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Alimentry > Surgery For Pancreatic Diseases > Flashcards

Surgery For Pancreatic Diseases Flashcards

1
Q

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

A

Men

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2
Q

Cancer in head of pancreas is common in what age group

A

60-80 years

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3
Q

List the aetiology for cancer in head

A 
Cigarette smoking 
Chronic pancreatitis 
Adult onset of diabetes mielitus less than two years
Hereditary pancreatitis 
Inherited predisposition 
FAP
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4
Q

What is the presentation for pancreatic cancer

A 
Diabetes
Abdominal pain/ back pain
Anorexia 
Vomitting 
Weight. Loss 
Recurrent bouts of pancreatitis
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5
Q

What investigations are conducted with someone with suspected pancreatic cancer

A

Blood tests
LFT
Tumour markers
Imaging CT

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6
Q

What tumour marker is used for pancreatic cancer

A

CA19-9

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7
Q

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

A

Double duct

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8
Q

In an ERCP, what is a double duct

A

Simulaneous dilation of pacnreatic and bile duct

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9
Q

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

A

CXR
ECG
pulmonary function tests
Physiological scoring systems (SORT)

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10
Q

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

A

Uss

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11
Q

What is no longer used for staging disease

A

ERCP

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12
Q

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

A

ERCP stent

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13
Q

What the typical type of surgery for pancreatic cancer

A

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

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14
Q

What is an an alternative to shippers surgery for pancreatic cancer

A

PPPD- pyloric preserving. Keeps pyloric pace makers.

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15
Q

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

A

True

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16
Q

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

A

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

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17
Q

How can acute pancreatitis be split

A

Mild -70%

Necrotising- 30%

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18
Q

What is the aetiology for acute pancreatitis

A 
Gallstones
Alcohol
Viral infection: CMV and mumps
Tumours 
Anatomical abnormalities 
ERCP 
lipid abnormalities
Hpercalcaemai 
Post op
Ischaemia 
Drugs
Scorpion
19
Q

In relation to alcohol , how does alcohol cause acute pacnreattis

A

Direct injury
Increased sensitivity to stimulation
Oxidation products

20
Q

How do gallstones and ERCP cause acute pancreatitis

A

Increased pancreatic ducts pressure

21
Q

What are the symptoms of acute pancreatitis

A

Abdominal pain
Nausea
Vomiting
Collapse due to circulatory failure

22
Q

What are the signs of pancreatic cancer

A

Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure

23
Q

What is the intital management of acute pancreatitis

A

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

24
Q

In acute pancreatitis what is the investigations done to predict severity

A

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

25
Q

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

A

ERCP

May have gall removed

26
Q

In acute pancreatitis, is its important to establish causes

A

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

27
Q

In acute pancreatitis when is ct scanning helpful

A

Severe disease
To identify necrosis
Assess fluid complications

28
Q

When are antibiotics used in acute pancreatitis

A

Not recommended until septics

29
Q

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

A

Ct guided fna of pancreatic necrosis

30
Q

In acute pancreatitis when is ERCP used

A

Jaundice and cholangitis

31
Q

In acute pancreatitis nutrition is important, how is it managed

A

Start oral

Move to nasogastric feeding

32
Q

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

A

Only if infected necrosis

33
Q

How is infective necrosis treated

A

Necrosectomy va laparotomy or minimally invasive

34
Q

List the causes of chronic pancreatitis

A 
O-A - TIGER 
O is obstruction like tumour, trauma 
Autoimmune 
Toxin 
Idiopathic 
Genetic 
Environmental 
Recurrent injuries
35
Q

What is the clinic features of chronic pancreatitis

A 
Pain 
Pancreatic exocrine unduffienvy leading to diarrhoea/ nutrition issues 
Diabetes
 Jaundice 
Duodenal obstruction
36
Q

What investigations are conducted in someone with chronic pancreatitis

A

Ct scan
ERCP / Mrcp
Pancreatic exocrine function

37
Q

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

A

Creon

38
Q

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

A

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

39
Q

What is surgical options for someone with CP

A

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

40
Q

What is mutinous cystic neoplasia of the pancreas

A

Small cystic lesions

41
Q

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

A

MCN has only one

42
Q

What are the main types of mucous things

A

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

43
Q

Describe worrisome features of MD-PIMN and MCN

A

See slide

44
Q

When is it indicated to resect the muscous thins

A

See slide

Alimentry (9 decks)

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