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Gastrointestinal Pathology > Surgery of Pancreatic Disorders > Flashcards

Surgery of Pancreatic Disorders Flashcards

1
Q

What age group is the most common to get cancer of the head of the pancreas?

A

60 - 80 y/o

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2
Q

Which gender gets pancreatic head cancer more?

A

M:F 1.5:2

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3
Q

Risk factors for head of pancreas cancer

A 
Smoking 25-30%
Chronic pancreatitis 5-15x
Adult onset DM of less than 2 years duration 
Hereditary pancreatitis 
Inherited predisposition 
- periampullary cancer feature of FAP
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4
Q

What is periampullary cancer?

A

Cancer that forms near the ampulla of vater

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5
Q

Presentation of head of pancreas cancer

A 
Obstructive jaundice
Diabetes 
Abdominal Pain
Back pain 
Anorexia
Vomiting
Weight loss
Recurrent bouts of pancreatitis 
Can also be an incidental finding
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6
Q

Investigations for head of pancreas cancer

A 
FBC
CXR
Tumour markers
- CA19-9
USS
Possible ERCP
CT
MRCP
EUS + FNA
Percutaneous needle biopsy 
PET scan 
Peritoneal cytology
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7
Q

Treatment for head of pancreas cancer if patient is fit for surgery

A
  1. USS then ERCP + stent
  2. Spiral CT + MRI
  3. Laparotomy
  4. Resection
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8
Q

Treatment for head of pancreas cancer if cancer is unresectable or patient is unfit for surgery?

A
  1. USS then ERCP + stent
  2. Spiral CT + MRI
  3. Laparoscopic bypass
  4. Can also do open bypass
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9
Q

Types of surgery

A

Kausch-Whipple surgery

PPPD surgery

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10
Q

Definition of chronic pancreatitis

A

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

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11
Q

Which gender gets chronic pancreatitis more?

A

M > F

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12
Q

Causes of chronic pancreatitis

A 
Obstruction of main pancreatic duct
Autoimmune 
Toxins
- ethanol 
- smoking
- drugs 
Idiopathic
Genetic 
Environmental - tropical chronic pancreatitis 
Recurrent injuries 
- biliary 
- hyperlipidaemia
- hypercalcaemia
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13
Q

Causes of obstruction of the main pancreatic duct

A 
Tumour 
- adenocarcinoma
- IPMT 
Sphincter of oddi dysfunction 
Pancreatic divisum 
Duodenal obstruction 
- tumour
- diverticulum 
Trauma
Structure
- post necrotising radiation
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14
Q

What does IPMT stand for?

A

Intraductal papillary mucinous tumour of the pancreas

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15
Q

Pneumonic to remember the causes of chronic pancreatitis

A

O-A-TIGER

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16
Q

What is pancreatic divisum?

A

Inadequate accessory drainage

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17
Q

What are the genetic causes of chronic pancreatitis?

A

Autosomal dominant - codon 29 and 122

Autosomal recessive / modifier genes (CFTR, SPINK1, Codon A etc)

18
Q

Presentation of chronic pancreatitis

A 
Pain 
Pancreatic exocrine insufficiency (late manifestation)
Diabetes
Jaundice
Duodenal obstruction (uncommon) 
Upper GI Haemorrhage
19
Q

What is pain in chronic pancreatitis linked to?

A

Binges

20
Q

Investigations for chronic pancreatitis

A

CT
ERCP/MRCP
Pancreatic exocrine function

21
Q

Treatment of chronic pancreatitis

A 
Abstinence from alcohol 
Management of acute attacks
Analgesia 
Avoid high fat, high protein diet
Pancreatic supplementation 
Anti-oxidant therpat 
R
Treat DM
Surgery 
Interventional treatmentss
22
Q

When would surgery be done in chronic pancreatitis?

A

Suspicion of malignancy

Intractable pain

23
Q

Complications of surgery for chronic pancreatitis

A 
Pancreatic duct stenosis
Cysts/pseudocysts 
Biliary tract obstruction 
Splenic vein thrombosis/gastric varices
Portal vein compression/mesenteric vein thrombosis
Duodenal stenosis
Colonic stricture
24
Q

What are interventional treatments for chronic pancreatitis?

A

For pancreatic duct stenosis and obstruction; Endoscopic PD sphincterectomy, dilation and lithotripsy
CBD stenting or bypass
Thorascopy splanchnectomy
Coeliac plexus block

25
Q

Prognosis of chronic pancreatitis

A

50% over 20 - 25 years

20% die of complications

26
Q

Definition of acute pancreatitis

A

An acute inflammatory process of the pancreas, with variable involvement of other regional tissues or remote organ systems

27
Q

Types of acute pancreatitis

A

Mild acute pancreatitis

Severe acute pancreatitis

28
Q

What is mild acute pancreatitis?

A

Assosiated with minimal organ dysfunction and uneventful recovery

29
Q

What is severe acute pancreatitis?

A

Assosiated with organ failure or local complications e.g.

  • acute fluid collections
  • pseudocyst
  • pancreatic abscess
  • pancreatic necrosis
30
Q

Causes of acute pancreatitis

A 
Gallstones 
Alcohol 
Viral infection; CMV, Mumps
Tumours
Anatomical abnormalities (P.D.)
ERCP
Lipid abnormalities 
Hypercalcaemia 
Post op trauma 
Ischaemia
Drugs
Scorpion venom
idiopathic
31
Q

What is the most common two causes of acute pancreatitis?

A

Gallstones

Alcohol

32
Q

Why can gallstones cause acute pancreatitis?

A

Raised pancreatic ductal pressure

33
Q

What effects does alcohol have on the pancreas to induce acute pancreatitis?

A

Direct injury
Increased sensitivity to stimulation
Oxidation products (acetaldehyde)
Non oxidative metabolism (fatty acid ethyl esters)

34
Q

Why can ERCP cause acute pancreatitis?

A

Increased pancreatic ductal pressure

35
Q

Presentation of acute pancreatitis

A 
Abdominal pain 
Nausea + vomiting 
Collapse
Pyrexia
Dehydration 
Abdominal tenderness
Circulatory failure
36
Q

Treatment of acute pancreatitis

A 
Analgesia
IV fluids
Treat precipitating cause
Prevention of recurrent attacks
- management of gallstones
- alcohol abstinence 
Management of necrosis
Management of fluid collection
37
Q

Investigations for acute pancreatitis

A 
U and Es
Glucose
Serum amylase
FBC, clotting
LFTs
ABG
CXR
AXR
USS 
CT scanning
38
Q

3 or more of this modified Glasgow criteria of acute pancreatitis at 48 hours indicates severe

A

a) Glucose > 10mmol/L
b) Serum [Ca2+] <2.00mmol
c) WCC > 15000/mm3
d) Albumin <32g/L
e) LDH > 700 IU/L
f) Urea > 16mmol/L
g) AST/ALT >200 IU/L
h) Arterial Po2 <60mmHg

39
Q

What is done to predict the severity of acute pancreatitis?

A 
Clinical assessment
Modified Glasgow criteria (3 or more)
CT scanning
Individual markers
- CXR
- CRP ( >200 or perisists > 150)
- IL 6
- TAP
40
Q

Late complications of acute pancreatitis

A

Haemorrhage
Portal HTN
Pancreatic duct stricture

Gastrointestinal Pathology (26 decks)

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