Flashcards in Surgery of Pancreatic Disorders Deck (31):
What is ERCP?
Endoscopic Retrograde Cholangiopancreatography
What is MRCP?
Magnetic Resonance Cholangiopancreatography
In what age group is pancreatic cancer most common and what is the 5year survival rate?
What is the aetiology for pancreatic cancer?
How does pancreatic cancer present? (7)
Obstructive jaundice - Main one
Recurrent bouts of pancreatitis
What investigations should be done for pancreatic cancer?
Tumour markers - CA19-9
Is patient fit enough for surgery?
History and Examination
Physiological "scoring system"
What is Whipple's surgery?
Remove half of the stomach and the head of the pancreas and some of the duodenum to make an anastamosis with a loop of the jejunum
In Whipple's, if what is retained will there be a better outcome from a gastric point of view?
What can occur for obstructive jaundice or duodenal obstruction?
Palliative bypass plus astent
What is acute pancreatitis?
Acute inflammation of the pancreas, with variable involvement of other regional tissues or remote organ systems
What is the difference between mild and severe acute pancreatitis?
Mild - Minimal organ disruption and uneventful recovery
Severe - Associated with organ failure or local complication
What are the possible complications of acute pancreatitis?
Acute fluid collections
What is the aetiology of acute pancreatitis?
What is the pathophysiology of acute pancreatitis?
Increased sensitivity to stimulation
ERCP can caused increased pancreatic ductal pressure
What are the symptoms of acute pancreatitis?
What are the signs of acute pancreatitis?
What investigations should be done for acute pancreatitis? (7)
FBC, U+E's, LFTs & Amylase
What indicates that acute pancreatitis is severe? (8)
Glucose > 10 mmol/L
Serum [Ca2+] 15000/mm3
Albumin 700 IU/L
Urea > 16 mmol/L
AST/ALT > 200 IU/L Arterial pO2
What precipitating factors should be managed for acute pancreatitis?
What are late complications of acute pancreatitis?
Pancreatic duct stricture
What is the problem for those who get pancreatitis from drinking?
If they stop it may go away but if they start drinking again it will come back
What is chronic pancreatitis?
Continuing chronic inflammation of the pancreas, characterized by irreversible morphological changes leading to chronic pain and / or impairment of endocrine and exocrine function of the pancreas
What is chronic pancreatitis associated with and in what sex is it more prominent?
What are the causes of chronic pancreatitis?
Obstruction of MPD e.g. Tumour, Trauma etc.
Toxin - Ethanol
What are the features of chronic pancreatitis?
Pancreatic exocrine insufficiency
Upper GI haemorrhage
What investigation should be done for chronic pancreatitis?
Diagnostic enzyme replacment
How should chronic pancreatitis be managed? (8)
Avoid fat, high protein diet
Under what circumstances should surgery be done for chronic pancreatitis?
Suspicion of malignancy
Complications e.g. Cyst/Pancreatic duct stenosis
*Drainage or resection can also occur*
What is the prognosis of chronic pancreatitis?
Mortality of 50% for over 20-25 years old
*20% die of complications*