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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
What is used to diagnose infection with acute pancreatitis?
CT guided FNA or pancreatic necrosis
26
What is the definitive management of acute pancreatitis summarised?
Prevention of recurrent attacks Fluid collection Management of necrosis Managment of complications
27
What management is used to prevent further attacks of acute pancreatitis?
Management of gallstones Investigations of non-gallstones pancreatitis Alcohol abstinence
28
How is necrosis due to acute pancreatitis managed?
Laparotomy
29
What are examples of different kinds of necrosis due to acute pancreatitis?
Sterile necrosis Infected necrosis Abscess
30
What are examples of different kinds of late complications due to acute pancreatitis?
Haemorrhage Portal hypertension Pancreatic duct stricture
31
What is chronic pancreatitis?
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
How does the incidence of males and females compare for chronic pancreatitis?
Males greater than females
33
What are some causes of chronic pancreatitis?
Obstruction of the main pancreatic duct Autoimmune Toxin Idiopathic Genetic Environmental Recurrent injuries
34
What are examples of things that can cause obstruction of the main pancreatic duct?
Tumour (adenocarcinoma, IPMT) Sphincter of Oddi dysfunction Pancreatic divisum Duodenal obstruction (tumour, diverticulum) Trauma Stricture
35
What are examples of toxins that can cause chronic pancreatitis?
Ethanol Smoking Drugs
36
What are examples of genetic causes of chronic pancreatitis?
Autosomal dominant (codon 29 and 122) Autosomal ressesive (CFTR, SPINK1, codon A)
37
What are examples of recurrent injuries that can cause chronic pancreatitis?
Biliary Hyperlipidaemia Hypercalcaemia
38
What is done to look at pancreatic exocrine function?
Faecal/serum enzymes (elastase) Pancreolauryl test (enzyme response to stimulus)
39
What is the management of chronic pancreatitis?
Counselling Abstinence from alcohol Management of acute attacks Analgesia Avoid high fat, high protein diet Surgery
40
What are some possible complications of chronic pancreatitis that requires surgery to fix?
Pancreatic duct stenosis Cyst/pseudocysts Biliary tract obstruction Splenic vein thrombosis/gastric varices Portal vein compression/mesenteric vein thrombosis Duodenal stenosis Colonic stricture
41
What interventional procedures can be done for treatment of chronic pancreatitis?
CBD stenting or bypass Thoracoscopic splanchnectomy Caeliac plexus block
42
What procedures can be done for pancreatic duct stenosis and obstruction?
Endoscopic PD sphincterotomy, dilation and lithotripsy
43
What are the different approaches for a caeliac plexus block?
Classic trans-crural Trans-aortic Anterior approach
44
What are different ways of guiding a caeliac plexus block?
CT guided EUS guided Fluoroscopy guided
45
What surgery can be done for drainage during chronic pancreatitis?
Pancreatic duct sphincteroplasty Rochelle modification
46
What surgery can be done for resection during chronic pancreatitis?
DPPHR PPPD Whipple's pancreaticoduodectomy Frey procedure Spleen-preserving distal pancreatectomy Central pancreatectomy
47
What does DPPHR stand for?
Duodenal preserving pancreatic head resection
48
What is mucinous cystic neoplasia of the pancreas?
Mucin producing and septated cyst forming epithelial neoplasia of the pancreas with distincive ovarian type stroma
49
What is stroma?
Part of an organ or tissue with a structural or connective role
50
What does MCN stand for?
Mucinous cystic neoplasia of the pancreas
51
What is another condition similar to MCN?
Intraductal papillary mucinous neoplasm (IPMN)
52
What does IPMN stand for?
Intraductal papillary mucinous neoplasm
53
What are different kinds of IPMN?
MD-IPMN (main duct) BD-IPMN (biliary duct)
54
What are worrisome features of MD-IPMN?
Main pancreatic duct 5-9mm Non-enhanced mural nodule Abrupt change in main pancreatic duct Lymph nodes involvement
55
When is IPMN considered high risk?
MPD \> 10mm Enhanced solid component
56
When is MCN considered high risk?
\>1cm with enhanced solid component Main pancreatic duct \>1cm
57
What are worrisome features of MCN?
\>3cm Enhanced cyst wall Non-enhanced nodules
58
What are indications for resection for MD-IPMN?
Always indicated
59
What are indications for resection for BD-IPMN?
In elderly \>3cm without high risk In younger patients \>2cm may be considered
60
What are indications for resection for MCN?
All MCN in fit patients are indicated
61
What are methods of IPMN and MCN resection?
Pancreatectomy Focal and LN or spleen sparing (laparoscopic, robotic, multifocal BD-IPMN)

Mariam Alimentary (43 decks)

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