Surgery for pancreatic disorders Flashcards

1
Q

What are some risk factors for cancer of the head of the pancreas?

A

smoking

FAP, chronic pancreatitis and adult onset diabetes

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2
Q

How may patients with pancreatic cancer present?

A

obstructive jaundice, abdominal pain, weight loss, diabetes, vomiting

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3
Q

What tumour marker would you look for?

A

CA19-9

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4
Q

What imaging/invasive investigations would be undertaken for cancer?

A

CT, ERCP, EUS, PET, USS, percutaneous needle biopsy, cytology, MRCP

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5
Q

What symptom is ERCP useful to treat?

A

jaundice - stenting

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6
Q

What are the steps and test which allow us to decide if a patient is fit for major pancreatic resection?

A

respiratory tests
exercise tests - lactate
CXR, ECG

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7
Q

If pancreatic cancer is unresectable what steps are taken?

A

ERCP and stent
laparascopic bypass - weight loss
open bypass

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8
Q

What are the steps for a resectable cancer?

A

USS, ERCP and stent, spiral CT/MRI, laparascopy, laparotomy, resect
At any stage can find out is unresectable and change treatment plan

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9
Q

What is the Kausch whipple surgery? basic principles.

A

Remove the head of pancreas (tumour), duodenum, gallbladder, proximal jejunum and part of stomach and join the stomach, pancreas and common hepatic duct to the jejunum

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10
Q

How is obstructive jaundice treated with palliative draining?

A

ERCP and stent after a palliative bypass

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11
Q

How is duodenal obstruction treated with palliative draining?

A

palliative bypass and duodenal stent

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12
Q

What is the difference between mild and severe acute pancreatitis?

A

mild - minimal organ dysfunction, quick recovery

severe - organ failure association

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13
Q

What are local complications of acute pancreatitis?

A

fluid collection (acute) -> pseudocyst -> pancreatic abscess -> pancreatic necrosis

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14
Q

What are the most common causes of acute pancreatitis?

A

gallstones, alcohol, virus, drugs, tumours of head of pancreas, ERCP, idiopathic

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15
Q

Explain briefly how alcohol, gallstones and ERCP can cause acute pancreatitis?

A

alcohol - directly toxic, oxidation increased (acetylaldehyde)
other 2 both increase the pancreatic ductal pressure

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16
Q

Symptoms of acute pancreatitis?

A

abdominal pain, vomiting, nausea and collapse

17
Q

Signs of acute pancreatitis?

A

pyrexia, tachycardia, dehydration, abdominal tenderness

18
Q

General supportive care measures for acute pancreatitis

A

analgesia, IV fluids, support - CVS, resp, renal

19
Q

Investigations for acute pancreatitis?

A

U+E, glucose, serum amylase, LFT, AXR, CXR, USS, CT, FBC and clotting

20
Q

Monitoring acute pancreatitis…

A

arterial line
catheter - urine output
pulse, bp, CVP,

21
Q

What are used to predict the severity of acute pancreatitis?

A

Modified Glasgow criteria - after 48 hours, score>3
CRP >200
CT, CXR

22
Q

What is encompassed in the modified Glasgow criteria?

A

glucose, serum amylase, albumin, white cell count, serum calcium, AST/ALT, urea, arterial PO2

23
Q

How is acute pancreatitis managed?

A

antibiotics for infection
alcohol abstinence
nutrition through NG tube
CT and ERCP

24
Q

What does ERCP help treat in acute pancreatitis and what 2 conditions is it used to relieve?

A

gallstone obstruction

jaundice and cholangitis

25
How are recurring attacks of acute pancreatitis prevented?
gallstone removal alcohol abstinence identify the cause and treat
26
What are other definitive managements of acute pancreatitis?
fluid drainage, managing necrosis and late complications eg haemorrhage and portal hypertension
27
What is the mnemonic for chronic pancreatitis aetiology?
O-A-TIGER
28
Explain chronic pancreatitis mnemonic
``` O - obstructive MPD - tumour, stricture A - autoimmune T - toxin I - idiopathic G - genetic eg CFTR E - environmental R - recurrent injury ```
29
3 main clinical features of acute pancreatitis?
jaundice, pain, diabetes
30
Investigations of acute pancreatitis? imaging and blood
CT - local anatomy and complications ERCP/MRCP serum amylase/faecal amylase
31
Management of chronic pancreatitis? non surgical methods
``` analgesia alcohol abstinence pancreatic enzyme supplements avoid high fat diet - steathorrea diabetic control ```
32
Treatment for chronic pancreatitis?
caeliac plexus block (CT, FLUORSCOPY, EUS guided) pancreatic duct sphincteroplasty - lithotripsy, dilation CBD stent or bypass
33
What surgery is used to help drain in chronic pancreatitis?
pancreatic duct sphincterotomy | Peustow - join jejunum to stomach and pancreas to restore GIT
34
Resection surgery in chronic pancreatitis?
whipples | spleen preserving pancreatectomy
35
Prognosis for chronic pancreatitis?
high risk of death, 20-25yrs = 50% mortality