Surgery For Pancreatic Diseases Flashcards by Kim Crane

Cancer in head of pancreases is more common in men or women

Men

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Cancer in head of pancreas is common in what age group

60-80 years

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List the aetiology for cancer in head

Cigarette smoking 
Chronic pancreatitis 
Adult onset of diabetes mielitus less than two years
Hereditary pancreatitis 
Inherited predisposition 
FAP

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What is the presentation for pancreatic cancer

Diabetes
Abdominal pain/ back pain
Anorexia 
Vomitting 
Weight. Loss 
Recurrent bouts of pancreatitis

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What investigations are conducted with someone with suspected pancreatic cancer

Blood tests
LFT
Tumour markers
Imaging CT

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What tumour marker is used for pancreatic cancer

CA19-9

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Using and ERCP for the diagnosis of pancreatic cancer in head shows what sign

Double duct

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In an ERCP, what is a double duct

Simulaneous dilation of pacnreatic and bile duct

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To determine weather a patient is fit enough for a pancreatic resection, what assessments are considered

CXR
ECG
pulmonary function tests
Physiological scoring systems (SORT)

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If a tumour is potentially respectable, is a USS or CT first used

Uss

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What is no longer used for staging disease

ERCP

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If a patient is unfit for surgery what do they receive to treat jaundice in their pancreatic cancer

ERCP stent

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What the typical type of surgery for pancreatic cancer

Whipple -anatomises of pancreas to duodenum and stomach to lower down

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What is an an alternative to shippers surgery for pancreatic cancer

PPPD- pyloric preserving. Keeps pyloric pace makers.

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Is it true that regardless of the surgery for pancreatic cancer there will be 5% mortality, 40% chance of delayed gastric emptying and 20% leakage of pancreatic duct

True

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What are the treatment options for patient with pancreatic cancer who are not fit for surgery

Must treat jaundice ! Must sort this before chemotherapy. ECRP stenting
Duodenal obstruction is treated with palliative bypass and duodenal stent

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How can acute pancreatitis be split

Mild -70%

Necrotising- 30%

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What is the aetiology for acute pancreatitis

Gallstones
Alcohol
Viral infection: CMV and mumps
Tumours 
Anatomical abnormalities 
ERCP 
lipid abnormalities
Hpercalcaemai 
Post op
Ischaemia 
Drugs
Scorpion

In relation to alcohol , how does alcohol cause acute pacnreattis

Direct injury
Increased sensitivity to stimulation
Oxidation products

How do gallstones and ERCP cause acute pancreatitis

Increased pancreatic ducts pressure

What are the symptoms of acute pancreatitis

Abdominal pain
Nausea
Vomiting
Collapse due to circulatory failure

What are the signs of pancreatic cancer

Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure

What is the intital management of acute pancreatitis

General supportive, managing specific organ failure
Monitoring
Investigations In blood
USS for gall

In acute pancreatitis what is the investigations done to predict severity

Clinical assessment
Ct scanning
Individual markers like CXR, CRP, IL 6

In someone with acute pancreatitis, you have to establish is they have cholelithaiasis . How is that done

ERCP | May have gall removed

In acute pancreatitis, is its important to establish causes

What is driving it, eg ischemia, drugs, alcohol, gall stones, hyperlipdaemia, anatomy

In acute pancreatitis when is ct scanning helpful

Severe disease To identify necrosis Assess fluid complications

When are antibiotics used in acute pancreatitis

Not recommended until septics

How is it determined if it’s sepsis of SIRS in acute pancreatitis

Ct guided fna of pancreatic necrosis

In acute pancreatitis when is ERCP used

Jaundice and cholangitis

In acute pancreatitis nutrition is important, how is it managed

Start oral | Move to nasogastric feeding

In management of necrosis in acute pancreatitis, when is fluid collected

Only if infected necrosis

How is infective necrosis treated

Necrosectomy va laparotomy or minimally invasive

List the causes of chronic pancreatitis

``` O-A - TIGER O is obstruction like tumour, trauma Autoimmune Toxin Idiopathic Genetic Environmental Recurrent injuries ```

What is the clinic features of chronic pancreatitis

``` Pain Pancreatic exocrine unduffienvy leading to diarrhoea/ nutrition issues Diabetes Jaundice Duodenal obstruction ```

What investigations are conducted in someone with chronic pancreatitis

Ct scan ERCP / Mrcp Pancreatic exocrine function

In order to maintain nutrition, what enzyme replacement therapy is given to someone with chronic pancreatitis

Creon

How is treatment dealt with in someone with chronic pancreatitis (non-surgically)

Pancreatic duct stenosis is treated with endoscopic PD sphincetortomy Management of pseudocysts Caeliac plexus block

What is surgical options for someone with CP

drainage via PD sphincteroplasty Puestow Resection via PPPD, whipple, DPPHR, Frey’s procedure, spleen preserving distal pancreatectomy

What is mutinous cystic neoplasia of the pancreas

Small cystic lesions

In mucinous cystic neoplasia of the pancreas, what is the diff between IPMN and MCN

MCN has only one

What are the main types of mucous things

Main duct- IPMN Bile duct- IPMN MCN All increase risk of cancer

Describe worrisome features of MD-PIMN and MCN

See slide

When is it indicated to resect the muscous thins

See slide