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The Alimentary Canal > Surgery of Pancreatic Disorders > Flashcards

Surgery of Pancreatic Disorders Flashcards

1
Q

What are some pancreatic disorders?

A

Pancreatic cancer
Acute pancreatitis
Chronic pancreatitis
IPMN - Intraductal papillary mucinous neoplasm
Pancreatic cyst disease

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2
Q

Explain epidemiology of cancer of head of pancreas?

A

Commonest 60-80 years
Equal ratio of men to women
5 year survival is 7%
5th killer of cancer in UK

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3
Q

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

A

Smoking
Chronic pancreatitis
Adult onset of DM
Hereditary pancreatitis

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4
Q

What is the presentation of cancer of head of pancreas?

A

Obstructive jaundice
Diabetes
Abdominal pain/ back pain
Anorexia, vomiting, weight loss, recurrent bouts pancreatitis

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5
Q

What are the general investigations of cancer in head of pancreas?

A

Blood tests and CXR

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6
Q

What imaging is used for cancer of head of pancreas?

A

CT is gold standard
USS rules out gall stones
PET
ERCP

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7
Q

What is the tumour marker for cancer of head of pancreas?

A

CA19-9 but is not diagnostic

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8
Q

What is a diagnostic feature of pancreatic cancer on ERCP?

A

Double duct
In bile duct and ampulla - injecting contrast
Shows dilation and obstruction of pancreatic duct

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9
Q

What is used for patient assessment when considering major pancreatic resection?

A

CXR, ECG
Resp tests
Scoring - none established, performance status, lactate threshold

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10
Q

What happens if pancreatic cancer is unresectable or patient unfit?

A

ERCP and stent to get rid of jaundice
Laparoscopic bypass
Open bypass

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11
Q

What happens if pancreatic cancer is resectable?

A

USS then spiral CT/MRI
Laparotomy
Resection

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12
Q

What is the types of surgery used for resection of pancreatic cancer?

A

Kausch-Whipple
PPPD - pylorus preserving pancreaticoduodenectomy

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13
Q

Explain Kausch-Whipple surgery

A

Half/quarter of stomach removed with head of pancreas, duodenum and lower end of bile duct
Replacing open ends by anastomosing

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14
Q

Explain PPPD surgery

A

Removes bile duct, head of pancreas and duodenum but leaves stomach intact
Better functional outcome

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15
Q

What are the palliative options for obstructive jaundice?

A

Palliative bypass or ERCP/ PTC stenting

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16
Q

What are the palliative options for duodenal obstruction?

A

Palliative bypass or duodenal stent

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17
Q

What is the definition acute pancreatitis?

A

Acute inflammatory process of the pancreas with other regional tissues or remote organ system

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18
Q

What are the classification of acute pancreatitis?

A

Mild and Severe AP

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19
Q

What is mild AP?

A

Associated with minimal organ dysfunction and uneventful recovery - 70% is this

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20
Q

What is severe AP?

A

Associated with organ failure or local complication

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21
Q

What are some local complications of acute pancreatitis?

A

Acute fluid collections
Pseudocyst
Pancreatic abscess
Pancreatic necrosis

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22
Q

What are the main causes of acute pancreatitis?

A

Gall stones
Alcohol
Viral infection
Tumours

23
Q

How does alcohol cause acute pancreatitis?

A

Direct injury
Increased sensitivity to simulation
Oxidation products
Non-oxidative metabolism

24
Q

How does gall stones cause acute pancreatitis?

A

Passage of gall stones is essential so raised pancreatic ductal pressure

25
Q

How does ERCP (endoscopic retrograde cholangiopancreatography) cause acute pancreatitis?

A

Increased pancreatic ductal pressure

26
Q

What are the symptoms for acute pancreatitis?

A

Abdominal pain
Nausea, vomiting
Collapse

27
Q

What are the signs for acute pancreatitis?

A

Pyrexia, dehydration, abdominal tenderness and circulatory failure

28
Q

What investigations are used for acute pancreatitis?

A

U/E, glucose, FBC, clotting, LFT, ABG< CXR, USS and CT if doubtful

29
Q

What are some general supporting care for acute pancreatitis?

