Hepatic System: Pancreatic Cancer and Peritonitis

Question 1

Pancreatic cancer is one of the most deadly. What is the mortality forecast post-dx?

Answer 1

• 3-5mos

Question 2

Which part of the pancreas is cancer more common in?

Answer 2

• Head

Question 3

How is cancer in the head of the pancreas resolved surgically?

Answer 3

• The Whipple procedure

Question 4

Describe the Whipple procedure.

Answer 4

• Surgeons remove the head of the pancreas, most of the duodenum (a part of the small intestine), a portion of the bile duct, the gallbladder and associated lymph nodes.
• The remaining pancreas is then attached to the end of the remaining intestine (and cut of the duodenum) and then the liver is attached a little further down the intestine

Question 5

What are the risk factors for pancreatic cancer?

Answer 5

• Age
• Smoking
• *Red meat diet
• *Male
• *Black
• *DM
• *Chronic pancreatitis
• *Cirrhosis
• Obesity
• Family hx

Question 6

For those that have had a pancreas removal, what will be a life long result they will have to manage?

Answer 6

• They will need to take digestive enzymes for the rest of their life
• They will need to inject insulin

Question 7

What are s/s of the lack of digestive enzymes?

Answer 7

• ↓ weight

* ↑ fatty stool

Question 8

A pt that has had their pancreas removed will be connected to multiple sumps. Name and describe each.

Answer 8

•	NG Tube
o	Gastric decompression to avoid vomiting and suture rupture
•	Jejunostomy tube
o	For feeding
•	Two drainage sumps (one for each side)
o	To drain peritoneal fluids while healing
•	Irrigation tube
o	For peritoneal cleaning

Question 9

What is peritonitis?

Answer 9

• Inflammation of the peritoneum

Question 10

What are some causes of peritonitis?

Answer 10

• Hepatitis
• Organs in or around the peritoneal cavity (anything GI, Hepatic or Renal) that perforate or become infected
• Abdominal wound or injury
• Invasive procedures

Question 11

What are the s/s of peritonitis?

Answer 11

• Abdominal tenderness (all over)
• Abdomen pain that gets more intense w/ movement or touch
• Bloating/distension
• Rebound tenderness
• N/V/D/C, inability to flatulate
• Loss of appetite
• Minimal urine OP

Question 12

What is the non-surgical tx for peritonitis?

Answer 12

• NPO
• NG tube
• IV fluids
• Abx
• Analgesics

Question 13

Why can peritonitis spread throughout the abdomen so quickly?

Answer 13

• Due to the greater omentum that extends down from the stomach covering much of the colon ands small intestines

Question 14

What is the surgical tx for peritonitis?

Answer 14

• Repair/removal of perforated organ

* Intraabdominal lavage (washing out body cavity w/ water or medicated solution)