Surgery of the Exocrine Pancreas Flashcards
Which function is this:
Secreting hormones into the circulation, which is primarily (though not exclusively) associated with the maintenance of normoglycaemia via the production of hormones insulin and glucagon.
Endocrine
Which function is this:
Secreting pancreatic products into the gastrointestinal tract, primarily associated with the digestive process via the production of enzymes like trypsin, amylase and lipase which enter the duodenum via the pancreatic ducts and the duodenal papillae.
Exocrine
Blood supply of R limb?
pancreatic branches of the pancreaticoduodenal arteries
Blood supply of L limb?
splenic artery.
In dogs, pancreatic secretions travel along each lobe in ducts before meeting in a Y-shape, forming the?
Accessory pancreatic duct
the accessory pancreatic duct which continues to the (2)
Duodenum + minor duodenal papilla
There is also a second duct which arises from the ducts in the left and right pancreatic lobes which enters the duodenum with the bile duct at the
Major duodenal papilla
What is usually not present in cat?
ACcessory panc duct
A number of risk factors for the development of pancreatitis in dogs and cats have been proposed, which include: (8)
Trauma to the pancreas
Obesity;
Dietary indiscretion;
Hyperlipidaemia and hyperlipoproteinemia;
Drug administration (in particular corticosteroids);
Obstruction of the pancreatic ducts;
Ischaemia (potentially from hypotension under general anaesthesia or in shock as well as from vascular obstruction);
Genetic predisposition.
Select the statement that you think is true.
If acute pancreatitis is recurrent there is a permanent change to the histopathology of the pancreas.
Vomiting is a typical clinical manifestation of pancreatitis.
Vomiting is a typical clinical manifestation of pancreatitis.
Blood markers to look for with panc? (4)
Amylase
Lipase
TLI
PLI
Other than panc, reasons for elevation is amylase + lipase (4)
GI
Hepatic
Neoplasia
Impaired GFR/renal excretion
T or F
Amylase/lipase are alwyas raised in panc
False
Sensitivty of TLI for panc?
Poor (36%)
What is TLI?
This detects trypsin, trypsinogen and trypsin-inhibitor complexes and these are pancreatic specific molecules.
False positive rate for PLI?
40%
Radiography findings with panc?
subtle changes in some cases with a loss of contrast in the right cranial quadrant being seen in some, but not all, pancreatitis patients
U/S findings of panc?
There can be changes in the echodensity of the pancreas with chronic fibrosis or a hyperechoic mesentery surrounding the pancreas due to inflammation.
In panc; contrast CT has also been used to image pancreatitis patients with a heterogeneous contrast enhancement associated with?
poor prognosis in canine pancreatitis patients.
Tx of panc?
Medical management is the mainstay of pancreatitis with analgesia, fluid and electrolyte balance and anti-emesis/nausea
When may surgery be required for panc? (3)
diagnosis (via pancreatic biopsy) or in cases where there is biliary obstruction or pancreatic abscessation.
One of the possible, but uncommon (1-6% of cases), sequels of pancreatitis is
a collection of necrotic tissue and degenerate inflammatory cells (pus) either within the pancreas or originating from it.
Typical signs of panc abscess? (4)
V+
Anorexia
Lethargy
D+
Panc abscess - what is seen on xray?
Gas in panc
Panc abscess - what is seen on u/s?
pancreatic mass/masses with focal hypoechoic area(s).
Always C+S a panc abscess, what is the common findings?
Sterile
How to increase chances of +ve culture with panc abscess?
Multiple samples from abdo
There is less debate about the required treatment with surgery indicated for pancreatic abscesses. The surgery required is dependent on the location and size of the abscess but might include: (8)
Debridement
Omentalisation
Partial pancreatectomy
Pancreatic biopsy
Drainage
Cholecytoenterostomy
Duodenal resection and anastomosis
Feeding tube placement.
The prognosis for panc abscess is guarded with survival in the region of
40%
Panc abscess - worth noting that intraoperative euthanasia significantly affects mortality rate and some small case series have suggested survival rates of ? with omentalisation.
> 60%
What are pancreatic pseudocysts?
Pancreatic pseudocysts are fluid filled masses closely associated with the pancreas.
Pancreatic pseudocysts:
What would be seen on samples?
Increased concentrations of pancreatic enzymes compared to those found in circulation.
Signs of pancreatic psuedocysts? (3)
V+
Abdo pain
Anorexia
Diagnosis of panc psuedocysts?
Imaging
Fluid analysis
U/S findings with pancreatic psuedocysts
fluid filled mass in close association with the pancreas as an anechoic (possibly with some slightly echogenic debris) fluid filled structure.
if the cyst recurs, then surgical techniques are reported to establish cyst drainage. (5)
Cystoduodenostomy
Cystojejunostomy
Cystogastrotomy
Omentalisation
Partial pancreatectomy.
Where are the pseudocysts mostly reported?
Left limb of the pancreas
How common are panc neoplasia?
Rare
Prognosis of panc neoplasia?
Grave
Most common neoplasia of the pancreas?
Acinar carcinomas
Clinical signs of panc neoplasia
Clinical signs are non-specific and include vomiting, inappetence and diarrhoea.
Metastatic disease was detected in what % of cases at the time of diagnosis, attesting to the aggressive nature of the disease.
78%
Panc neoplasia palliative procedure in animals with obstructive disease
Gastrojejunostomy
PAnc torsion xray findings?
Loss of serosal detail and a soft tissue mass caudal and to the right of the stomach, the left limb of the pancreas was found to be torsed and was ligated and resected.
Post op; T or F
The nil per os approach is no longer recommended.
True
What should be considered placing for post op?
Feeding tubes
Post panc surgery - high risk for what post op syndrome?
multi-organ failure (MOF) syndrome.
