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2ND YEAR SYSTEMS: GI > Surgery of pancreatic disorders > Flashcards

Surgery of pancreatic disorders Flashcards

1
Q

epidemiology of pancreatic cancer

A

F>M
5 year survival 0.4%

6th killer cancer in uk

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2
Q

risk factors for pancreatic cancer (5)

A

cigarette smoking: 25–30%

chronic pancreatitis: 5–15 fold

Adult onset DM of less than two years’ duration

Hereditary pancreatitis

Inherited predisposition ie
Periampullary cancer is a feature of FAP

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3
Q

presentation of pancreatic cancer (7)

A 
obstructive jaundice
diabetes
abdominal pain radiating to the back
anorexia
vomiting 
weight loss
recurrent bouts pancreatitis
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4
Q

investigations carried out for pancreatic head cancer

A 
blood tests
CXR
tumour markers - CA19-9
ERCP - examines pancreatic and bile ducts
USS
CT
MRI
MRCP
Laparoscopy + Lap USS
peritoneal cytology
percutaneous needle biopsy 
PET scan
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5
Q

what is a double duct seen in imaging and what does it indicate

A

simultaneous dilatation of common bile and pancreatic ducts

indicates carcinoma of the head of the pancreas and ampullary tumours

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6
Q

what is the ‘whipple’ otherwise known as a pancreaticoduodenectomy?

A

generally the removal of the gallbladder, common bile duct, part of the duodenum, and the head of the pancreas

most common type of surgery to remove pancreatic tumours

only carried out usually if cancer hasn’t spread past the head

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7
Q

Palliative drainage can be carried out in which cases?

A

used to treat symptoms but not cure

sometimes used if patient has obstructive jaundice or duodenal obstruction

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8
Q

Definition of acute pancreatitis

A

An acute inflammatory process of the pancreas, with variable

involvement of other regional tissues or remote organ systems

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9
Q

severe Acute pancreatitis

A

associated with organ failure or local complication

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10
Q

local complications of acute pancreatitis

A

acute fluid collections
pseudocyst
pancreatic abscess
pancreatic necrosis

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11
Q

Aetiologies of acute pancreatitis (11)

A 
Gallstones 
Alcohol 
Viral Infection: CMV, mumps 
Tumours 
ERCP
Lipid abnormalities
Hypercalcaemia 
Postoperative Trauma 
Ischaemia 
Drugs	
“Idiopathic”
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12
Q

Alcohol as a cause of acute pancreatitis

A

direct injury
increased sensitivity to stimulation
oxidation products
non-oxidative metabolism

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13
Q

Gallstones as a cause of acute pancreatitis

A

blockage causes raised pancreatic ductal pressure

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14
Q

signs of acute pancreatitis

A

pyrexia
dehydration
abdominal tenderness
circulatory failure

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15
Q

symptoms of acute pancreatitis

A

abdominal pain
nausea
vomiting
collapse

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16
Q

general management of acute pancreatitis

A

analgesia
IV fluids
cardio, resp and renal support

17
Q

How is acute pancreatitis monitored in high dependency or intensive care unit?

A

pulse, BP
urine output
CVP
arterial line

18
Q

investigations carried out for acute pancreatitis (8)

A 
Urea + electrolytes
glucose
FBC
clotting
LFT
CXR
USS
CT scan
19
Q

Management options if there is malignancy present

A

resection (removing cancerous tissue)

bypass

20
Q

specific aspects of acute pancreatitis management (6)

A 
CT scanning
Antibiotics 
Diagnosis of infection
ERCP in gallstone pancreatitis
Nutrition
Manipulation of the inflammatory response
21
Q

why is CT used for acute pancreatitis? (4)

A

occasionally helpful in diagnosis

useful in severe disease

days 4-10 to identify necrosis

useful for complications like acute fluid collections, abscess, necrosis, monitoring progress of disease

22
Q

What is a CT-guided FNAC?

A

CT guided Fine Needle Aspiration Cytology

a safe, rapid, and reliable procedure to look for pancreatic necrosis

takes a sample from pancreas

23
Q

How can nutritional support be given to patients?

A

nasogastric feeding - tolerable in most cases

enteral feeding (through GI tract) is better than IV feeding

24
Q

acute pancreatitis management

A

prevention of recurrent attacks
management of gallstones

investigations of non-gallstone pancreatitis
alcohol abstinence

Manage fluid collection

25
Q

types of fluid collection you could get with acute pancreatitis?

A

early collection
pseudocyst
pancreatic duct fistula

26
Q

Management of necrosis

A

necrosectomy - laparotomy or minimally invasive

27
Q

Causes of chronic pancreatitis. Remember O-A-TIGER

A

Obstruction of MPD
Autoimmune

Toxin - ethanol, smoking, drugs
Idiopathic
Genetic - Aut. dominant, Aut. recessive
Environmental - tropical ch. pancreatitis
Recurrent injuries - biliary, hyperlipidaemia/hypercalcemia

28
Q

genetic causes of chronic pancreatitis: examples of autosomal dominant and recessive genes

A

dominant = Condon 29 and 122

recessive = CFTR, SPINK1, Codon A

29
Q

clinical features of chronic pancreatitis (6)

A 
pain 
pancreatic exocrine insufficiency - late on
diabetes
jaundice
duodenal obstruction - rare
upper GI heamorrhage
30
Q

Investigations for chronic pancreatitis (5)

A

CT scan: local anatomy and complications

ERCP / MRCP

Pancreatic exocrine function (used infrequently):
faecal / serum enzymes (elastase)

Pancreolauryl test (enzyme response to a stimulus)

Diagnostic Enzyme replacement

31
Q

Management of chronic pancreatitis (9)

A

Counselling

Abstinence from alcohol

Management of acute attacks

Analgesia

Avoid high fat, high protein diet

Pancreatic supplementation controversial for pain

Anti-oxidant therapy

Steatorrhoea:
Reduce fat intake
Pancreatic supplementation

Diabetes

32
Q

Is surgery offered to patients with chronic pancreatitis?

A

only after full evaluation

suspicion of malignancy?
intractable pain

have to evaluate the risks/complications like pancreatic duct stenosis, cysts, biliary tract obstruction, duodenal stenosis etc

33
Q

Interventional procedures for chronic pancreatitis

A

For pancreatic Duct Stenosis and obstruction: Endoscopic PD sphincterotomy, dilation and lithotripsy - shock waves

Management of chronic pseudocyst

CBD stenting or bypass

Thoracoscopic

Splanchniectomy - splanchnic nerve removal

Caeliac plexus block to alleviate pain

  • CT guided
  • EUS guided
  • Fluoroscopy guided
34
Q

mortality rate for chronic pancreatitis?

A

mortality 50% over 20-25 years

20% die of complications

35
Q

Methods of resection surgery

A

Pancreatectomy + Lymp nodes

Focal and LN or spleen sparing:

Laparoscopic

Robotic

36
Q

What are the types of drainage surgery of the pancreas?

A

Pancreatic duct sphincteroplasty

Puestow (Rochelle modification)

2ND YEAR SYSTEMS: GI (38 decks)

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