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Surgical Recall 55 - Pancreas
Terms in this set (114)
What structure does the head of the pancreas tickle?
What are the two pancreatic ducts?
Which duct is the main duct?
Why must the duodenum be removed if the head of the pancreas is removed?
share the same blood supply
What is the endocrine function of the pancreas?
islets of langerhans
alpha = glucagon
beta = insulin
What is the exocrine function of the pancreas?
What maneuver is used to mobilize the duodenum and pancreas and evaluate the entire pancreas?
What is acute pancreatitis?
inflammation of the pancreas
What are the most common etiologies of acute pancreatitis in the united states?
What are the symptoms of acute pancreatitis?
What are the signs of pancreatitis?
diffuse abdominal tenderness
decreased bowel sounds
What lab tests should be ordered for pancreatitis?
amylase and lipase
type and cross
What is the most common sign of pancreatitis on AXR?
What is the treatment of pancreatitis?
NGT if vomiting
TPN vs postpyloric tube feeds
analgesia - demerol
correction of coats/electrolytes
alcohol withdrawal prophylaxis
What are the possible complications of pancreatitis?
splenic/mesenteric/portal vessel rupture or thrombosis
pancreatic ascites/pleural effusion
What is the prognosis of pancreatitis?
Are postpyloric tube feeds safe in acute pancreatitis?
What is the etiology of hypocalcemia with pancreatitis?
fat saponification - fat necrosis binds to calcium
What complication is associated with splenic vein thrombosis?
Can TPN with lipids be given to a patient with pancreatitis?
yes if the patient does not suffer from hyperlipidemia
What is the least common cause of acute pancreatitis?
What is chronic pancreatitis?
chronic inflammation of the pancreas region causing destruction of the parenchyma, fibrosis, and calcification resulting in loss of endocrine and exocrine function
What are the subtypes of chronic pancreatitis?
What are the causes of chronic pancreatitis?
What are the symptoms of chronic pancreatitis?
epigastric and or back pain
What are the associated signs of chronic pancreatitis?
What are the signs of pancreatic exocrine insufficiency?
What are the signs of pancreatic endocrine insufficiency?
What are the common pain patterns of chronic pancreatitis?
What are the appropriate lab tests of chronic pancreatitis?
72 hour fecal fat analysis
glucose tolerance test
Why may amylase and lipase be normal in a patient with chronic pancreatitis?
extensive pancreatic tissue loss
What radiographic tests are helpful in chronic pancreatitis?
CT =greatest affinity
What is the medical treatment of chronic pancreatitis?
insulin for T1 DM
pancreatic enzyme replacement
narcotics for pain
What is the surgical treatment of chronic pancreatitis?
Peustow - longitudinal pancreaticojejunostomy
Duval - distal pancreaticojejunostomy
Near - total pancreatectomy
What is the Frey procedure?
longitudinal pancreaticojejunostomy with core resection of the pancreatic head
What is the indication for surgical treatment of chronic pancreatitis?
severe prolonged refractory pain
What are the possible complications of chronic pancreatitis?
insulin dependent DM
splenic vein thrombosis
pancreatic ascites/pleural effusion
splenic artery aneurysm
What is gallstone pancreatitis?
acute pancreatitis from a gallstone in or passing through the ampulla of Vater
How is the diagnosis of gallstone pancreatitis made?
acute pancreatitis and cholelithiasis and/or choledocholithiasis with no signs of other causes of pancreatitis
What radiologic tests should be performed for gallstone pancreatitis?
ultrasound for gallstones
CT to see pancreas
What is the treatment of gallstone pancreatitis?
conservative measures and early interval cholecystectomy and intraoperative cholangiogram 3-5 days
Why should early interval cholecystectomy be perfumed on patients with gallstone pancreatitis?
pancreatitis will reoccur in 33% in 8 weeks so just do it
What is the role of ERCP?
What is hemorrhagic pancreatitis?
bleeding into the parenchyma and retroperitoneal structures with extensive pancreatic necrosis
What are the signs of hemorrhagic pancreatitis?
What is Cullen's sign?
bluish discoloration of the periumbilical area
What is Grey-Turner's sign?
ecchymosis or discoloration of the flank
What is fox's sign?
ecchymosis of the inguinal ligament
What are the significant lab values in hemorrhagic pancreatitis?
decreased calcium levels
What radiologic test should be performed hemorrhagic pancreatitis?
CT scan with IV contrast
What is a pancreatic abscess?
infected peripancreatic purulent fluid collection
What are the signs and symptoms of pancreatic abscess?
What radiographic tests should be ordered with pancreatic abscess?
abdominal CT with needle aspiration
What are the associated lab findings of pancreatic abscess?
positive gram stain and cx of bacteria
What organisms are found in pancreatic abscess?
gram neg - e. coli, pseudomonas, klebsiella
gram + s aureas
What is the treatment of pancreatic abscess?
abx and percuaneous drain placement or operative debridement and placement of drains
What is pancreatic necrosis?
dead pancreatic tissue usually following acute pancreatitis
How is the diagnosis of pancreatic necrosis made?
abdominal CT with IV contrast, dead pancreas does not take up contrast
What is the treatment of sterile pancreatic necrosis?
