pancreatic tumor _صالح Flashcards
WHATS THE BENIGN TUMOR (DUCTAL) IN THE PANCREAS ?
intraductal papillary mucinous neoplasm (IPMN)
intraductal papillary mucinous neoplasm (IPMN) IS
a premalignant condition
intraductal papillary mucinous neoplasm characterized by ….
- papillary projections of mucin-secreting epithelial cells
- excessive mucin production
- cystic dilation of the pancreatic duct
intraductal papillary mucinous neoplasm (IPMN) diagnose by…
EUS
Insulinomas means
bignin tumer of the islet of cells is single and begnin
Insulinomas symptomas …
- fasting hypoglycemia
- symptoms of hypoglycemia
- relief of symptoms following the administration of glucose
——————all these called wipple triad
Insulinomas diagnosis …
- fasting hypoglycemia (<50 mg/dL)
- hyperinsulinemia (>20 μU/mL) that yield an insulin-to-glucose ratio of greater than 0.3
Insulinoma treatment …
simple enucleation is the preferred treatment
Zollinger- Ellison syndrome is caused by ,,,
is caused by a gastrin- producing islet cell tumor.
Verner-Morrison syndrome is caused by ,,,
caused by an islet cell tumor that produces vasoactive intestinal peptide
Verner Morrison syndrome is characterized by ….
- watery diarrhea
- hypokalemia
- achlorhydria
- Hypercalcemia may occur,
- parathyroids are usually normal
Zollinger-Ellison syndrome is characterized by ….
Hypercalcemia may occur because of associated parathyroid abnormalities
Zollinger- Ellison syndrome AND Verner-Morrison syndrome result in ….
Both syndromes are frequently the result of malignant islet cell tumors
glucagon-secreting tumors presented with…
- diabetes,
- anemia,
- weight loss,
- venous thrombosis,
- glossitis,
- cutaneous lesion known as necrolytic migratory erythema.
glucagon-secreting tumors is characteristic cutaneous lesion known as …
necrolytic migratory erythema.
glucagon-secreting tumors treatment …
often metastatic at the time of diagnosis. Treatment is directed at achieving as complete a resection as possible.
most common cancer in the pancreas is …
Pancreatic adenocarcinoma 85 per cent while the Endocrine tumors of the pancreas are rare.
most common site
is ductal in the head
cyctic tumor gives ….
Good prognosis and divide into serous and mucinous
which type of cyctic convert into maliginent is serous or moucinus ?
moucinous
cyctic tumer(mucinous ) should differenate from …
pesdocycte
why the pancreas is very diffucly to take biobsy ?
its retroperitoneal and its in area highly vascular ?
Pancreatic cancer is
sixth leading cause of cancer death.
Ductal adenocarcinomas arise most commonly in the
head of the gland
Ductal adenocarcinomas are characterized by …
characterized by neoplastic tubular glands within a markedly desmoplastic fibrous stroma
Cystic tumors of the pancreas …
may be serous or mucinous.
Serous cyst adenomas are typically found in
older women
are large aggregations of multiple small cysts, almost like bubble wrap. They are benign.
Mucinous tumours have
potential for malignant transformation
They include
- mucinous cystic neoplasms (MCNs)
- intraductal papillary mucinous neoplasms (IPMNs)
pseudocysts be confused
Mucinous tumors
Peri-umpullary tumors are
Group of tumors of different origin around ampulla of Vater
Peri-umpullary tumors are in …
1-doudenal tumor .
2-lower CBD cholangiocarcinoma.
3-pancreatic head tumor
4-others other malignant neoplasms can arise at the ampulla, such as carcinoid tumors
5- high-grade neuroendocrine carcinomas.
Peri-umpullary tumors is different intity from the pancreatic CA by
good prognosis and early presentation and the most common diagnostic feature is obstructive juaindice
Clinical features Of Pancreatic CA in the head ?
- painless jaundice common type is obstructive
- nausea
- epigastric discomfort
- Pruritus
- dark urine and pale stools with steatorrhoea.
-Upper abdominal symptoms in a recently diagnosed diabetic, especially in one above 50 years of age, with no family history or obesity, should raise suspicion
+Pruritus or itch is defined as an unpleasant sensation of the skin that provokes the urge to scratch. sign of cancer
Clinical features Of Pancreatic CA in the body and tail ?
