Surgery of Pancreatic Disorders Flashcards by Sarah Anderson

What is the aeitology of pancreatic cancer

cigarette smoking

chronic pancreatitis

Diabetes Melitus (less than 2 yrs duration)

Hereditary pancreatitis
Inherited predisposition

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What is the clinical presentation/signs of pancreatic cancer

Obstructive jaundice

Diabetes

Abdominal pain / Back pain

Anorexia

Vomiting

Weight loss

Recurrent bouts pancreatitis

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What is the Invasive investigations for pancreatic cancer

USS
ERCP
CT
MR, 
MRCP
Laparoscopy + Lap USS
Peritoneal cytology
EUS + FNA/ Bx
Percutaneous needle biopsy
PET

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What is the tumour marker for pancreatic cancer

CA19-9

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What is the treatment options for pancreatic cancer

Surgery: resection

Palliative drainage

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What is the name of the pancreatic resection surgery

Kaush whipple

{pancreaticoduodenectomy}

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Describe the Kausch- Whipple

major surgical operation involving the removal of the head of the pancreas, the duodenum, the proximal jejunum, gallbladder, and part of the stomach

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Why is the pylorus preserved in Kausch- whipple

Maintaining the pylorous of the stomach as is where the pacemaker is therefore gastric emptying isn’t delayed

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What is palliative draining used to treat

Obstructive jaundice

Duodenal obstruction

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What is the methods of palliative drainage used to treat obstructive jaundice in pancreatic cancer

Palliative bypass
ERCP
PTC stenting

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What is the methods of palliative drainage used to treat duodenal obstruction in pancreatic cancer

Palliative bypass

Duodenal stent

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Define the two classification of acute pancreatitis

Mild AP: Associated with minimal organ dysfunction and uneventful recovery

Severe AP: Associated with organ failure or local complication

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What is the local complications caused by acute pancreatitis

Acute fluid collections

Pseudocyst

Pancreatic abscess

Pancreatic necrosis

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What is the aetiology of acute pancreatitis

Gallstones

Alcohol

Viral Infection (CMV, Mumps)

Tumours

Anatomical abnormalities (pancreas divisum)

ERCP

Lipid abnormalities

Hypercalcaemia

Postoperative Trauma

Ischaemia

Drugs

Idiopathic

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What is the pathophysiology of how alcohol causes acute pancreatitis

direct injury
increased sensitivity to stimulation
oxidation products (acetaldehyde)

non-oxidative metabolism (fatty acid ethyl esters)

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What is the pathophysiology of how ERCP causes acute pancreatitis

Increases pancreatic ductal pressure

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What is the symptoms of acute pancreatitis

Abdominal pain
Nausea/vomiting
Collapse

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What is the signs of acute pancreatitis

Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure

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What is the general supportive care given in acute pancreatitis

Analgesia
Intravenous fluids
Support to:
Cardiovascular	
Respiratory
Renal

What is monitored in acute pancreatitis

Pulse,

BP - arterial line

Urine output

Central Venous Pressure

Intensive unit care

What is the imagery investigations for acute pancreatitis

Chest and Abdomen X ray

Ultrasound

ERCP

What further test are investigated in acute pancreatitis

U&amp;E, 
glucose
serum amylase
FBC, 
LFT
arterial blood gas

What are the results that predict the severity of acute pancreatitis in Modified Glasgow Criteria

Severe is >3

Glucose > 10 mmol/L

Serum [Ca2+] < 2.00 mmol

WCC > 15000/mm3

Albumin< 32 g//L

LDH > 700 IU/L

Urea > 16 mmol/L

AST/ALT > 200 IU/L

Arterial pO2 < 60mmHg

What is the treatment of acute pancreatitis if caused by gallstones

ERCP &ES

cholecystectomy

What is the management of acute pancreatitis

If due to Hyperlipideamia: Diet, lipid lowering drugs Overall good nutrition abstinence from alcohol or drugs Correct anatomical abnormalities If due to infection: -antibiotics Manipulate inflammatory response Fluid collection

Why is CT scanning useful in the diagnosis and management of acute pancreatitis

Shows complications Acute fluid collections Abscess Necrosis Monitors progress of disease

How is a Infection diagnosed in acute pancreatitis and what is the importance of this

CT guided fine needle aspiration Make sure sepsis complications have not occurred

How is necrosis managed in acute pancreatitis

Necrosectomy | through Laparotomy

What are the later complications of acute pancreatitis due to necrosis

Abscess Haemorrhage Portal hypertension Pancreatic duct stricture

What is the definition of chronic pancreatitis

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

Aetiology chronic pancreatitis

O-A- TIGER Obstruction of main pancreatic duct Autoimmune Toxic (alcohol, smoking, drugs) Idiopathic Genetic Environmental (tropical chronic pancreatitis) Recent injuries

What are the causes ob obstruction to main pancreatic duct

Spinchter of Oddi dysfunction Pancreatic divisum (single pancreatic duct not formed) Duodenal obstruction - Tumour - Diverticulum (blind tube) Trauma structure change due to radiation

What are the Hereditary genes of chronic pancreatitis

Autosomal dominant (Condon 29 and 122) | Autosomal recessive/modifier genes CFTR, SPINK1, Codon A etc

What are the recurrent injuries that occur to causee chronic pancreatitis

Biliary Hyperlipidemia Hypercalcemia

What is the clinical features of chronic pancreatitis

Pain Exocrine insufficiency Diabetes Jaundice Duodenal obstruction Upper GI haemorrhage

What is the imaging investigations for chronic pancreatitis

CT scan - shows local anatomy and complications ERCP MRCP

How is pancreatic exocrine function tested in the investigation of chronic pancreatitis

faecal / serum enzymes (elastase) Pancreolauryl test (trypsin reponse to a stimulus) Diagnostic Enzyme replacement

What is the management of chronic pancreatitis

abstinence from alcohol analgesia avoid high fat/protein diet pancreatic supplementation for pain anti-oxidant therapy Insulin - for diabetes

When would surgery occur in chronic pancreatitis

Suspicion of malignancy Intractable pain Complications

What are the potential complications of chronic pancreatitis

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

How do you manage pancreatic duct stenosis and obstruction

Endoscopic PD sphincetortomy, dilation lithotripsy

How do you manage chronic pseuodocyts in chronic pancreatitis

Common biliary duct stenting or bypass

Define Caeliac plexus block and how you perform it

injections of pain medication that help relieve abdominal pain Is either - CT guided - EUS guided - Fluoroscopy guided

Define Splanchnectomy

surgical excision of a segment of one or more splanchnic nerves to relieve hypertension.

What are the two surgical procedures that are performed in chronic pancreatitis

Drainage Resection

What are the types of drainage surgeries in Chronic pancreatitis

Pancreatic duct sphincteroplasty Puestow (Rochelle modification)

What are the types of resection surgeries in Chronic pancreatitis

Duodenum preserving pancreatic head resection PPHR (Beger) PPPD -pylorus preserving Pancreatoduodectomy Whipple’s pancreatico-duodenectomy ``` Frey procedure (longitudinal pancreato-jejunostomy with local pancreatic resection) ``` Spleen-preserving distal pancreatectomy Central pancreatectomy