Surgery for pancreatic disorders Flashcards
List 3 main types of pancreatic disease
- Pancreatic cancer
- Acute pancreatitis
- Chronic pancreatitis
How many people in the UK are diagnosed with cancer of the head of the pancreas every year?
100/million p/a in UK
Who are most commonly affected by cancer of the head of the pancreas?
- Commonest in 60-80y, though there are more younger patients recently
- M:F = 1.5-2
What are the risk factors for cancer of the head of the pancreas?
– Cigarette smoking: increases risk by 25–30%
– Chronic pancreatitis: 5–15 fold chance of developing cancer
– Adult onset DM of less than two years’ duration
– Hereditary pancreatitis (rare)
– Inherited predisposition
– Periampullary cancer is a feature of FAP
How do patients with cancer of the head of the pancreas present?
- Obstructive jaundice – very gradual change, often present too late
- Diabetes
- Abdominal pain/back pain – often occurs in late stage disease
- Anorexia
- Vomiting
- Weight loss
- Recurrent bouts of pancreatitis
- Incidental finding
What tumour marker is associated with pancreatic cancer?
CA19-9
What imaging or invasive investigations are used for pancreatic cancer?
– USS – ERCP – CT – MR, MRCP – Laparoscopy + Lap USS – Peritoneal cytology – EUS + FNA/ Bx – Percutaneous needle biopsy – PET
List the 2 types of surgery offered for pancreatic tumours
Kausch- Whipple: A pancreaticoduodenectomy or Kausch-Whipple procedure, is a major surgical operation involving the removal of the head of the pancreas, the duodenum, the proximal jejunum, gallbladder, and part of the stomach. This operation is most often performed to remove cancerous or pre-cancerous tumours of the head of the pancreas or one of the related structures (Ampulla of Vater, duodenum or bile duct). Less commonly, it may be used for the management of pancreatic or duodenal trauma, or chronic pancreatitis.
PPPD or pylorus preserving pancreatoduodectomy - same procedure except pylorus is preserved to maintain gastric emptying, though some doubt its effectiveness in adequacy for cancer removal therefore
Describe acute pancreatitis
An acute inflammatory process of the pancreas, with variable involvement of other regional tissues or remote organ systems
What are some local complications associated with acute pancreatitis?
- Acute fluid collections
- Pseudocyst
- Pancreatic abscess
- Pancreatic necrosis
Describe the aetiology of acute pancreatitis
- Gallstones - most common cause
- Alcohol – 2nd most common cause
- Viral Infection: CMV, mumps
- Tumours, especially of head of pancreas, blocks the pancreatic duct
- Anatomical abnormalities (P.D.)
- Lipid abnormalities
- Hypercalcaemia
- Postoperative trauma/general trauma
- Ischaemia
- Drugs
- Scorpion venom
- “Idiopathic” - 2% of cases, check there is no genetic link
- ERCP
I GET SMASHED
Idiopathic Gallstones Ethanol (alcohol) Tumours/trauma Scorpion venom Mumps/malignancy Autoimmune Steroids and other drugs Hypertriglycerides or hypercalcaemia ERCP Drugs
Describe the I GET SMASHED mnemonic for acute pancreatitis causes
I GET SMASHED
Idiopathic Gallstones Ethanol (alcohol) Tumours/trauma Scorpion venom Mumps/malignancy Autoimmune Steroids and other drugs Hypertriglycerides or hypercalcaemia ERCP Drugs
Describe the OATIGER mnemonic for chronic pancreatitis
Obstruction - tumour/trauma Autoimmune Toxin - alcohol, smoking Idiopathic Genetic - CF Environmental - tropical chronic pancreatitis Recurrent injury
How does alcohol cause acute pancreatitis?
Direct injury
Increased sensitivity to stimulation
Oxidation products (acetaldehyde)
Non-oxidative metabolism (fatty acid ethyl esters)
How does acute pancreatitis present - symptoms and signs?
Symptoms:
Abdominal pain
Nausea, vomiting
Collapse
Signs: Pyrexia Dehydration Abdominal tenderness Circulatory failure
