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GI System > Surgery of Pancreatic Disorders > Flashcards

Surgery of Pancreatic Disorders Flashcards

1
Q

What is ERCP?

A

Endoscopic Retrograde Cholangiopancreatography

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2
Q

What is MRCP?

A

Magnetic Resonance Cholangiopancreatography

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3
Q

In what age group is pancreatic cancer most common and what is the 5year survival rate?

A

60-80year olds

0.4%

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4
Q

What is the aetiology for pancreatic cancer?

A

Smoking
Chronic pancreatitis
Hereditary pancreatitis
Inherited predisposition

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5
Q

How does pancreatic cancer present? (7)

A 
Obstructive jaundice - Main one
Diabetes
Abdominal/back pain
Anorexia
Vomiting 
Weight loss
Recurrent bouts of pancreatitis
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6
Q

What investigations should be done for pancreatic cancer?

A 
CXR
Blood test
Tumour markers - CA19-9
CT-MRI
Biopsy
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7
Q

Is patient fit enough for surgery?

A 
History and Examination
CXR
ECG
Respiratory function
Physiological "scoring system"
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8
Q

What is Whipple’s surgery?

A

Remove half of the stomach and the head of the pancreas and some of the duodenum to make an anastamosis with a loop of the jejunum

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9
Q

In Whipple’s, if what is retained will there be a better outcome from a gastric point of view?

A

Pylorus

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10
Q

What can occur for obstructive jaundice or duodenal obstruction?

A

Palliative bypass plus astent

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11
Q

What is acute pancreatitis?

A

Acute inflammation of the pancreas, with variable involvement of other regional tissues or remote organ systems

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12
Q

What is the difference between mild and severe acute pancreatitis?

A

Mild - Minimal organ disruption and uneventful recovery

Severe - Associated with organ failure or local complication

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13
Q

What are the possible complications of acute pancreatitis?

A

Acute fluid collections
Pseudocyst
Pancreatic abscess/necrosis

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14
Q

What is the aetiology of acute pancreatitis?

A 
Gallstones
Tumour
Alcohol
Ischaemia
Anatomical abnormalities
Drugs
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15
Q

What is the pathophysiology of acute pancreatitis?

A 
Direct injury
Increased sensitivity to stimulation
Oxidation products 
Non-oxidative metabolism
Gallstone blockage
ERCP can caused increased pancreatic ductal pressure
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16
Q

What are the symptoms of acute pancreatitis?

A

Abdominal pain
Nausea/Vomiting
Collapse

17
Q

What are the signs of acute pancreatitis?

A

Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure

18
Q

What investigations should be done for acute pancreatitis? (7)

A 
FBC, U+E's, LFTs & Amylase
Gluscose
Clotting
CXR
USS
CT
ABG
19
Q

What indicates that acute pancreatitis is severe? (8)

A 
Glucose > 10 mmol/L
Serum [Ca2+]  15000/mm3
Albumin 700 IU/L
Urea > 16 mmol/L
AST/ALT > 200 IU/L Arterial pO2
20
Q

What precipitating factors should be managed for acute pancreatitis?

A 
Cholelithiasis
Alcohol
Ischaemia
Malignancy
Hyperlipidaemia
Anatomical abnormalities 
Drugs
21
Q

What are late complications of acute pancreatitis?

A

Haemorrhage
Portal hypertension
Pancreatic duct stricture

22
Q

What is the problem for those who get pancreatitis from drinking?

A

If they stop it may go away but if they start drinking again it will come back

23
Q

What is chronic pancreatitis?

A

Continuing chronic inflammation of the pancreas, characterized by irreversible morphological changes leading to chronic pain and / or impairment of endocrine and exocrine function of the pancreas

24
Q

What is chronic pancreatitis associated with and in what sex is it more prominent?

A

Alcohol consumption

Males

25
Q

What are the causes of chronic pancreatitis?

A 
Obstruction of MPD e.g. Tumour, Trauma etc.
Autoimmune
Toxin - Ethanol
Idiopathic
Genetic
Environmental
Recurrent injuries
26
Q

What are the features of chronic pancreatitis?

A 
Pain
Pancreatic exocrine insufficiency
Diabetes
Jaundice
Duodenal obstruction
Upper GI haemorrhage
27
Q

What investigation should be done for chronic pancreatitis?

A

CT
ERCP/MRCP
Faecal/serum enzymes
Diagnostic enzyme replacment

28
Q

How should chronic pancreatitis be managed? (8)

A 
Counselling
Alcohol abstinence
Analgesia
Avoid fat, high protein diet
Pancreatic supplmentation
Diabetes
Steatorrhoea
Anti-oxidant therapy
29
Q

Under what circumstances should surgery be done for chronic pancreatitis?

A

Suspicion of malignancy
Intractable pain
Complications e.g. Cyst/Pancreatic duct stenosis
Drainage or resection can also occur

30
Q

What is the prognosis of chronic pancreatitis?

A

Mortality of 50% for over 20-25 years old

20% die of complications

31
Q

Under what conditions should an intervention of chronic pancreatitis occur?

A

CBD stenting or bypass
Management of chronic pseudocyst
PD stenosis and obstruction

GI System (38 decks)

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