Ch 97 Pancreas Flashcards

Question

Abscess Sx

Answer 1

- debridement of necrotic pancreas, - partial pancreatectomy, - cholecystoenterostomy, - provision of drainage, - omentalization, surgical placement of some form of feeding tube is appropriate bacterial culture - reliability of bacteriologic culture depends on the tissue obtained for culture. - Specimens from multiple sites in the abdominal cavity should be submitted

Answer 2

Aspiration of the fluid filled contect and assessment of concentration of amylase and lipase. Higher concentrations in the pseudocyst fluid than of serum confirms the diagnosis | majority of pseudocysts are reported in the left limb

Answer 3

* Clinical signs perist after aspiration * Pseudocyst enlarges or fails to resolve * Percutaneous aspiration is not possible * Recurrence * Causing a pancreatic duct obstruction Treatment options: - u/s guided aspiration (may need repeat) * Omentalisation * Cystoduodenotomy * Cystojejunostomy * Cystogastrostomy * Complete excision | >75% have been treated successfully and survived

Answer 4

of the free left limb

Answer 5

extremely poor - Aggressive behaviour, - majority have metastasised to liver and local lymoh nodes at time of diagnosis, - resistant to chemotherapy. - Surgical options should not be highly considered but if obstructive, a gastrojejunostomy can be considered for palliation. Serum lipase concentration over 25x the normal upper limit - In many cases, pancreatic carcinoma cannot be differentiated from pancreatitis on the basis of clinical signs, diagnostic imaging, or serum biochemistry results.

Answer 6

- 60% of insulinomas are carcinomas; the remainder are adenomas - On histology, many of these tumors appear benign; however, their biologic behavior is aggressive - 50% of affected dogs having metastatic disease at the time of diagnosis - lymph nodes and liver are the most common sites of metastasis - When glucose concentrations are less than 80 mg/dL in a normal animal, insulin secretion is inhibited. - beta cell tumors secrete insulin in excessive amounts, resulting in profound, and in some cases life-threatening, hypoglycemia. - hyperinsulinism with concurrent hypoglycemia results CS -9 to 10 years - clinical signs related to hypoglycemia, including seizures, weakness, collapse, ataxia, and mental dullness. - precipitated by excitement, exercise, or fasting

Answer 7

Chronic hypoglycaemia can lead to neuronal demyelination and axonal degeneration. Can also cause facial nerve paralysis, oesophageal dysfunction, decreased anal tone and peripheral polyneuropathies

Answer 8

Normal to increased insulin concentrations at a time of documented hypoglycaemia is diagnostic. Decreased fructosamine concentration is also supportive. normal [5 to 26 µU/mL] - On cytology, beta cell tumors lack the pink zymogen granules commonly seen in exocrine cells imaging - Ultrasonography for the diagnosis of insulinoma and evaluation for metastatic disease. - pancreatic mass and abdominal metastasis identified in 56% and 19% of cases - contrast u/s: uniformly hypervascular and may therefore be differentiated from the more hypovascular exocrine carcinoma - CT reportedly had increased sensitivity - appear hyperintense on MRI T2-weighted images and isointense on T1-weighted images

Answer 9

* Small, frequent feeds of a high protein, high complex carbohydrate diet * Glucocorticoid therapy - Increases hepatic glucose production and decreases cellular glucose uptake * 5% dextrose CRI - Can stimulate insulin secretion causing hypoglycaemia so close monitoring is necessary * Glucagon CRI - Use for intractable hypoglycaemia * Avoid pre-op fasting, instead offer a small amount of canned food 2-3hr prior to surgery

Answer 10

- surgery is not usually curative because of the frequency of metastatic disease - reducing the amount of neoplastic tissue will improve response to medical management and survival time - Frequent monitoring of [glucose] throughout the procedure critical to prevent life-threatening hypoglycemia - 80% of dogs, a solitary 0.5 to 4 cm nodule is evident - A partial pancreatectomy is performed (vessel sealing device quicker, no pancreatitis) - occasionally tumor thrombi that extend into the pancreaticoduodenal vein - Liver metastases are frequently identified as pale nodule - Pancreatitis may develop after manipulation of the pancreas

Answer 11

If cannot identify insulinoma can inject **3mg/kg of 1% methylene blue** in 250ml of 9% saline over 30 minutes. Maximal staining is achieved within approx 30 min. - Heinz body anaemia has been reported as a complication

Answer 12

Medical management * Streptozocin - a chemotherapeutic, nitrosurea antibiotic which **selectively destroys beta cells** in the pancreas or at metastatic sites. Requires saline diuresis during administration to minimise nephrotoxicity (Adverse events includ GI toxicity 63% and diabetes mellitus 42%) * Diazoxide - Inhibits insuline secretion and stimulates hepatic gluconeogenesis * Octreotide - Long-acting systemic somatostatin analogue. Inhibits insulin secretion and synthesis. Insulin suppression only lasts 3-4hr * Glucocorticoids

