Surgery of Pancreatic Disorders Flashcards

1
Q

What is the presentation for carcinoma of the head of pancreas?

A
Obstructive jaundice
Diabetes
Abdominal/back pain
Anorexia
Vomiting
Weight loss
Recurrent pancreatitis
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2
Q

What are the investigations for carcinoma of pancreatic head?

A
Blood tests
CXR
USS
ERCP
CT scan
MRCP
EUS
PET
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3
Q

What type of surgery can be done for pancreatic head carcinoma?

A

Kausch-whipple

Pancreas head, duodenum, gallbladder and bile duct are removed

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4
Q

How is acute pancreatitis managed?

A

identify and manage precipitating factors
Cholelithaiasis = ERCP + ES, cholecystectomy
Alcohol = abstinence, counselling
Malignancy = resection or bypass
Hyperlipidaemia = diet
Drugs = stop or change

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5
Q

What is the role of CT scanning in acute pancreatitis?

A

Occasional helpful with diagnosis
Used in days 4-10 to identify necrosis
Useful for identifying fluid, abscess, necrosis and monitoring progress of disease

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6
Q

How can recurrent attacks of acute pancreatitis be prevented?

A

Gallstone management
Investigations of non-gallstone pancreatitis
Alcohol abstinence

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7
Q

What are the causes of chronic pancreatitis?

A
Obstruction of MPD (tumour, obstruction, trauma etc)
Autoimmune
Toxin (alcohol, drugs)
Idiopathic
Genetic
Environment
Recurrent injuries
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8
Q

What are the clinical features of chronic pancreatitis?

A
Pain
Pancreatic exocrine insufficiency
Diabetes
Jaundice
Duodenal obstruction
Upper GI haemorrhage
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9
Q

How is chronic pancreatitis managed?

A
Counselling
Alcohol abstinence
Management of acute attacks
Analgesia
Healthy diet
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10
Q

When is surgery used as treatment in chronic pancreatitis?

A

Malignancy?
Pain
Complications (pancreatic duct stenosis, cysts, obstruction, thrombosis, duodenal stenosis, strictures)

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11
Q

What interventional procedures can be done for chronic pancreatitis?

A

Endoscopic PD sphincetortomy, dilation and lithotripsy (PD stenosis)
CBD stenting/bypass
Thoracoscopic splanchnectomy
Coeliac plexus block

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12
Q

What is MD-IPMN?

A

Main duct - intraductal papillary mucinous neoplasia

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13
Q

What is MCN

A

Mucinous cystic neoplasia

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14
Q

What are the indications for resection for BD-IPMN?

A

In elderly >3cm without high risk stigmata

Younger patients >2cm depends on location

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15
Q

What are the indications for resection for MCN?

A

All MCN in fit patients indicated

<4cm without mural nodules

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16
Q

What are the methods of resection?

A
Pancreatectomy + LNs
Focal and LN or spleen sparing
Laparoscopic
Robotic
Multifocal BD-IPMN: total pancreatectomy