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18 Cards in this Set
- Front
- Back
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What are the 4 general etiological catagories of acute pancreatitis?
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1. metabolic
2. mechanical 3. post-op 4. infecitous |
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What are the most common acute pancreatitis etiologies?
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metabolic alcoholic = 40% and mechanical gallstones account for 60% of all non-alcoholic
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What are the surgical indications for acute pancreatitis?
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1. gallstone pancreatitis should be surgically resolved by correcting GB
2. pancreatic necrosis 3. pancreatic abscesses |
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What will gallstones cause if not surgically resolved?
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gallstones will pass into the common bile duct and will then cause the pancreatic duct to be obstructed. Lap chole (lap. Cholecystectomy) with IOC (intraoperative cholangiography) should be used with same admission
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How is necrotizing pancreatitis dx'ed?
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Dx'ed – debridement on CT
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What are the indications for surgery in chronic pancreatitis?
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1. incapacitation pain 2. anatomic abnormalities that cause recurrence id'ed by ERCP or MRCP (“chain of lakes” sign) NOTE: pt must maintain alcoholic abstinence
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What does the Puestow procedure accomplish?
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circumvents the pancreatic duct if recurrent obstruction occurs and causes pancreas to empty directly into jejunem
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What is the statistical significance of a pancreatic pseudocyst?
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it's the most common complication of acute pancreatitis
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How does one evaluate a pancreatic pseudocyst before intervention?
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Give 4-6 wks of monitoring to allow for resolution of symptoms.
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When should you surgically intervene for a mature pancreatic pseudocyst?
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After 6 weeks, go for it, if further indicated. Depending on the cyst you can lance it, or you may have to lap. or open to drain/remove.
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What is are absolute indications for intervention?
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debilitating symptoms, chronic occurrence, obvious growth phase, overt complications, questionable malignancy
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When is it ok to just observe a pancreatic pseudocyst?
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1. asymptomatic
2. uncomplicated 3. stable or decreasing size |
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How can you tell the difference between a pseudocyst and a cystic tumor? That is the scare of a pseudocyst, ya know.
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Pseudocyst – hx of pancreatitis, trauma, imaging shows single, non-loculated, no septae, < 4mm thin wall, MRCP/ERCP shows duct-cyst connection in 65%; Cystic Tumor – no hx of pancreatitis, imaging shows multilocular, septae, thick walled, MRCP/ERCP shows no duct-cyst connection
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What are the indications for pancreatic CA resection?
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on CT there is absence of extra-pancreatic dz, patent SMPV confluence, no direct extension into the celiac axis or SMA
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What is the surgical tx for pancreatic CA?
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whipple procedure
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What are some significant points regarding the whipple rescection?
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1. when dissecting the portal, preserve the nerves of Latarjet to avoid postop gastropareisis 2. when the pancreas is reflected laterally, the small venous tributaries from the portal vein and the superior mesenteric vein can be differentiated 3. the SMV bifurcates to the ileum and jejunum
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What patients are not eligible for whipple's procedure becaues of antral complication?
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1. those with bulky pancreatic head tumors 2. duodenal tumors within the 1st or 2nd portions of the duodenum 3. lesions with grossly positive pyloric or peripyloric lymph nodes
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What are some significant points regarding the whipple reconstruction?
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1. asymptomatic
2. uncomplicated 3. stable or decreasing size |
