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Year 2- GIT > Surgery of Pancreatic Disorders > Flashcards

Surgery of Pancreatic Disorders Flashcards

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1
Q

Describe who is more likely to get pancreatic cancer.

A

60-80yo
Pretty even male : female

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2
Q

What is the cause of pancreatic cancer?

A

Unknown

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3
Q

What are some of the risk factors for pancreatic cancer?

A

Smoking
Chronic pancreatitis
Adult onset of diabetes
Genetics

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4
Q

How does pancreatic cancer prsent?

A

Obstructive jaundice
Weight loss
Anorexia
Recurrent pancreatitis
Vomiting
Abdominal/back pain

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5
Q

What are the general investigations carried out for diagnosis of pancreatic cancer?

A

CXR
Bloods

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6
Q

List some imaging investigations which can be useful for staging of the pancreatic cancer.

A

Ultrasound
CT
MRI
PET
ERCP

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7
Q

Which investigation is the gold standard for diagnosing pancreatic cancer?

A

CT scan

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8
Q

What happens during ERCP (endoscopic retrograde cholangio pancreatography)?

A

Camera goes down stomach -> duodenum
Catheter is inserted in the bile duct and ampulla to inject contrast which would show a dilated bile duct

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9
Q

How would it be determined whether a patient is fit for major pancreatic resection or not?

A

Basic history and examination
CXR, ECG
Resp. function tests
Physiosocial scoring

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10
Q

In terms of staging, which two investigations would be carried out first?

A

Ultrasound, then CT

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11
Q

Name two procedures that can be done for pancreatic resection.

A

Whipple’s
PPD (pylorus pancreaticoduodenectomy)

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12
Q

In terms of palliative care, how can obstructive jaundice be resolved?

A

ERCP and stenting

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13
Q

If during a surgery, removal of the pancreatic cancer is not doable, what can be done instead?

A

Biliary bypass

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14
Q

In terms of palliative care, how can duodenal obstruction be resolved?

A

Duodenal stent

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15
Q

What is acute pancreatitis?

A

Acute inflammatory process of pancreas with variable involvement of other regional tissues/organs

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16
Q

What is meant by mild acute pancreatitis?

A

Associated w minimal organ dysfunction and uneventful recovery

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17
Q

What is meant by severe acute pancreatitis?

A

Associated w organ failure or local complication

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18
Q

What are some of the local complications those with severe acute pancreatitis may face?

A

Acute fluid collections
Pseudocyst
Pancreatic abscess
Pancreatic necrosis

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19
Q

What causes acute pancreatitis?

A

Gallstones
Alcohol
Viral infection
Tumours
Anatomical abnormalities
Drugs
Hypercalcaemia
Ischaemia
Scorpion venom!!!

Just read through, next card is gonna ask which are more common!

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20
Q

What are the most likely causes of acute pancreatitis?

A

Gallstones
Alcohol

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21
Q

Describe how alcohol can cause acute pancreatitis.

A

Causes direct injury as produces oxidation products like acetaldehyde.

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22
Q

How does acute pancreatitis present?

A

Abdominal pain
Nausea, vomiting
Collapse

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23
Q

What are some of the clinical signs suggesting acute pancreatitis?

A

Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure

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24
Q

In acute pancreatitis, what would be raised in the bloods?

A

Amylase

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25
Q

What can be done to help rank the severity of acute pancreatitis?

A

Clinical assessment
Use of modified Glasgow criteria
CT scanning
Individual markers e.g. CXR

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26
Q

How is acute pancreatitis managed?

A

Treat the underlying condition first e.g. if the cause is cholelithiasis, presenting with jaundice, we would give an ERCP

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27
Q

What would you do if the acute pancreatitis was brought about by alcohol?

A

Refer the patient to alcohol cessation

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28
Q

What would be the management if the acute pancreatitis was due to hyperlipidaemia?

A

Lipid lowering drugs or diet

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29
Q

What would be the management if the acute pancreatitis was due to malignancy?

A

Resection or bypass

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30
Q

What would be the management if the acute pancreatitis was due to anatomical abnormalities?

A

Correction of abnormalities if possible

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31
Q

What would be the management if the acute pancreatitis was due to drugs?

A

Change or correct the drugs being taken

32
Q

How many days does it take to identify necrosis on CT after acute pancreatitis?

A

4-10

33
Q

Why are antibiotics not given at the start of a mild acute attack of pancreatitis?

A

No sepsis and body would develop resistant microorganisms

33
Q

When would a patient w acute pancreatitis be given antibiotics?

A

If there were signs of sepsis

33
Q

How can we determine if something is sepsis or SIRS (systemic inflammatory response syndrome)?

A

CT guided FNA of pancreas

fine needle aspiration

34
Q

When would a patient w acute pancreatitis be given ERCP?

A

If the patient has jaundice or associated cholangitis

35
Q

In terms of nutrition, what is done for those with acute pancreatitis?

