pancreatic surgery Flashcards
risk factors for pancreatic cancer
ciggarets
chronci pancratis
diabets for less than 2 years
hereditary
inherited preopiesoin
prewsentaio of pancratic caner
diabetes, abdomal pain, anorexia, vommitin, weight loss, recurrent botus panctiaons, obsturcive jaunice (pre hepatic)
investigaion for pancratic cancer non invasie
tumoru markers, ca19-9 (blood)
cxr
genral testes
uss
ct
mr
invasive test for pancreti ccaner
ercp, mrcp, laprosypy, peritno cytolgy, eus, percuatio neede biopys, pet
signs on ercp of oancreatic naer
double duct
double duct meanin
both pancreatic and bile duct are dilated
test to determine if a paitent is possible to have pancreatic surgery
cxr, ecg, resp fucnito test, physolica score (mily lactate)
what is stages of screeing for resecbailty
uss then spiral ct/ mri, laproptym then resection is possibel
what hapens if uss, or spianl ct shows tumor is not portialy recpaly
ercp adn steing is done
what happen if laprycoy hsows stening is not possible
laprosocpic bypass or ercp and stene
what pahen is after laprotym (large cut in abdominal wall) is done and the tumour is not found to be resceoab is done
open bypass of pancrese
what is the wipple
remove heat do pancrease and attche duodun, the duoduem and bile duct and coall blader, directly to jejuma . the jujum is connect to the sotamch after the pancrase and the common epatic duct is connect direlcy to the jujeum
paltive jajade for obsuticve jaunde
bypass, ercp or ptc sedning
dudenal obstion patlive care
by pass or duodenal sent
what is acute pancreatio
inlfaot of pancere whch can be mild which can lead to reocapry or sever wth organ faiulre
local compation of acure pancreasi
acute fluid colleciton, pseudocyts, pancrais absess, pancratic necoroiss
cuase of acute pancreatis
gallstones, alchol, viral infetion , tumorus, anatomcla abnomralies, ercp, lipid abdomali, hpercalcea, icheam, drugs, scopion vemno, idiopathic
why does achol cause acute pancratis
direct injjery, incrs sentifly to stiumation, acedalthy and fatty acid ehty esters
why does gall sotns calsue pancre
rasied pancraic ductal pressure
why does ercp cause pancrati
raieded pancrati duc pressure
symptoms of acute panrea
abdomalpain, nausea , vomian , caollpase
signs of acute pancreatis
pyreexia, dehydaiotn, abdomal tenderness, circulary failrue
blood invseioc for acute pancre
gluose, u and em serum abolse, clotitn and fbc , lft, abg,
sacn for acute pancraits
cxr, axr, usss, ct scan
what is coverd in the acute pracies glashgow criterisa
glucose,
serum ca
wcc
albumin
ldh
urea
ast/ alt
arteireal pO2
what markers are presnt in acute pancris
crp, il 6 and tap
what is comon treatment long term for abcure pancres
find issue sucha s alhcolism adn fix tough council
surical issue ssuchha s malignancy, treat with surgyer
treatment of acute pancreatis
ct scanning for progesion
antibioti,
digaosi of infection
erc if gall stone present
nutritional support vy enteric
manipulation of inlfatory response
is ct helpgul in montior acute prnaec
yes afer 4-10 days to see if necoirs is present or tlo look for asciete,s absces, and motion of disease
is antiboic requeid for acute pancresi
no, as they can cuase antibioci resistance if given small dose then a second wave of more signic ancres hapesn
what to do if gall stones are present along side pancre
removea using ercp
what is late compaoit of acure pancreiatis
hemorea,e portal hypertio, pancreatic duct stricutre
chronci pancreatis
chronciinfcaotnof the pancre, caus ign irreveralsbel morphaocl changes, leading to chronic pan and impairemt of endocrine and exocine fucntof the pancrawse
what is chronic pancreatis raled with
alhcol and being male
obstucve cause of chronic panfcrits
tumour,
spincter of odi dysfuction,
pancreatic divisum
duodeunal obstuciot
tramau
stucre
toxin cuase of chornc pancrea
ethanaol, smoking , and drugs
is chronic pancre does realsted
yes
genetic gnes that cuase choihci pancreis
domina t - codon 29 and 122
recivesive - cftr, spink 1 and codon a
other cuase of chronic pancritis
recurent injury to billar, hyperlipidemia, hypercalcemia ,
enviromenta e.e tropics
idiopathic
autoimmune
what is resoponse for 70% of pancretics chronic canses
alhcol
symptons of choci pancreatis
pain - lined to binges
janice
constipation
sings of chic pancreatis
pancratix exocirne insufffice, diabets, jaunice, duodenal obsution, upper gi haemorrhage
chronci pancreatits invesigoin
ct sacna
ercp - wth pancratic exocine fuciotn
faeclar / swerum enzymes
pancreolauyste test (enzyme response to stimulus)
diagnos enzyme replacement
manage ment of chronc pancreatis
concelsing, absentanc eform alchol, mangemet of acute aktakce, angelsi, avoid high fat, high proiten diet, pancrati csuplent , anti oxiant therapy, steatorrhera (reduce fat inkae , pancre suppletion ) treat diabetes
when shold choc pancreits surgyer be offerd
suspision of malignacy,
intractable pain
complioaion, pancratic duct stenois, csyss
bilary tarct obsuciotn
spleic vien thormoisis
portal vien compression
dudoeal stanos
colonic sticure
what intervela procedures are availbe for choicn pancratiss
pd stenos and obstuion - edospcidc spincetoymy, dilation and lithotripsy
management of choice pseudoctys
csd stening or bypass
thoracospic splanchnectomy
caelica pleux block
- ct guide, eus guice , flurosocpy guidned
surgery for choinc pancretis
drainage - duct sphincter pospy
pusesow
resection
dpphr
pppd
whipples pancracy duodecotmy
frey proceud
spleee presivn disal pancracy
centlla pancracyly
