Surgery of Pancreatic Disorders Flashcards
What is ERCP?
Endoscopic Retrograde Cholangiopancreatography
What is MRCP?
Magnetic Resonance Cholangiopancreatography
In what age group is pancreatic cancer most common and what is the 5year survival rate?
60-80year olds
0.4%
What is the aetiology for pancreatic cancer?
Smoking
Chronic pancreatitis
Hereditary pancreatitis
Inherited predisposition
How does pancreatic cancer present? (7)
Obstructive jaundice - Main one Diabetes Abdominal/back pain Anorexia Vomiting Weight loss Recurrent bouts of pancreatitis
What investigations should be done for pancreatic cancer?
CXR Blood test Tumour markers - CA19-9 CT-MRI Biopsy
Is patient fit enough for surgery?
History and Examination CXR ECG Respiratory function Physiological "scoring system"
What is Whipple’s surgery?
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
In Whipple’s, if what is retained will there be a better outcome from a gastric point of view?
Pylorus
What can occur for obstructive jaundice or duodenal obstruction?
Palliative bypass plus astent
What is acute pancreatitis?
Acute inflammation of the pancreas, with variable involvement of other regional tissues or remote organ systems
What is the difference between mild and severe acute pancreatitis?
Mild - Minimal organ disruption and uneventful recovery
Severe - Associated with organ failure or local complication
What are the possible complications of acute pancreatitis?
Acute fluid collections
Pseudocyst
Pancreatic abscess/necrosis
What is the aetiology of acute pancreatitis?
Gallstones Tumour Alcohol Ischaemia Anatomical abnormalities Drugs
What is the pathophysiology of acute pancreatitis?
Direct injury Increased sensitivity to stimulation Oxidation products Non-oxidative metabolism Gallstone blockage ERCP can caused increased pancreatic ductal pressure
What are the symptoms of acute pancreatitis?
Abdominal pain
Nausea/Vomiting
Collapse
What are the signs of acute pancreatitis?
Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure
What investigations should be done for acute pancreatitis? (7)
FBC, U+E's, LFTs & Amylase Gluscose Clotting CXR USS CT ABG
What indicates that acute pancreatitis is severe? (8)
Glucose > 10 mmol/L Serum [Ca2+] 15000/mm3 Albumin 700 IU/L Urea > 16 mmol/L AST/ALT > 200 IU/L Arterial pO2
What precipitating factors should be managed for acute pancreatitis?
Cholelithiasis Alcohol Ischaemia Malignancy Hyperlipidaemia Anatomical abnormalities Drugs
What are late complications of acute pancreatitis?
Haemorrhage
Portal hypertension
Pancreatic duct stricture
What is the problem for those who get pancreatitis from drinking?
If they stop it may go away but if they start drinking again it will come back
What is chronic pancreatitis?
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
What is chronic pancreatitis associated with and in what sex is it more prominent?
Alcohol consumption
Males
What are the causes of chronic pancreatitis?
Obstruction of MPD e.g. Tumour, Trauma etc. Autoimmune Toxin - Ethanol Idiopathic Genetic Environmental Recurrent injuries
What are the features of chronic pancreatitis?
Pain Pancreatic exocrine insufficiency Diabetes Jaundice Duodenal obstruction Upper GI haemorrhage
What investigation should be done for chronic pancreatitis?
CT
ERCP/MRCP
Faecal/serum enzymes
Diagnostic enzyme replacment
How should chronic pancreatitis be managed? (8)
Counselling Alcohol abstinence Analgesia Avoid fat, high protein diet Pancreatic supplmentation Diabetes Steatorrhoea Anti-oxidant therapy
Under what circumstances should surgery be done for chronic pancreatitis?
Suspicion of malignancy
Intractable pain
Complications e.g. Cyst/Pancreatic duct stenosis
Drainage or resection can also occur
What is the prognosis of chronic pancreatitis?
Mortality of 50% for over 20-25 years old
20% die of complications
Under what conditions should an intervention of chronic pancreatitis occur?
CBD stenting or bypass
Management of chronic pseudocyst
PD stenosis and obstruction
