Pancreatic surgery

Question 1

What are the risk factors of pancreatic cancer?

Answer 1

○ cigarette smoking: 25–30%
○ chronic pancreatitis: 5–15 fold
○ Adult onset DM of less than two years’ duration
○ Hereditary pancreatitis
○ Inherited predisposition:
○ Periampullary cancer is a feature of FAP

Question 2

What is the presentation of pancreatic cancer?

Answer 2

• Obstructive jaundice
• Diabetes
• Abdominal pain / Back pain
• Anorexia
• Vomiting
• Weight loss
• Recurrent bouts pancreatitis
• Incidental finding

Question 3

What are the investigations for pancreatic cancer?

Answer 3

○ General investigations 
- Blood tests
- CXR
○ Tumour marker
- CA19-9
○ Imaging/ invasive investigations 
- USS
- ?ERCP
- CT
- MR, MRCP
- Laparoscopy + Lap USS
- Peritoneal cytology
- EUS + FNA/ Bx
- Percutaneous needle biopsy
- PET

Question 4

What are the surgeries for pancreatic cancer?

Answer 4

○ Kausch- Whipple

○ PPPD

Question 5

What are the classifications of acute pancreatitis?

Answer 5

○ Mild AP: Associated with minimal organ dysfunction and uneventful recovery
○ Severe AP: Associated with organ failure or local complication

Question 6

What are the local complications of acute pancreatitis?

Answer 6

○ Acute fluid collections
○ Pseudocyst
○ Pancreatic abscess
○ Pancreatic necrosis (may turn into infective necrosis)

Question 7

What is the aetiology of acute pancreatitis?

Answer 7

○ Gallstones 
○ Alcohol 
○ Viral Infection: CMV, mumps 
○ Tumours 
○ Anatomical abnormalities (P.D.)
○ ERCP
○ Lipid abnormalities
○ Hypercalcaemia 
○ Postoperative Trauma 
○ Ischaemia 
○ Drugs	
○ Scorpion venom
○ “Idiopathic”

Question 8

What are the signs and symptoms of acute pancreatitis?

Answer 8

• Symptoms
○ Abdominal pain
○ Nausea, vomiting
○ Collapse
• Signs		
○ Pyrexia
○ Dehydration
○ Abdominal tenderness
○ Circulatory failure

Question 9

What general supportive care is put in place for individuals with acute pancreatitis?

Answer 9

○ Analgesia
○ Intravenous fluids
○ Cardiovascular	}
○ Respiratory	        }  support
○ Renal		        }

Question 10

How does one monitor acute pancreatitis?

Answer 10

○ Pulse, BP
○ Urine output
○ CVP
○ Arterial line
○ HDU / ITU

Question 11

What are the investigations of acute pancreatitis?

Answer 11

○ U/E, glucose
○ serum amylase
○ FBC, clotting
○ LFT	ABG
○ CXR	AXR
○ USS
○ CT scanning

Question 12

What are the causes of chronic pancreatitis?

Answer 12

○ Obstruction of MPD
- Tumour
□ Adenocarcinoma
□ IPMT
- Sphincter of Oddi dysfunction
- Pancreatic divisum
□ Inadequate accessory drainage
- Duodenal obstruction
□ Tumour
□ Diverticulum
- Trauma
- Structure
- Post necrotizing radiation
○ Autoimmune
○ Toxins
- Ethanol (related to amount and length of consumption)
- Smoking (odds ratio 8 to 17)
- Drugs
○ Idiopathic
○ Genetic 
- Autosomal dominant (Condon 29 and 122)
- Autosomal recessive/modifier genes
□ (CFTR, SPINK1, Codon A etc)
○ Environmental 
- Tropical chronic pancreatitis 
○ Recurrent injuries 
- Biliary
- Hyperlipidaemia
- Hypercalcemia