A

Analgesia, IV fluids
Cardio, Resp and renal support

30
Q

What is used for prediction of severity of disease?

A

Clinical assessment
CT scanning
Individual markers - CXR, CRP, TAP

31
Q

What are some precipitating factors for acute pancreatitis?

A

Cholelithiasis
Alcohol
Ischaemia
Malignancy
Hyperlipidaemia
Drugs

32
Q

What is the management for acute pancreatitis?

A

CT scanning, antibiotics, diagnosis of infection, ERCP if gall stones, nutrition and manipulation of inflammatory response

33
Q

Why is CT scans used for acute pancreatitis?

A

Acute fluid collections
Abscess
Necrosis - shows 4-10 days
Monitoring progress of disease

34
Q

Why are antibiotics controversial in acute pancreatitis?

A

Not recommended in acute attack as sepsis is not there yet
Patient could then become resistant to microorganisms

35
Q

How is infection diagnosed in acute pancreatitis?

A

Sepsis or SIRS systemic inflammatory response syndrome)
CT guided FNA of pancreatic necrosis

36
Q

Describe ERCP in acute pancreatitis

A

Reduces complication in severe gallstones AP
Associated with higher mortality
Indicated in those with jaundice and cholangitis

37
Q

How do we prevent recurrent attacks in acute pancreatitis?

A

Management of gallstones
Investigations of non- gallstone pancreatitis
Alcohol abstinence

38
Q

When is fluid collection done in acute pancreatitis?

A

Early collection
Pseudocyst
Pancreatic duct fistula

39
Q

How is necrosis managed in acute pancreatitis?

A

If infected then necroscopy - laproscopy,
Abscess drained through skin

40
Q

What are some late complications of acute pancreatitis?

A

Haemorrhage
Portal hypertension
Pancreatic duct stricture

41
Q

What is the definition of chronic pancreatitis?

A

Continuing chronic inflammatory process of pancreas characterised by irreversible morphological change leading to pain or impairment of endocrine function

42
Q

What are the causes for chronic pancreatitis?

A

Obstruction of main pancreatic duct
Autoimmune
Toxin
Idiopathic
Genetic
Environmental
Recurrent injuries (O-A-TIGER)

43
Q

What is the main issue affecting the body and tail of pancreas?

A

Alcohol

44
Q

What are some clinical features of chronic pancreatitis?

A

Pain and erythema
Pancreatic exocrine insufficiency
Diabetes
Jaundice
Duodenal obstruction
Upper GI haemorrhage

45
Q

What investigations are used for chronic pancreatitis?

A

CT scan
ERCP/ MRCP
Pancreatic exocrine function - serum enzymes, pancreolauryl test and diagnostic enzyme replacement

46
Q

When is surgery used for chronic pancreatitis?

A

Suspicion of malignancy
Intractable pain
Complications

47
Q

What are some interventional procedures used for chronic pancreatitis?

A

Endoscopic PD sphincterotomy
CBD stenting or bypass
Thoracoscopic
Splanchnectomy
Coeliac plexus block

48
Q

What resection surgery can used in chronic pancreatitis?

A

DPPHR, PPPD, Whipple’s, Frey, Spleen preserving and central pancreatectomy

49
Q

What drainage techniques can be used in chronic pancreatitis?

A

Pancreatic duct sphincteroplasty
Puestow

50
Q

What are the types if mucinous cystic neoplasia of the pancreas?

A

IPMN - intraductal papillary mucinous neoplasia
Can get main duct or bile duct
MCN - mucinous cystic neoplasia

51
Q

When is MD-IPMN high risk stigmata?

A

If MPD is more than 1cm
Enhanced solid component

52
Q

When is MCN high risk stigmata?

A

More than 1cm with enhanced solid component
MPD is more than 1cm

53
Q

When IPMN and MCN indicated for resection?

A

MD-IPMN and MCN indicated
BD-IPMN - if more than 3cm in elderly without moral nodules then can be observed
But if younger and over 2cm then considered

54
Q

What are the methods of resection for IPMN and MCN?

A

Pancreatectomy and LN
Focal and LN or spleen sparing - laparoscopic, robotic
Total pancreatectomy

The Alimentary Canal (33 decks)

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