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Alimentary System: Pathology SA > Surgery of Pancreatic Disorders > Flashcards

Surgery of Pancreatic Disorders Flashcards

1
Q

What is the aeitology of pancreatic cancer

A

cigarette smoking

chronic pancreatitis

Diabetes Melitus (less than 2 yrs duration)

Hereditary pancreatitis
Inherited predisposition

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2
Q

What is the clinical presentation/signs of pancreatic cancer

A

Obstructive jaundice

Diabetes

Abdominal pain / Back pain

Anorexia

Vomiting

Weight loss

Recurrent bouts pancreatitis

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3
Q

What is the Invasive investigations for pancreatic cancer

A 
USS
ERCP
CT
MR, 
MRCP
Laparoscopy + Lap USS
Peritoneal cytology
EUS + FNA/ Bx
Percutaneous needle biopsy
PET
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4
Q

What is the tumour marker for pancreatic cancer

A

CA19-9

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5
Q

What is the treatment options for pancreatic cancer

A

Surgery: resection

Palliative drainage

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6
Q

What is the name of the pancreatic resection surgery

A

Kaush whipple

{pancreaticoduodenectomy}

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7
Q

Describe the Kausch- Whipple

A

major surgical operation involving the removal of the head of the pancreas, the duodenum, the proximal jejunum, gallbladder, and part of the stomach

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8
Q

Why is the pylorus preserved in Kausch- whipple

A

Maintaining the pylorous of the stomach as is where the pacemaker is therefore gastric emptying isn’t delayed

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9
Q

What is palliative draining used to treat

A

Obstructive jaundice

Duodenal obstruction

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10
Q

What is the methods of palliative drainage used to treat obstructive jaundice in pancreatic cancer

A

Palliative bypass
ERCP
PTC stenting

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11
Q

What is the methods of palliative drainage used to treat duodenal obstruction in pancreatic cancer

A

Palliative bypass

Duodenal stent

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12
Q

Define the two classification of acute pancreatitis

A

Mild AP: Associated with minimal organ dysfunction and uneventful recovery

Severe AP: Associated with organ failure or local complication

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13
Q

What is the local complications caused by acute pancreatitis

A

Acute fluid collections

Pseudocyst

Pancreatic abscess

Pancreatic necrosis

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14
Q

What is the aetiology of acute pancreatitis

A

Gallstones

Alcohol

Viral Infection (CMV, Mumps)

Tumours

Anatomical abnormalities (pancreas divisum)

ERCP

Lipid abnormalities

Hypercalcaemia

Postoperative Trauma

Ischaemia

Drugs

Idiopathic

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15
Q

What is the pathophysiology of how alcohol causes acute pancreatitis

A

direct injury
increased sensitivity to stimulation
oxidation products (acetaldehyde)

non-oxidative metabolism (fatty acid ethyl esters)

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16
Q

What is the pathophysiology of how ERCP causes acute pancreatitis

A

Increases pancreatic ductal pressure

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17
Q

What is the symptoms of acute pancreatitis

A

Abdominal pain
Nausea/vomiting
Collapse

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18
Q

What is the signs of acute pancreatitis

A

Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure

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19
Q

What is the general supportive care given in acute pancreatitis

A 
Analgesia
Intravenous fluids
Support to:
Cardiovascular	
Respiratory
Renal
20
Q

What is monitored in acute pancreatitis

A

Pulse,

BP - arterial line

Urine output

Central Venous Pressure

Intensive unit care

21
Q

What is the imagery investigations for acute pancreatitis

A

Chest and Abdomen X ray

Ultrasound

CT

ERCP

22
Q

What further test are investigated in acute pancreatitis

A 
U&E, 
glucose
serum amylase
FBC, 
LFT
arterial blood gas
23
Q

What are the results that predict the severity of acute pancreatitis in Modified Glasgow Criteria

A

Severe is >3

Glucose > 10 mmol/L

Serum [Ca2+] < 2.00 mmol

WCC > 15000/mm3

Albumin< 32 g//L

LDH > 700 IU/L

Urea > 16 mmol/L

AST/ALT > 200 IU/L

Arterial pO2 < 60mmHg

24
Q

What is the treatment of acute pancreatitis if caused by gallstones

A

ERCP &ES

cholecystectomy

25
Q

What is the management of acute pancreatitis

A

If due to Hyperlipideamia: Diet, lipid lowering drugs

Overall good nutrition

abstinence from alcohol or drugs

Correct anatomical abnormalities

If due to infection:
-antibiotics

Manipulate inflammatory response

Fluid collection

26
Q

Why is CT scanning useful in the diagnosis and management of acute pancreatitis

A

Shows complications Acute fluid collections
Abscess
Necrosis

Monitors progress of disease

27
Q

How is a Infection diagnosed in acute pancreatitis and what is the importance of this

