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Year 2 GI (JK) > Surgery for pancreatic disorders > Flashcards

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
Q

How are recurring attacks of acute pancreatitis prevented?

A

gallstone removal
alcohol abstinence
identify the cause and treat

26
Q

What are other definitive managements of acute pancreatitis?

A

fluid drainage, managing necrosis and late complications eg haemorrhage and portal hypertension

27
Q

What is the mnemonic for chronic pancreatitis aetiology?

A

O-A-TIGER

28
Q

Explain chronic pancreatitis mnemonic

A 
O - obstructive MPD - tumour, stricture 
A - autoimmune 
T - toxin 
I - idiopathic 
G - genetic eg CFTR 
E - environmental 
R - recurrent injury
29
Q

3 main clinical features of acute pancreatitis?

A

jaundice, pain, diabetes

30
Q

Investigations of acute pancreatitis? imaging and blood

A

CT - local anatomy and complications
ERCP/MRCP
serum amylase/faecal amylase

31
Q

Management of chronic pancreatitis? non surgical methods

A 
analgesia 
alcohol abstinence 
pancreatic enzyme supplements 
avoid high fat diet - steathorrea 
diabetic control
32
Q

Treatment for chronic pancreatitis?

A

caeliac plexus block (CT, FLUORSCOPY, EUS guided)
pancreatic duct sphincteroplasty - lithotripsy, dilation
CBD stent or bypass

33
Q

What surgery is used to help drain in chronic pancreatitis?

A

pancreatic duct sphincterotomy

Peustow - join jejunum to stomach and pancreas to restore GIT

34
Q

Resection surgery in chronic pancreatitis?

A

whipples

spleen preserving pancreatectomy

35
Q

Prognosis for chronic pancreatitis?

A

high risk of death, 20-25yrs = 50% mortality

Year 2 GI (JK) (39 decks)

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