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Mariam Alimentary > Surgery of Pancreatic Disorders > Flashcards

Surgery of Pancreatic Disorders Flashcards

1
Q

What investigations are done for pancreatic cancer?

A

Blood tests

Chest x-ray

Tumour markers (CA19-9)

Imaging/invasive investigations

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2
Q

What antigen is released by cancerous pancreatic cells that can be tested for?

A

CA19-9

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3
Q

What imaging/invasive tests can be done to investigate pancreatic cancer?

A

CXR

USS

CT

MRCP

Laparoscopic USS

Peritoneal cytology

Percutaneous needle biopsy

PET scan

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4
Q

What is considered when considering if a patient with pancreatic cancer is fit for pancreatic resection?

A

Basic history and examination

Chest x-ray and ECG

Respiratory function tests

Physiological scoring system

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5
Q

What types of surgery can be done for pancreatic cancer?

A

Kausch-Whipple

Pylorus-preserving pancreaticoduodenectomy (PPPD)

Palliative drainage

Metal stenting

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6
Q

What is a pylorus-preserving pancreaticoduodenectomy

A

Similar to Whipples operation but none of the stomach is removed

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7
Q

What is Kausch-Whipple surgery?

A

Removes head of pancreas, bile duct, gallbladder and the duodenum

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8
Q

What is Kausch-Whipple surgery also known as?

A

Pancreaticoduodectomy

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9
Q

What does the management of acute pancreatitis involve?

A

General supportive care (analgesia, IV fluids, cardiovascular, respiratory and renal support)

Monitoring (pulse, BP, urine output, CVP, arterial line, HDU/ITU)

Investigations

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10
Q

What should be monitored when managing acute pancreatitis?

A

Pulse, BP

Urine output

Central venous pressure (CVP)

Arterial line

HDU/ITU

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11
Q

What investigations should be done for acute pancreatitis?

A

U/E, glucose

Serum amylase

FBC, clotting

LFT ABG

Chest x-ray, abdomen x-ray

USS

CT scan

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12
Q

What critera does preducting severity of acute pancreatitis use?

A

Glasgow criteria

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13
Q

What urea level gives a score of 1 on the Glasgow criteria?

A

>16mmol/L

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14
Q

What AST/ALT level gives a score of 1 on the Glasgow criteria?

A

>200IU/L

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15
Q

As well as the Glasgow criteria, what else can be used to predict the severity of acute pancreatitis?

A

Clinical assessment

CT scanning

Individual markers (CRP, IL-6)

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16
Q

How is acute pancreatitis due to cholelithiasis managed?

A

ERCP and ES,

Cholecystectomy

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17
Q

How is acute pancreatitis due to alcohol managed?

A

Abstinence

Counselling

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18
Q

How is acute pancreatitis due to ischaemia managed?

A

Careful support

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19
Q

How is acute pancreatitis due to malignancy managed?

A

Resection or bypass

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20
Q

How is acute pancreatitis due to hyperlipidaemia managed?

A

Diet

Lipid lowering drugs

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21
Q

How is acute pancreatitis due to anatomical abnormalities managed?

A

Correction if possible

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22
Q

How is acute pancreatitis due to cholelithiasis managed?

A

Stop or change

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23
Q

What are specific aspects of managing acute pancreatitis?

A

CT scanning

Antibiotics

Diagnosis of infection

ERCP in gallstone pancreatitis

Nutrition

Manipulation of inflammatory response

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24
Q

What kind of complications from acute pancreatitis can be picked up by CT scanning?

A

Acute fluid collections

Abscess

Necrosis

Monitoring progress of disease

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25
Q

What is used to diagnose infection with acute pancreatitis?

A

CT guided FNA or pancreatic necrosis

26
Q

What is the definitive management of acute pancreatitis summarised?

A

Prevention of recurrent attacks

Fluid collection

Management of necrosis

Managment of complications

27
Q

What management is used to prevent further attacks of acute pancreatitis?

A

Management of gallstones

Investigations of non-gallstones pancreatitis

Alcohol abstinence

28
Q

How is necrosis due to acute pancreatitis managed?

A

Laparotomy

29
Q

What are examples of different kinds of necrosis due to acute pancreatitis?

A

Sterile necrosis

Infected necrosis

Abscess

30
Q

What are examples of different kinds of late complications due to acute pancreatitis?

A

Haemorrhage

Portal hypertension

Pancreatic duct stricture

31
Q

What is 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 function of the pancreas

32
Q

How does the incidence of males and females compare for chronic pancreatitis?