( It is often grow silently, and present at an advanced unresectable stage. )
- vague discomfort,
- anorexia and weight loss, and are frequently dismissed by both patient and doctor.
- Back pain is a worrying symptom, raising the possibility of retroperitoneal infiltration.
- unexplained attack of pancreatitis It is often grow silently, and present at an advanced unresectable stage.
Examinationc of Pancreatic CA …
- when we do abdominal examination and palpate palpable Gallblader its more likely CA
if not its stone this called (courvoiser law )
_Other signs of intra-abdominal malignancy should be looked for with care, such as a palpable mass,
ascites, supraclavicular nodes and tumour deposits in the pelvis; when present, they indicate a grim prognosis
Investigation of Pancreatic CA …
-CBP blood film morphology.
-LFT ---- obstructive jaundice. which include prothrombin time (PT/INR) activated Partial Thromboplastin Time (aPTT) albumin bilirubin (direct and indirect),
-Ultrasound
not very senstive
whether or not the bile duct is dilated. If it is, and there is a genuine suspicion of a tumor in the head of the pancreas,
- contrast-enhanced CT scan
the preferred test
+ is a tumour in the pancreas and if it is resectable.
+The presence of hepatic or peritoneal metastases, +lymph node metastases distant from the pancreatic head
+ encasement of the superior mesenteric,hepatic or coeliac artery by tumour are clear contraindications to surgical resection.
-Endoscopic U\S
used in
+Transduodenal or transgastric FNA or Trucut biopsy
(used for the diameter , consistancy , biopsy) used only when imaging fail because vascular invasion or when there is pesdocycte sperated from tumer to take biobsy
-ERCP and biliary stenting
diagnostic and for assessment of the severity of tumor
by can relieves the jaundice provide a brush cytology or biopsy done only when there is cholangitis and doubt and sever cases
whats the benefit of the CT scan for PC ?
+ is a tumour in the pancreas and if it is resectable.
+The presence of hepatic or peritoneal metastases,
+lymph node metastases distant from the pancreatic head
+ encasement of the superior mesenteric,hepatic or coeliac artery by tumour are clear contraindications to surgical resection.
Endoscopic U\S used in
used in
+Transduodenal or transgastric FNA or Trucut biopsy
(used for the diameter , consistancy , biopsy)
used only when imaging fail because vascular invasion or when there is pesdocycte sperated from tumer to take biobsy
ct can be used as
diagnostic and for assessment of the severity of tumor
ERCP and biliary stenting is indicated in:
1- if there is any suggestion of cholangitis.
2- if there is diagnostic doubt (small ampullary lesions may not be seen on CT.
3- in sever case
if the patient is deeply jaundiced (serum bilirubin >250 mmol/L), or there are distressing symptoms (e.g. pruritus) and there is likely to be a delay between diagnosis and surgery.
It relieves the jaundice and can also provide a brush cytology or biopsy specimen to confirm the diagnosis. …..
ERCP and biliary stenting can relieves the jaundice
provide a brush cytology or biopsy
Management pf pancreatic CA …
- 85 per cent of patients with ductal adenocarcinoma are unsuitable for resection because the disease is too advanced so need palliative TRT
- 15% need surgical treatment
which tumor can we perform the surgery on then ? and why ?
1- cyctic tumor because it good prognosis
2-umors of the ampulla have a good prognosis
SURGERY FOR CARCINOMA HEAD PANCREAS NAME … FOR pancreatic head or the ampulla
Pancreatoduodenectomy (PPPD). Or Whipple procedure.
SURGERY FOR CARCINOMA HEAD PANCREAS NAME … FOR body and tail
Distal pancreatectomy with splenectomy
in unresectable tumor
Palliation
Preoperative preparation to patient with obstructive jaundice مهم كللللللللللللللللللش
1-Intravenous fluid preferably G\W + mannitol 200ml\twice daily in order to prevent hepatorenal shut down.
2-Vitamin K
3-Antibiotics
4-Laxative ( PEG )
5-Non absorbable antibiotics
6- Management of pruritus
Traditionally, antihistamines are used to treat itch. Examples include diphenhydramine (Benadryl), hydroxyzine (Atarax), and chlorpheniramine (Chlor-Trimeton and others).
Which of the following statements about chronic pancreatitis is/are correct?
For patients with disabling chronic pancreatitis and a dilated pancreatic duct with associated stricture formation, a longitudinal pancreaticojejunostomy is an appropriate surgical option.
