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surgery > pancreatic tumor _صالح > Flashcards

pancreatic tumor _صالح Flashcards

1
Q

WHATS THE BENIGN TUMOR (DUCTAL) IN THE PANCREAS ?

A

intraductal papillary mucinous neoplasm (IPMN)

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2
Q

intraductal papillary mucinous neoplasm (IPMN) IS

A

a premalignant condition

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3
Q

intraductal papillary mucinous neoplasm characterized by ….

A
  • papillary projections of mucin-secreting epithelial cells
  • excessive mucin production
  • cystic dilation of the pancreatic duct
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4
Q

intraductal papillary mucinous neoplasm (IPMN) diagnose by…

A

EUS

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5
Q

Insulinomas means

A

bignin tumer of the islet of cells is single and begnin

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6
Q

Insulinomas symptomas …

A
  • fasting hypoglycemia
  • symptoms of hypoglycemia
  • relief of symptoms following the administration of glucose

——————all these called wipple triad

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7
Q

Insulinomas diagnosis …

A
  • fasting hypoglycemia (<50 mg/dL)

- hyperinsulinemia (>20 μU/mL) that yield an insulin-to-glucose ratio of greater than 0.3

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8
Q

Insulinoma treatment …

A

simple enucleation is the preferred treatment

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9
Q

Zollinger- Ellison syndrome is caused by ,,,

A

is caused by a gastrin- producing islet cell tumor.

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10
Q

Verner-Morrison syndrome is caused by ,,,

A

caused by an islet cell tumor that produces vasoactive intestinal peptide

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11
Q

Verner Morrison syndrome is characterized by ….

A
  • watery diarrhea
  • hypokalemia
  • achlorhydria
  • Hypercalcemia may occur,
  • parathyroids are usually normal
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12
Q

Zollinger-Ellison syndrome is characterized by ….

A

Hypercalcemia may occur because of associated parathyroid abnormalities

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13
Q

Zollinger- Ellison syndrome AND Verner-Morrison syndrome result in ….

A

Both syndromes are frequently the result of malignant islet cell tumors

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14
Q

glucagon-secreting tumors presented with…

A
  • diabetes,
  • anemia,
  • weight loss,
  • venous thrombosis,
  • glossitis,
  • cutaneous lesion known as necrolytic migratory erythema.
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15
Q

glucagon-secreting tumors is characteristic cutaneous lesion known as …

A

necrolytic migratory erythema.

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16
Q

glucagon-secreting tumors treatment …

A

often metastatic at the time of diagnosis. Treatment is directed at achieving as complete a resection as possible.

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17
Q

most common cancer in the pancreas is …

A

Pancreatic adenocarcinoma 85 per cent while the Endocrine tumors of the pancreas are rare.

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18
Q

most common site

A

is ductal in the head

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19
Q

cyctic tumor gives ….

A

Good prognosis and divide into serous and mucinous

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20
Q

which type of cyctic convert into maliginent is serous or moucinus ?

A

moucinous

21
Q

cyctic tumer(mucinous ) should differenate from …

A

pesdocycte

22
Q

why the pancreas is very diffucly to take biobsy ?

A

its retroperitoneal and its in area highly vascular ?

23
Q

Pancreatic cancer is

A

sixth leading cause of cancer death.

24
Q

Ductal adenocarcinomas arise most commonly in the

A

head of the gland

25
Q

Ductal adenocarcinomas are characterized by …

A

characterized by neoplastic tubular glands within a markedly desmoplastic fibrous stroma

26
Q

Cystic tumors of the pancreas …

A

may be serous or mucinous.

27
Q

Serous cyst adenomas are typically found in

A

older women

are large aggregations of multiple small cysts, almost like bubble wrap. They are benign.

28
Q

Mucinous tumours have

A

potential for malignant transformation
They include

  • mucinous cystic neoplasms (MCNs)
  • intraductal papillary mucinous neoplasms (IPMNs)
29
Q

pseudocysts be confused

A

Mucinous tumors

30
Q

Peri-umpullary tumors are

A

Group of tumors of different origin around ampulla of Vater

31
Q

Peri-umpullary tumors are in …

A

1-doudenal tumor .

2-lower CBD cholangiocarcinoma.

3-pancreatic head tumor

4-others other malignant neoplasms can arise at the ampulla, such as carcinoid tumors

5- high-grade neuroendocrine carcinomas.

32
Q

Peri-umpullary tumors is different intity from the pancreatic CA by

A

good prognosis and early presentation and the most common diagnostic feature is obstructive juaindice

33
Q

Clinical features Of Pancreatic CA in the head ?

A
  • painless jaundice common type is obstructive
  • nausea
  • epigastric discomfort
  • Pruritus
  • dark urine and pale stools with steatorrhoea.

-Upper abdominal symptoms in a recently diagnosed diabetic, especially in one above 50 years of age, with no family history or obesity, should raise suspicion

+Pruritus or itch is defined as an unpleasant sensation of the skin that provokes the urge to scratch. sign of cancer

34
Q

Clinical features Of Pancreatic CA in the body and tail ?

