Surgery for pancreatic disorders Flashcards
What are the risk factors for pancreatic cancer?
Smoking
Chronic pancreatitis
Hereditary pancreatitis
Inherited predisposition
What noninvasive investigations are done for pancreatic cancer?
Blood tests CXR Tumour marker tests Ultrasound CT PET
What invasive investigations are done for pancreatic cancer?
ERCP MRCP Laproscopy and lap ultrasound Endoscopic ultrasound and biopsy Percutaneous needle biopsy
What procedures can be carried out to palliate obstructive jaundice?
Palliative bypass
ERCP or PTC setnting
What procedures can be carried out to palliate duodenal obstruction?
Palliative bypass
Duodenal stent
What are the classifications of acute pancreatitis?
Mild- associated with minimal organ dysfunction and uneventful recovery
Severe- accosted with organ failure or local complications
What local complications may arise in acute pancreatitis?
Acute fluid collections
Psudocyst
Pancreatic abscess
Pancreatic necrosis
How does alcohol cause acute pancreatitis?
Direct injury- increases sensitivity to stimulation
Oxidation process
How do gallstones and ERCP cause acute pancreatitis?
Raised pancreatic ductal pressure
What general measures are used to manage acute pancreatitis?
Analgesia
IV fluids
Cardio, resp and renal support
What is used in monitoring of acute pancreatitis?
Pulse, BP Urine output CVP Arterial line ITU
How are gallstones in acute pancreatitis treated?
ECRP, endoscopic sphincterectomy
Cholecystectomy
How is ischaemia in acute pancreatitis treated?
Support and correct cause
How is malignancy causing acute pancreatitis treated?
Resection or bypass
How is hyperlipidaemia in acute pancreatitis treated?
Diet
Lipid lowering drugs
What is a CT useful for in acute pancreatitis?
Acute fluid collections
Ascites
Necrosis
Monitoring progress of disease
How are recurrent attacks of acute pancreatitis prevented?
Management of gallstones
Alcohol abstinence
Investigation
How is fluid collection associated with acute pancreatitis managed?
Early collection
Diagnose as pseudocyst or pancreatic duct fistula
What are the late complications of acute pancreatitis?
Haemorrhage
Portal hypertension
Pancreatic duct stricture
What investigations are done for chronic pancreatitis?
CT
ERCO/MRCP
Pancreatic exocrine function
When is surgery used in chronic pancreatitis?
Suspicion of malignancy Intractable pain Pancreatic duct stenosis Cyst/pseudocysts Biliary tract obstruction Splenic vein thrombosis Portal vein compression Mesenteric vein thrombosis Duodenal stenosis Colonic stricture
What procedure is used to treat intractable pain in chronic pancreatitis?
Celiac plexus block
What is used to treat pancreatic duct stenosis?
endoscopic sphincterectomy
Dilation
Lithotripsy
What is used to treat biliary tract obstruction?
Stent
Bypass