Answer 13

Depends on stage of disease at time of diagnosis and what paper you read.. - Dogs undergoing surgery +/- medical management more likely to become euglycaemic, remain euglycaemic and have longer survival than those which do not undergo surgery (Tobin et.al) - No detectable mets at time of surgery remained euglycaemic for 14 months vs 2.5m with mets. MST with no detectable mets at time of surgery 18m vs 7-9m with mets (Caywood et.al) - MST for partial pancreatectomy 785d, if treated with pred at time of relapse increased to 1316d (Polton et al) - Poorer prognosis if tumour >2cm, has metastasised to the liver and lymph nodes, Ki67 index >2.5% (Buishand et al)

Answer 14

Malignant transformation of the somatostatin-secreting delta islet cells into cells which secrete excessive gastin. - This results in gastric acid hypersecretion and subsequent oesophageal and gastroduodenal erosions and ulcerations - Metastasis at the time of diagnosis in approximately 70% | non–beta cell neuroendocrine tumor

Answer 15

- Zollinger-Ellison syndrome

Answer 16

increased fasting gastrin serum concentration is highly suggestive of gastrinoma, especially in the prescense of gastric hyperacidity (pH<3) | tumors are extremely small, imaging often fails to identify the tumor

Answer 17

Medical management: * proton pump inhibitors (omeprazole) * Gastroprotectants (sucralfate, misoprostal) * Octreotide - Suppresion of gastrin secretion with a somatostatin analogue Surgical Management * Partial pancreatectomy with staging biopsies of LNs and liver (approx 70% mets at time of diagnosis) * Resection of GI ulceration if necessary

Answer 18

Superficial necrolytic dermatitis (hepatocutaneous syndrome). CS - primary effect is to increase blood glucose concentrations, affected dogs may have hyperglycemia, or even overt diabetes mellitus resistant to insulin treatment Prognosis for glucagonoma is poort due to high rate of surgical complications and high rate of early metastasis

Answer 19

Retrospective study. Pancreatic tumors were located in the left lobe (7), in the right lobe (4) and in the body of the pancreas (1). A 3- or 4-port technique Ligasure in nine dogs, a harmonic scalpel in two dogs no conversion to open laparotomy All dogs survived the surgical procedure, were discharged Major complications (2/12). The first dog had idiopathic seizures, The second dog had signs of pancreatitis particularly for small tumors located in the distal aspect of the pancreatic lobes. should be considered that large tumors (>60 mm) located in the left limb or in the body of the pancreas could be more challenging to excise using laparoscopy, and an open approach should be considered.

Answer 20

(1/9; 11%) resulting in minor hemorrhage from a caudal splenic vein branch. A grade 2 postoperative complication occurred within 3 days after surgery in one cat (1/9; 11%), involving localized, sterile peritonitis Laparoscopic pancreatectomy of the left limb results in adequate exocrine and endocrine function in the long-term

Answer 21

blood glucose increased in 11/11 cases intra-op (mean increase 6.35±4.5mmol/L) - ongoing exploration and resection of abnormal tissue until increased glucose noted - initial increase then decrease → subsequent increase following further excision - MST 762d - 3/11 metastatectomy → longer survival - tumour stage not associated with outcome

Answer 22

excision of the right lobe and head of pancreas → left pancreaticoduodenostomy in a cat - cat presented with fluid-filled cavity in place of the right pancreatic duct - excision of cavity and right pancreatic lobe and body - 1.5cm strip of cyst/pancreas wall adjacent to duodenum not dissected - left pancreatic duct isolated → end-to-side anastomosis to duodenum - Left pancreatic duct was severely dilated - no complications; death due to metastatic carcinomatosis at 225d post-op

Answer 23

partial pancreatectomy 63.2% (36/57) and in cats was pancreatic biopsy 62.5% (15/24). The most common histologic diagnosis in dogs was pancreatic islet cell carcinoma 50.9% (29/57) and in cats was pancreatitis 41.7% (10/24). mortality rate 14d 10.5% (6/57) mortality rate in dogs 20.8% (5/24) mortality rate in cats. - Three dogs were euthanased and three died on their own. Three cats were euthanased and two died on their own. 86.5% survival rate in the first 14 days

Answer 24

- clinical signs: weakness (59.5%), seizures (33.6%), altered mentation (27.6%) - 32/116 altered neurological examination: obtundation, decreased withdrawal, absent menace - overall survival: surgery 20m; medical 8m – associated with px - presence of metastasis → shorter survival

Answer 25

pancreatic nodule (33/35 detected) with hyperattenuation in arterial phase (27/33 overall; 20/21 confirmed insulinoma detected) - mean size 15.1mm - hypoattenuation and isoattenuation uncommon; deformation of pancreatic shape in 18/21 confirmed, 8/12 suspected insulinoma

Ch 97 Pancreas Flashcards

(50 cards)