Surgery of Pancreatic Disorders Flashcards Preview

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Flashcards in Surgery of Pancreatic Disorders Deck (31):
1

What is ERCP?

Endoscopic Retrograde Cholangiopancreatography

2

What is MRCP?

Magnetic Resonance Cholangiopancreatography

3

In what age group is pancreatic cancer most common and what is the 5year survival rate?

60-80year olds
0.4%

4

What is the aetiology for pancreatic cancer?

Smoking
Chronic pancreatitis
Hereditary pancreatitis
Inherited predisposition

5

How does pancreatic cancer present? (7)

Obstructive jaundice - Main one
Diabetes
Abdominal/back pain
Anorexia
Vomiting
Weight loss
Recurrent bouts of pancreatitis

6

What investigations should be done for pancreatic cancer?

CXR
Blood test
Tumour markers - CA19-9
CT-MRI
Biopsy

7

Is patient fit enough for surgery?

History and Examination
CXR
ECG
Respiratory function
Physiological "scoring system"

8

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

9

In Whipple's, if what is retained will there be a better outcome from a gastric point of view?

Pylorus

10

What can occur for obstructive jaundice or duodenal obstruction?

Palliative bypass plus astent

11

What is acute pancreatitis?

Acute inflammation of the pancreas, with variable involvement of other regional tissues or remote organ systems

12

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

13

What are the possible complications of acute pancreatitis?

Acute fluid collections
Pseudocyst
Pancreatic abscess/necrosis

14

What is the aetiology of acute pancreatitis?

Gallstones
Tumour
Alcohol
Ischaemia
Anatomical abnormalities
Drugs

15

What is the pathophysiology of acute pancreatitis?

Direct injury
Increased sensitivity to stimulation
Oxidation products
Non-oxidative metabolism
Gallstone blockage
ERCP can caused increased pancreatic ductal pressure

16

What are the symptoms of acute pancreatitis?

Abdominal pain
Nausea/Vomiting
Collapse

17

What are the signs of acute pancreatitis?

Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure

18

What investigations should be done for acute pancreatitis? (7)

FBC, U+E's, LFTs & Amylase
Gluscose
Clotting
CXR
USS
CT
ABG

19

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

20

What precipitating factors should be managed for acute pancreatitis?

Cholelithiasis
Alcohol
Ischaemia
Malignancy
Hyperlipidaemia
Anatomical abnormalities
Drugs

21

What are late complications of acute pancreatitis?

Haemorrhage
Portal hypertension
Pancreatic duct stricture

22

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

23

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

24

What is chronic pancreatitis associated with and in what sex is it more prominent?

Alcohol consumption
Males

25

What are the causes of chronic pancreatitis?

Obstruction of MPD e.g. Tumour, Trauma etc.
Autoimmune
Toxin - Ethanol
Idiopathic
Genetic
Environmental
Recurrent injuries

26

What are the features of chronic pancreatitis?

Pain
Pancreatic exocrine insufficiency
Diabetes
Jaundice
Duodenal obstruction
Upper GI haemorrhage

27

What investigation should be done for chronic pancreatitis?

CT
ERCP/MRCP
Faecal/serum enzymes
Diagnostic enzyme replacment

28

How should chronic pancreatitis be managed? (8)

Counselling
Alcohol abstinence
Analgesia
Avoid fat, high protein diet
Pancreatic supplmentation
Diabetes
Steatorrhoea
Anti-oxidant therapy

29

Under what circumstances should surgery be done for chronic pancreatitis?

Suspicion of malignancy
Intractable pain
Complications e.g. Cyst/Pancreatic duct stenosis
*Drainage or resection can also occur*

30

What is the prognosis of chronic pancreatitis?

Mortality of 50% for over 20-25 years old
*20% die of complications*

31

Under what conditions should an intervention of chronic pancreatitis occur?

CBD stenting or bypass
Management of chronic pseudocyst
PD stenosis and obstruction