A

CT guided fine needle aspiration

Make sure sepsis complications have not occurred

28
Q

How is necrosis managed in acute pancreatitis

A

Necrosectomy

through Laparotomy

29
Q

What are the later complications of acute pancreatitis due to necrosis

A

Abscess
Haemorrhage
Portal hypertension
Pancreatic duct stricture

30
Q

What is the definition of chronic pancreatitis

A

Continuing chronic inflammatory process of the pancreas, characterized by irreversible morphological changes leading to chronic pain and / or impairment of endocrine and exocrine function of the pancreas

31
Q

Aetiology chronic pancreatitis

A

O-A- TIGER

Obstruction of main pancreatic duct

Autoimmune

Toxic
(alcohol, smoking, drugs)

Idiopathic

Genetic

Environmental
(tropical chronic pancreatitis)

Recent injuries

32
Q

What are the causes ob obstruction to main pancreatic duct

A

Spinchter of Oddi dysfunction

Pancreatic divisum (single pancreatic duct not formed)

Duodenal obstruction

  • Tumour
  • Diverticulum (blind tube)

Trauma

structure change due to radiation

33
Q

What are the Hereditary genes of chronic pancreatitis

A

Autosomal dominant (Condon 29 and 122)

Autosomal recessive/modifier genes
CFTR, SPINK1, Codon A etc

34
Q

What are the recurrent injuries that occur to causee chronic pancreatitis

A

Biliary
Hyperlipidemia
Hypercalcemia

35
Q

What is the clinical features of chronic pancreatitis

A

Pain

Exocrine insufficiency

Diabetes

Jaundice

Duodenal obstruction

Upper GI haemorrhage

36
Q

What is the imaging investigations for chronic pancreatitis

A

CT scan - shows local anatomy and complications

ERCP
MRCP

37
Q

How is pancreatic exocrine function tested in the investigation of chronic pancreatitis

A

faecal / serum enzymes (elastase)

Pancreolauryl test (trypsin reponse to a stimulus)

Diagnostic Enzyme replacement

38
Q

What is the management of chronic pancreatitis

A

abstinence from alcohol

analgesia

avoid high fat/protein diet

pancreatic supplementation for pain

anti-oxidant therapy

Insulin - for diabetes

39
Q

When would surgery occur in chronic pancreatitis

A

Suspicion of malignancy

Intractable pain

Complications

40
Q

What are the potential complications of chronic pancreatitis

A

Pancreatic duct stenosis

Cyst / pseudocysts

Biliary tract obstruction

Splenic/mesenteric vein thrombosis

Gastric varices

Portal vein compression

Duodenal stenosis

Colonic stricture

41
Q

How do you manage pancreatic duct stenosis and obstruction

A

Endoscopic PD sphincetortomy, dilation

lithotripsy

42
Q

How do you manage chronic pseuodocyts in chronic pancreatitis

A

Common biliary duct stenting or bypass

43
Q

Define Caeliac plexus block and how you perform it

A

injections of pain medication that help relieve abdominal pain

Is either

  • CT guided
  • EUS guided
  • Fluoroscopy guided
44
Q

Define Splanchnectomy

A

surgical excision of a segment of one or more splanchnic nerves to relieve hypertension.

45
Q

What are the two surgical procedures that are performed in chronic pancreatitis

A

Drainage

Resection

46
Q

What are the types of drainage surgeries in Chronic pancreatitis

A

Pancreatic duct sphincteroplasty

Puestow (Rochelle modification)

47
Q

What are the types of resection surgeries in Chronic pancreatitis

A

Duodenum preserving pancreatic head resection PPHR (Beger)

PPPD -pylorus preserving Pancreatoduodectomy

Whipple’s pancreatico-duodenectomy

Frey procedure 
(longitudinal pancreato-jejunostomy with local pancreatic resection)

Spleen-preserving distal pancreatectomy

Central pancreatectomy

Alimentary System: Pathology SA (27 decks)

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