A

( It is often grow silently, and present at an advanced unresectable stage. )

  • vague discomfort,
  • anorexia and weight loss, and are frequently dismissed by both patient and doctor.
  • Back pain is a worrying symptom, raising the possibility of retroperitoneal infiltration.
  • unexplained attack of pancreatitis It is often grow silently, and present at an advanced unresectable stage.
35
Q

Examinationc of Pancreatic CA …

A
  • when we do abdominal examination and palpate palpable Gallblader its more likely CA
    if not its stone this called (courvoiser law )

_Other signs of intra-abdominal malignancy should be looked for with care, such as a palpable mass,
ascites, supraclavicular nodes and tumour deposits in the pelvis; when present, they indicate a grim prognosis

36
Q

Investigation of Pancreatic CA …

A

-CBP blood film morphology.

-LFT ---- obstructive jaundice. 
which include 
prothrombin time (PT/INR)
 activated Partial Thromboplastin Time (aPTT)
 albumin
 bilirubin (direct and indirect),

-Ultrasound
not very senstive
whether or not the bile duct is dilated. If it is, and there is a genuine suspicion of a tumor in the head of the pancreas,

  • contrast-enhanced CT scan
    the preferred test

+ is a tumour in the pancreas and if it is resectable.
+The presence of hepatic or peritoneal metastases, +lymph node metastases distant from the pancreatic head
+ encasement of the superior mesenteric,hepatic or coeliac artery by tumour are clear contraindications to surgical resection.

-Endoscopic U\S
used in
+Transduodenal or transgastric FNA or Trucut biopsy
(used for the diameter , consistancy , biopsy) used only when imaging fail because vascular invasion or when there is pesdocycte sperated from tumer to take biobsy

-ERCP and biliary stenting
diagnostic and for assessment of the severity of tumor
by can relieves the jaundice provide a brush cytology or biopsy done only when there is cholangitis and doubt and sever cases

37
Q

whats the benefit of the CT scan for PC ?

A

+ is a tumour in the pancreas and if it is resectable.

+The presence of hepatic or peritoneal metastases,

+lymph node metastases distant from the pancreatic head

+ encasement of the superior mesenteric,hepatic or coeliac artery by tumour are clear contraindications to surgical resection.

38
Q

Endoscopic U\S used in

A

used in
+Transduodenal or transgastric FNA or Trucut biopsy
(used for the diameter , consistancy , biopsy)

used only when imaging fail because vascular invasion or when there is pesdocycte sperated from tumer to take biobsy

39
Q

ct can be used as

A

diagnostic and for assessment of the severity of tumor

40
Q

ERCP and biliary stenting is indicated in:

A

1- if there is any suggestion of cholangitis.

2- if there is diagnostic doubt (small ampullary lesions may not be seen on CT.

3- in sever case
if the patient is deeply jaundiced (serum bilirubin >250 mmol/L), or there are distressing symptoms (e.g. pruritus) and there is likely to be a delay between diagnosis and surgery.

41
Q

It relieves the jaundice and can also provide a brush cytology or biopsy specimen to confirm the diagnosis. …..

A

ERCP and biliary stenting can relieves the jaundice

provide a brush cytology or biopsy

42
Q

Management pf pancreatic CA …

A
  • 85 per cent of patients with ductal adenocarcinoma are unsuitable for resection because the disease is too advanced so need palliative TRT
  • 15% need surgical treatment
43
Q

which tumor can we perform the surgery on then ? and why ?

A

1- cyctic tumor because it good prognosis

2-umors of the ampulla have a good prognosis

44
Q

SURGERY FOR CARCINOMA HEAD PANCREAS NAME … FOR pancreatic head or the ampulla

A

Pancreatoduodenectomy (PPPD). Or Whipple procedure.

45
Q

SURGERY FOR CARCINOMA HEAD PANCREAS NAME … FOR body and tail

A

Distal pancreatectomy with splenectomy

46
Q

in unresectable tumor

A

Palliation

47
Q

Preoperative preparation to patient with obstructive jaundice مهم كللللللللللللللللللش

A

1-Intravenous fluid preferably G\W + mannitol 200ml\twice daily in order to prevent hepatorenal shut down.

2-Vitamin K

3-Antibiotics

4-Laxative ( PEG )

5-Non absorbable antibiotics

6- Management of pruritus

Traditionally, antihistamines are used to treat itch. Examples include diphenhydramine (Benadryl), hydroxyzine (Atarax), and chlorpheniramine (Chlor-Trimeton and others).

48
Q

Which of the following statements about chronic pancreatitis is/are correct?

A

For patients with disabling chronic pancreatitis and a dilated pancreatic duct with associated stricture formation, a longitudinal pancreaticojejunostomy is an appropriate surgical option.

surgery (28 decks)

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