A

If you cannot establish nutrition orally, an MG tube will be used via enteric route

36
Q

How can recurrent attacks of acute pancreatitis be prevented?

A

Treat gallstones
Alcohol abstinence

37
Q

What should be done if there is sterile necrosis as a result of acute pancreatitis?

A

Nothing

38
Q

What should be done if there is infected necrosis as a result of acute pancreatitis?

A

Drainage or necrosectomy

39
Q

What should be done if there is abscess formation as a result of acute pancreatitis?

A

Drainage through the skin

40
Q

What are some of the late complications of acute pancreatitis?

A

Haemorrhage
Portal hypertension
Pancreatic duct stricture

41
Q

What is chronic pancreatitis?

A

Continuing inflammation of pancreas which impairs the exocrine and endocrine functions of the pancreas

42
Q

What are the causes of chronic pancreatitis?

A

O A TIGER!!!

Obstruction
Autoimmune
Toxin
Idiopathic
Genetic
Environmental
Recurrent injuries

43
Q

What are some of the obstructions which can cause chronic pancreatitis?

A

Tumours
Sphincter of Oddi dysfunction
Duodenal obstruction
Trauma

44
Q

What are some of the toxins which can cause chronic pancreatitis?

A

Drugs
Smoking
Alcohol

45
Q

What are some of the genetic conditions which can cause chronic pancreatitis?

A

Condon 29 and 122
CFTR
SPINK1
Condon A

46
Q

What are some of the recurrent injuries which can cause chronic pancreatitis?

A

Biliary
Hyperlipidaemia
Hypercalcinaemia

47
Q

What are the clinical presentations of chronic pancreatitis?

A

Pain
Jaundice
Pancreatic hormone insufficiency
Diabetes
Upper GI haemorrhage

48
Q

Which investigations are carried out for chronic pancreatitis?

A

CT
ERCP/MRCP
Test of pancreatic exocrine function
Diagnostic enzyme replacement

49
Q

Why is MRCP useful in the diagnosis of chronic pancreatitis?

A

Monitors progression

50
Q

Why is ERCP useful in the diagnosis of chronic pancreatitis?

A

Shows biliary or pancreatic duct obstruction

51
Q

When would surgery be carried out in cases of chronic pancreatitis?

A

Suspicion of malignancy
Intractable pain
Complications arise

52
Q

List the complications of chronic pancreatitis which require surgery.

A

-Pancreatic duct stenosis
-Cyst/ pseudocysts
-Biliary tract obstruction
-Splenic vein thrombosis
-Portal vein compression
-Duodenal stenosis
-Colonic stricture

53
Q

How would pancreatic duct stenosis be treated surgically?

A

Via endoscopy

54
Q

How would cysts be treated surgically?

A

Drainage

55
Q

How would splenic vein thrombosis be treated surgically?

A

Laparoscopic splenectomy

56
Q

How would portal vein compression be treated surgically?

A

Anticoagulation

57
Q

How would duodenal stenosis be treated surgically?

A

Laparoscopic bypass

58
Q

How would colonic stricture be treated surgically?

A

Surgical disconnection/excision of part of bowel

59
Q

Which nerve plexus could be blocked to reduce pain from chronic pancreatitis?

A

Caeliac plexus

60
Q

How can a caeliac plexus block be carried out?

A

CT guided

61
Q

Which types of surgery may be required for chronic pancreatitis if the medical management surgeries fail?

A

Drainage
Resection

62
Q

Name two types of drainage surgery for chronic pancreatitis.

A

Pancreatic duct sphincteroplasty
Puestow

63
Q

Name two types of resection surgery for chronic pancreatitis.

A

Whipple’s pancreatico-duodectomy
Spleen-preserving distal pancreatectomy

64
Q

What is mucinous cystic neoplasia of the pancreas (MCN)?

A

Rare tumours found in the pancreas

65
Q

What are the different types of MCN of the pancreas?

A

MD-IPMN (main duct intraductal papillary mucinous neoplasia)
BD-IPMN (branch duct intraductal papillary mucinous neoplasia)
MCN (mucinous cystic neoplasia)

66
Q

Describe MD-IPMN (main duct IPMN)

A

Arises from whole of pancreatic duct and pancreatic duct is dilated due to mucus

67
Q

Describe BD-IPMN (branch duct IPMN)

A

Side branch of pancreatic duct leading to a cyst

68
Q

Describe MCN

A

Single cyst

69
Q

Why are these MCN’s and subtypes important?

A

High chance they develop into cancer

70
Q

When would a MD-IPMN be at a high risk of developing into cancer?

A

When main pancreatic duct >10mm
Enhanced solid component

71
Q

When would a MCN be at a high risk of developing into cancer?

A

Enhanced solid component >1cm

72
Q

List some of the different methods of resection.

A

Pancreatectomy
Focal
Spleen sparing
Laparoscopic
Robotic
Multifocal

73
Q
A

Year 2- GIT (37 decks)

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