Surgery of Pancreatic Disorders Flashcards
What are examples of pancreatic disorders?
Pancreatic cancer
Acute pancreatitis
Chronic pancreatitis
Intraductal papillary mucinous neoplasm (IPMN) and pancreatic cystic disease
What does IPMN stand for?
Intraductal papillary mucinous neoplasm
What is the incidence of pancreatic cancer in the UK?
10/100000
What age group is pancreatic cancer most common in?
60-80 years old
What is the male:female ratio of pancreatic cancer?
3:4
What is the 5 year survival rate of pancreatic cancer?
0.4%
What are risk factors for pancreatic cancer?
Smoking
Chronic pancreatitis
Adult onset of diabetes
Hereditary pancreatitis
Inherited predisposition
What is the presentation of pancreatic cancer?
Obstructive jaundice
Diabetes
Abdominal pain/back pain
Anorexia
Vomiting
Weight loss
Recurrent bouts pancreatitis
What investigations are done for pancreatic cancer?
Blood tests
Chest x-ray
Tumour markers (CA19-9)
Imaging/invasive investigations
What antigen is released by cancerous pancreatic cells that can be tested for?
CA19-9
What imaging/invasive tests can be done to investigate pancreatic cancer?
CXR
USS
CT
MRCP
Laparoscopic USS
Peritoneal cytology
Percutaneous needle biopsy
PET scan
What is considered when considering if a patient with pancreatic cancer is fit for pancreatic resection?
Basic history and examination
Chest x-ray and ECG
Respiratory function tests
Physiological scoring system
What types of surgery can be done for pancreatic cancer?
Kausch-Whipple
Pylorus-preserving pancreaticoduodenectomy (PPPD)
Palliative drainage
Metal stenting
What does PPPD stand for?
Pylorus-preserving pancreaticoduodenectomy
What is a pylorus-preserving pancreaticoduodenectomy
Similar to Whipples operation but none of the stomach is removed
What is Kausch-Whipple surgery?
Removes head of pancreas, bile duct, gallbladder and the duodenum
What is Kausch-Whipple surgery also known as?
Pancreaticoduodectomy
What is acute pancreatitis?
An acute inflammatory process of the pancreas with involvement of other regional tissues or remote organ systems
What are the different classifications of acute pancreatitis?
Mild AP
Severe AP
What is mild acute pancreatitis associated with?
Minimal organ dysfunction and uneventful recovery
What is severe acute pancreatitis associated with?
Organ failure or local complication
What are some local complications of acute pancreatitis?
Acute fluid collection
Pseudocyst
Pancreatic abscess
Pancreatic necrosis
What is the aetiology of acute pancreatitis?
Gallstones
Alcohol
Viral infections (CMV, mumps)
Tumours
Anatomical abnormalities
ERCP
Lipid abnormalities
Hypercalcaemia
Postoperative trauma
Ischaemia
Drugs
Scorpion venom
Idiopathic
What viral infections can cause acute pancreatitis?
CMV
Mumps
What does CMV stand for?
Cytomegalovirus
What is the pathophysiology of acute pancreatitis caused by alcohol?
Direct injury
Increased sensitivity to stimulation
Oxidation products (acetaldehyde)
Non-oxidative metabolism (fatty acid ethyl esters)
What is the pathophysiology of pancreatitis caused by gallstones?
Passage of gallstone is essential
Raised pancreatic ductal pressure
What is the pathophysiology of acute pancreatitis caused by ERCP?
Increased pancreatic duct pressure
What are some symptoms of acute pancreatitis?
Abdominal pain
Nausea, vomiting
Collapse
What are some signs of acute pancreatitis?
Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure
What does the management of acute pancreatitis involve?
General supportive care (analgesia, IV fluids, cardiovascular, respiratory and renal support)
Monitoring (pulse, BP, urine output, CVP, arterial line, HDU/ITU)
Investigations
What should be monitored when managing acute pancreatitis?
Pulse, BP
Urine output
Central venous pressure (CVP)
Arterial line
HDU/ITU
What investigations should be done for acute pancreatitis?
U/E, glucose
Serum amylase
FBC, clotting
LFT ABG
Chest x-ray, abdomen x-ray
USS
CT scan
What critera does preducting severity of acute pancreatitis use?
Glasgow criteria
In the Glasgow criteria, what score inidcates severe acute pancreatitis?
3 or more
What does the Glasgow criteria check?
Glucose
Serum calcium
White cel count
Albumin
LDH
Urea
AST/ALT
Arterial pO2
What glucose level gives a score of 1 on the Glasgow criteria?
>10mmol/L
What serum calcium level gives a score of 1 on the Glasgow criteria?
<2mmol/L