Pancreatic surgery Flashcards
ampullary carcinoma has a worse prognosis when
3 types of adeno
distal third of the common bile duct courses through what part of the pancreas?
head of the pancreas
endocrine histologic neoplasia
insulinoma (benign)
Non-functioning PNETs
Functioning PNETs
(insulinoma, gastrinoma, glucagonoma, VIPoma, Somatostatinoma, polypeptoma, serotninoma, rare)
90% of the Exocrine Pancreatic cancers (which are 98% of pan cancers) are
adenomas
Incidence of Pancreatic Cancer
10/100,000 year
Survival of Pancreatic cancer (adenoma)
worst survivability
80-90% of pancreatic cancers are what stage?
III or IV or already IIB (w/ mets)
median age?
72
highest risk factor and others?
smoking
Chronic alcoholic pancreatitis
Obesity
Groups at risk
African american, Ashkenazi, Native Hawaiians, Maoris
Genetic Syndromes associated with panc cancer?
Peutz/jeghers
Hereditary Pancreatitis
Atypical Multiple Mole and Melanoma
Breast-ovarian cancer
HNPCC
CF
what percent of pan cancer is familiar?
10-15%
Mutations of Pancreatic cancer
Oncogenes (K-RAS)
Suppressor Genes (p16, p53)
> 200 gene mutations
early symptoms of pancreatic cancer
no symptoms
general symptoms
weight loss pain jaundice anoroexia stool change nausea weakness
Only diagnostic scan for pancreatic cancer staging pre-op? what about gold standard for tissue dx
CT
EndoscopicUS
double duct sign
distal common bile duct and pancreatic duct are dilated on CT,
pathognomonic for periampullary neoplasm
pancreatoduodenal complex (distal CBD, pancrease, duodenum) arise as outpouching right at the ____gut meets the ____gut
foregut meets the mid gut
Venous drainage and lymphatic drainage follows_____
arteries
Removing the body and tail of the pancreas requires a splenectomy because lymphatic drainage is through the
splenic vein
Bulk of the islet cells is in the
tail
Once you remove the tail what is a complication?
Insulin dependent Diabetes
Body is topographically
medial border of SM to the medial border of the Aorta
Body is topographically
medial border of SM to the medial border of the Aorta
neck is anterior to the
SMV
Head is to the right or lateral border of the
SMV
Tail is lateral to the left edge of the
aorta
inoperable hen
distant mets
pancreas is retro/intraperitoneal?
retroperitoneal
what is the connection between the SMA and SMV
gastroduodenal artery
benefits of rconnecting pancreas to stomach?
no enterokinase, low pH reduces likelihood of activation of proteolytic enzymes, Alkaline pancreatic secretions protect against ulceration
