Weke 3.7 - Surgery for Pancreatic Disorders Flashcards
What 4 surgeries will we discuss?
- pancreatic cancer
- acute pancreatitis
- chronic pancreatitis
- mucinous cystic neoplasia of the pancreas (IPMN and MCN)
What are risk factors for pancreatic cancer? (4)
- smoking
- chronic pancreatitis
- biological factors
- adult onset diabetes may be sign
How do pancreatic cancer patients present? (5)
- obstructive jaundice
- diabetes
- abdominal pain
- non-specific cancer …anorexia, weight loss, vomiting
- typically incidental
How do we investigate pancreatic cancer?
- LFT’s for signs of obstruction
- bloods
- kidney tests
- imaging CT gold standard, ultrasound, PET, some ERCP incidentally
How do we manage pancreatic cancer patients?
stage using CT or EUS, if unfit use ERCP or PTC for stent to remove jaundice symptoms
What surgical options are available for pancreatic cancer patients? what is an option?
- typically kausch whipple - stomach, pancreas head, gallbladder, duodenum and lower bile duct - remove all and anastamose.
- leaving pylorus in tact may lead to less risk of delayed gastric emptying.
What palliative options are available for pancreatic cancer patients?
- ERCP or PTC metal stent.
- chemo prolongs life.
- biliary bipass
What is acute pancreatitis?
acute inflammatory process of pancreas, possible involvement of other organ. mild or severe - organ failure and local complication
What do you see pathologically in acute pancreatitis?
fluid collection which may become abscess and necrosis
What are causes of acute pancreatitis?
- gallstones and alcohol most commonly through blockage or oxidisation products.
- premature activation of pancreatic enzymes
What symptoms are seen in acute pancreatitis?
- abdominal pain,
- abdominal tenderness,
- nausea,
- vomiting,
- pyrexia,
- circulatory failure
What tests are important when investigating for acute pancreatitis?
serum amylase and lipase will be higher. determine if mild or severe
How do you manage acute pancreatitis?
identify and manage cause.
- cholelithiasis, arrange cholecystectomy.
- if jaundice, ERCP/PTC stent
- malignancy, stent or bipass
- ischaemia, support
- antibiotics only if pepsis diagnosed
What is chronic pancreatitis?
continuing inflammatory process of the pancreas - irreversible morphological changes impairing endocrine and exocrine functions and chronic severe pain
What are causes of chronic pancreatitis?
O-A-TIGER
- obstruction
- autoimmune
- toxins
- idiopathic
- genetic
- environment
- recurrent injuries