What is the treatment of suspiciously infected pancreatic necrosis?
CT guided FNA
What is the treatment of toxic hypotensive pancreatic necrosis?
What is a pancreatic pseudocyst?
encapsulated collection of pancreatic fluid
Why is a pancreatic pseudocyst a pseudocyst?
wall is formed by inflammatory fibrosis not epithelial lining
What is the incidence of pancreatic pseudocyst?
1 in 10 after alcoholic pancreatitis
What are the associated risk factors of pancreatic pseudocyst?
acute pancreatitis < chronic pancreatitis
What is the most common cause of pancreatic pseudocyst in the united states?
chronic alcoholic pancreatitis
What are the symptoms of pancreatic pseudocyst?
What are the signs of pancreatic pseudocyst?
palpable epigastric mass
What tests should be performed for pancreatic pseudocyst?
What are the possible complications of pancreatic pseudocyst?
bleeding into the cyst
gastric outlet obstruction
What is the treatment of pancreatic psuedocyst?
drainage of cyst or observation
What is the waiting period before a pancreatic pseudocyst can be drained?
6 weeks for the pseudocyst walls to mature and beomce firm enough to hold sutures
What is the treatment for a pseudocyst bleeding into the cyst?
angiogram and embolization
What is the treatment of pancreatic pseudocyst with infection?
percutaneous external drainage
What are the three treatment options for pancreatic pseudocyst?
transpapillary stent via ERCP
What are the surgical options for pseudocyst adherent to the stomach?
What are the surgical options for a pseudocyst adherent to the duodenum?
What are the surgical option for a pseudocyst not adherent to the stomach or duodenum?
What are the surgical options in the tail of the pancreas?
resection of pancreatic tail with the pseudocyst
What is an endoscopic option for drainage of a pseudocyst?
What must be done during a surgical drainage procedure for a pancreatic pseudocyst?
biopsy of the cyst wall to r/o cystic carcinoma
What is the most common cause of death due to pancreatic pseudocyst?
massive hemorrhage into the pseudocyst
What is a pancreatic carcinoma?
adenocarcinoma of the pancreas arising from the duct cells
What are the associated risk factors of pancreatic cancer?
heavy ETOH use
diet high in fried meats
What are the different types of pancreatic cancers?
80% are duct cell adenocarcinomas
acinar cell carcinoma
Why are most pancreatic cancers in the tail nonresectable?
grow without symptoms until its too late and they have already spread
What are the signs and symptoms of pancreatic cancer at the head?
painless jaundice from obstruction of common bile duct
What are the signs and symptoms of pancreatic cancer in the body or tail?
weight loss and pain
nausea and vomiting
What are the most common symptoms of cancer of the pancreatic head?
What is Courvoisier's sign?
palpable nontender distended gallbladder
What is the classic presentation of pancreatic cancer in the head of the pancreas?
What metastatic lymph nodes described classically for gastric cancer have been found with metastatic pancreatic cancer?
Sister Mary Joseph nodule
What tumor marker is associated with pancreatic cancer?
What is the treatment of pancreatic cancer located in the head?
What is the treatment of pancreatic cancer in the body or tail?
What factors signify inoperability of pancreatic cancer?
distant lymph node mets
Is portal vein or SMV involvement an absolute contraindication for resection?
Should patients undergo preoperative biliary drainage?
What is the pylorus preserving Whipple?
no antrectomy, anastomose duodenum to jejunum
What are possible post-Whipple complications?
delayed gastric emptying
Why must the duodenum by removed if the head of the pancreas is resected?
share the same blood supply
What is the postoperative adjuvant therapy to pancreatic cancer?
chemo +/- XRT
What is the palliative treatment if the tumor is inoperable and biliary obstruction is present?
PTC or ERCP and placement of stent across obstruction
What is an annular pancreas?
pancreas encircling the duodenum
What is pancreatic divisum?
failure of the two pancreatic ducts to fuse
What is heterotropic pancreatic tissue?
tissue found in stomach, intestine, and duodenum
What is a Puestow procedure?
longitudinal filleting of the pancreas/pancreatic duct with a side-to-side anastomosis with small bowel
What medication decreases output from a pancreatic fistula?
Which pancreatic enzyme has a longer half-life?
What is the Whipple triad of pancreatic insulinoma?
symptoms of hypoglycemia
relief of symptoms with glucose
What is the most common islet cell tumor?
What pancreatic tumor is associated with gallstone formation?
What is the triad found with pancreatic somatostatinoma tumor?
What are the two classic findings with pancreatic glucagonoma tumors?
THIS SET IS OFTEN IN FOLDERS WITH...
Surgical Recall 49 - Anus
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