Part 1 Flashcards
Q20 Differential diagnostics of pancreatic cysts
Small= asymptomatic, incidental finding
Pseudocysts: History of pancreatitis, stones, alcohol abuse or abdominal trauma
Common cystic neoplasms:
IPMN – intraductal papillary mucinous neoplasm
▪ Can look like a SCN, but has no scar or calcifications
▪ Connection to pancreatic duct→highly specific
o SCN – serous cystic neoplasm-Uncommon cystic neoplasms, no communication with pancreatic duct
oSPEN(solidpseudopapillaryepithelialneoplasm)-rare(usuallybenign)pancreatic tumor
o Tumors with cystic degeneration – adenocarcinoma, neuroendocrine tumor
Q21 Types of pancreatic tumors
Exocrine tumours (95%) : Mainly ductal adenocarcinoma, then acing adenocarcinoma then others Endocrine(5%): Glucagonomas, Gastrinomas, Somatinostatinomas, Insulinomas, VIPomas, pancreatic polypeptide secreting endocrine tumors.
Q21 Surgical treatment methods of pancreatic tumours
- Pancreatic head carcinoma – pancreaticoduodenectomy (“Whipple procedure”)
o Resection of pancreatic head, distal stomach, duodenum, gallbladder, and common bile duct with lymphadenectomy
o Reconstruction by enterostomy or Roux-en-Y anastomosis - Pancreatic body and tail carcinoma
o Resection of the left side of pancreas with splenectomy
o In some cases, duodenopancreatectomy with splenectomy – indicated in a curative
treatment approach if partial removal of pancreas is insufficient -
Neoadjuvant or adjuvant chemoradiotherapy
o To reduce tumor size, improve symptoms, and prolong life
Q21 Palliative approach for pancreatic tumours
- Palliative chemotherapy – indicated in patients with advanced or metastatic pancreatic cancer
- Analgesia according to the WHO step-by-step plan
- Cholestasis – ERCP with stent implantation or percutaneous transhepatic bile duct drainage
(PTCD) - Gastroenterostomy – best supportive care in patients with gastric outlet stenosis→stomach
is anastomosed with the small intestine bypassing the duodenum - Percutaneous endoscopic gastrostomy (PEG) tube – indicated for severe palliative patients
with chronic ileus and subileus that are inoperable
- Acute disorders of mesenteric blood circulation: aetiology (classification)
Acute arterial embolism 50% (afib, MI, valvular disorders and endocarditis)
Arterial thrombosis 25%- atherosclerosis, aortic aneurysm/dissection
Venous thrombosis 10% (infection malignancy hypercoag oestrogen therapy)
Nonocclusive mesenteric ischemia 20%- criticar ill pt with low cardiac output
- Acute disorders of mesenteric blood circulation:clinical features.
Periumbilical pain that is disproportionate to physical findings
- Nausea and vomiting
- Diarrhea (bloody in later stages)
- Gangrenous bowel – rectal bleeding and signs of sepsis (e.g. tachycardia, hypotension)
- Clinical courses
o Acute arterial embolism – most abrupt and painful onset of all types (“abdominal apoplexy”)→severe abdominal pain, fever, bloody diarrhea, leukocytosis and atrial fibrillation
o Acute arterial thrombosis–presentation less severe because of collateral supply
o Nonocclusive ischemia–symptoms develop over several days
o Venous thrombosis – symptoms less dramatic, worsen gradually (e.g. abdominal
discomfort evolves over a week)
Q27 Treatment principles of spleen trauma
Conservative (low grade splenic injury in hemodynamically stable patient)
- repeat ultrasound for 10 days
- angiographic embolisation of vessel if needed
- avoid contact sport for 3 months
Operative
-high grade splenic injury/ hemodynamically unstable pt
-Laporotomy; splenic salvage; suture, coag, ligate
or partial splenic resection or if hilar rupture splenectomy
Q29 Classification of thoracic trauma, mechanisms of trauma. Principles of patient examination and diagnostic work up
- by location
injury to :
ribcage (rib fx, sternum fx, contusion and flail chest)
mediastinum (cardiac contusion, pericardial effusion, cardiac tamponade, aortic/oesophageal/diaphragm rupture)
lungs (hemo/pneumothorax, bronchus/trachea rupture)
-by mechanism (penetrating/blunt/iatrogenic)
-open vs closed
