Surgery of Pancreatic Disorders Flashcards
What is the presentation for carcinoma of the head of pancreas?
Obstructive jaundice Diabetes Abdominal/back pain Anorexia Vomiting Weight loss Recurrent pancreatitis
What are the investigations for carcinoma of pancreatic head?
Blood tests CXR USS ERCP CT scan MRCP EUS PET
What type of surgery can be done for pancreatic head carcinoma?
Kausch-whipple
Pancreas head, duodenum, gallbladder and bile duct are removed
How is acute pancreatitis managed?
identify and manage precipitating factors
Cholelithaiasis = ERCP + ES, cholecystectomy
Alcohol = abstinence, counselling
Malignancy = resection or bypass
Hyperlipidaemia = diet
Drugs = stop or change
What is the role of CT scanning in acute pancreatitis?
Occasional helpful with diagnosis
Used in days 4-10 to identify necrosis
Useful for identifying fluid, abscess, necrosis and monitoring progress of disease
How can recurrent attacks of acute pancreatitis be prevented?
Gallstone management
Investigations of non-gallstone pancreatitis
Alcohol abstinence
What are the causes of chronic pancreatitis?
Obstruction of MPD (tumour, obstruction, trauma etc) Autoimmune Toxin (alcohol, drugs) Idiopathic Genetic Environment Recurrent injuries
What are the clinical features of chronic pancreatitis?
Pain Pancreatic exocrine insufficiency Diabetes Jaundice Duodenal obstruction Upper GI haemorrhage
How is chronic pancreatitis managed?
Counselling Alcohol abstinence Management of acute attacks Analgesia Healthy diet
When is surgery used as treatment in chronic pancreatitis?
Malignancy?
Pain
Complications (pancreatic duct stenosis, cysts, obstruction, thrombosis, duodenal stenosis, strictures)
What interventional procedures can be done for chronic pancreatitis?
Endoscopic PD sphincetortomy, dilation and lithotripsy (PD stenosis)
CBD stenting/bypass
Thoracoscopic splanchnectomy
Coeliac plexus block
What is MD-IPMN?
Main duct - intraductal papillary mucinous neoplasia
What is MCN
Mucinous cystic neoplasia
What are the indications for resection for BD-IPMN?
In elderly >3cm without high risk stigmata
Younger patients >2cm depends on location
What are the indications for resection for MCN?
All MCN in fit patients indicated
<4cm without mural nodules