Surgery For Pancreatic Diseases Flashcards
Cancer in head of pancreases is more common in men or women
Men
Cancer in head of pancreas is common in what age group
60-80 years
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
What is the presentation for pancreatic cancer
Diabetes Abdominal pain/ back pain Anorexia Vomitting Weight. Loss Recurrent bouts of pancreatitis
What investigations are conducted with someone with suspected pancreatic cancer
Blood tests
LFT
Tumour markers
Imaging CT
What tumour marker is used for pancreatic cancer
CA19-9
Using and ERCP for the diagnosis of pancreatic cancer in head shows what sign
Double duct
In an ERCP, what is a double duct
Simulaneous dilation of pacnreatic and bile duct
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)
If a tumour is potentially respectable, is a USS or CT first used
Uss
What is no longer used for staging disease
ERCP
If a patient is unfit for surgery what do they receive to treat jaundice in their pancreatic cancer
ERCP stent
What the typical type of surgery for pancreatic cancer
Whipple -anatomises of pancreas to duodenum and stomach to lower down
What is an an alternative to shippers surgery for pancreatic cancer
PPPD- pyloric preserving. Keeps pyloric pace makers.
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
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
How can acute pancreatitis be split
Mild -70%
Necrotising- 30%
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