A

Males greater than females

33
Q

What are some causes of chronic pancreatitis?

A

Obstruction of the main pancreatic duct

Autoimmune

Toxin

Idiopathic

Genetic

Environmental

Recurrent injuries

34
Q

What are examples of things that can cause obstruction of the main pancreatic duct?

A

Tumour (adenocarcinoma, IPMT)

Sphincter of Oddi dysfunction

Pancreatic divisum

Duodenal obstruction (tumour, diverticulum)

Trauma

Stricture

35
Q

What are examples of toxins that can cause chronic pancreatitis?

A

Ethanol

Smoking

Drugs

36
Q

What are examples of genetic causes of chronic pancreatitis?

A

Autosomal dominant (codon 29 and 122)

Autosomal ressesive (CFTR, SPINK1, codon A)

37
Q

What are examples of recurrent injuries that can cause chronic pancreatitis?

A

Biliary

Hyperlipidaemia

Hypercalcaemia

38
Q

What is done to look at pancreatic exocrine function?

A

Faecal/serum enzymes (elastase)

Pancreolauryl test (enzyme response to stimulus)

39
Q

What is the management of chronic pancreatitis?

A

Counselling

Abstinence from alcohol

Management of acute attacks

Analgesia

Avoid high fat, high protein diet

Surgery

40
Q

What are some possible complications of chronic pancreatitis that requires surgery to fix?

A

Pancreatic duct stenosis

Cyst/pseudocysts

Biliary tract obstruction

Splenic vein thrombosis/gastric varices

Portal vein compression/mesenteric vein thrombosis

Duodenal stenosis

Colonic stricture

41
Q

What interventional procedures can be done for treatment of chronic pancreatitis?

A

CBD stenting or bypass

Thoracoscopic splanchnectomy

Caeliac plexus block

42
Q

What procedures can be done for pancreatic duct stenosis and obstruction?

A

Endoscopic PD sphincterotomy, dilation and lithotripsy

43
Q

What are the different approaches for a caeliac plexus block?

A

Classic trans-crural

Trans-aortic

Anterior approach

44
Q

What are different ways of guiding a caeliac plexus block?

A

CT guided

EUS guided

Fluoroscopy guided

45
Q

What surgery can be done for drainage during chronic pancreatitis?

A

Pancreatic duct sphincteroplasty

Rochelle modification

46
Q

What surgery can be done for resection during chronic pancreatitis?

A

DPPHR

PPPD

Whipple’s pancreaticoduodectomy

Frey procedure

Spleen-preserving distal pancreatectomy

Central pancreatectomy

47
Q

What does DPPHR stand for?

A

Duodenal preserving pancreatic head resection

48
Q

What is mucinous cystic neoplasia of the pancreas?

A

Mucin producing and septated cyst forming epithelial neoplasia of the pancreas with distincive ovarian type stroma

49
Q

What is stroma?

A

Part of an organ or tissue with a structural or connective role

50
Q

What does MCN stand for?

A

Mucinous cystic neoplasia of the pancreas

51
Q

What is another condition similar to MCN?

A

Intraductal papillary mucinous neoplasm (IPMN)

52
Q

What does IPMN stand for?

A

Intraductal papillary mucinous neoplasm

53
Q

What are different kinds of IPMN?

A

MD-IPMN (main duct)

BD-IPMN (biliary duct)

54
Q

What are worrisome features of MD-IPMN?

A

Main pancreatic duct 5-9mm

Non-enhanced mural nodule

Abrupt change in main pancreatic duct

Lymph nodes involvement

55
Q

When is IPMN considered high risk?

A

MPD > 10mm

Enhanced solid component

56
Q

When is MCN considered high risk?

A

>1cm with enhanced solid component

Main pancreatic duct >1cm

57
Q

What are worrisome features of MCN?

A

>3cm

Enhanced cyst wall

Non-enhanced nodules

58
Q

What are indications for resection for MD-IPMN?

A

Always indicated

59
Q

What are indications for resection for BD-IPMN?

A

In elderly >3cm without high risk

In younger patients >2cm may be considered

60
Q

What are indications for resection for MCN?

A

All MCN in fit patients are indicated

61
Q

What are methods of IPMN and MCN resection?

A

Pancreatectomy

Focal and LN or spleen sparing (laparoscopic, robotic, multifocal BD-IPMN)

Mariam Alimentary (43 decks)

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