-guided precutaneous aspiration
- surgical resection*
- debridement and drainage/omentalization
supportive care for pancreatitis
What is the most common cause of pancreatic abscesses? How are they diagnosed?
sequela to pancreatitis where the release of digestive enzymes leads to inflammation and fibrous tissue formation (bacterial contamination less common)
abdominal imaging and cytology of aspirated fluid
How are pancreatic abscesses treated?
emergency surgery consisting of debridement and omentalization or resection of affected tissue
- debridement is associated decreased morbidity
- place an active suction drain and culture fluid
What is the most common pancreatic neoplasia? How does it act?
exocrine pancreatic adenocarcinoma
highly malignant, locally invasive, and early to metastasize (poor prognosis) —> surgical exploratory needed for diagnosis
What are gastrinomas? How are they typically diagnosed?
adenocarcinomas of non-beta islet cells associated with Zollinger-Ellison Syndrome (increased gastrin causes ulcer formation)
fasting gastrin serum concentrations and resection of a primary tumor
What are insulinomas? What do they do? What are the most common clinical signs?
adenocarcinomas of beta islet cells that are mostly carcinomas
secrete insulin in spite of hypoglycemia
weakness, seizures, collapse
In what 3 ways are insulinomas diagnosed?
- ultrasound for identifying tumors
- CT/angiogram
- serum insulin concentrations during hypoglycemic episodes (normal or increased insulin levels)
What surgical management of insulinomas is most common? What are the 3 complications?
resection of all abnormal tissue, including primary tumor and all resectable metastasis, along with biopsies of regional LN and liver for staging
- persistent hypoglycemia
- hyperglycemia
- pancreatitis
