Gi - 3-3 - Carcinoma Of The Pancreas (Barth)

Front 1

Sx of lesion in head of pancreas

Back 1

Wt loss, jaundice, pain, anorexia

Front 2

Sx of lesion in body/tail of pancreas

Back 2

Wt loss, pain, weakness.

Jaundice is rare.

Front 3

Other periampullary tumors

Back 3

adenocarcinomas that have same location, sx and signs as pancreatic tumors. But better px that tumors of parenchyma of pancreas.

E.g. adenocarcinoma of...ampulla of vater, distal common bile duct or duodenum.

Front 4

Dx of pancreatic CA

Back 4

US (detect gallstones or biliary duct dilation)

CT - for staging and presence of mets
Endoscopic retrograde cholangiopancreatography and endoscopic US guided biopsy - good to get tissue for dx and provides palliative tx (e.g. stop jaundice)

CA 19-9 - px utility and response to therapy.

Front 5

% of pts that present and are resectable

Back 5

25%

CT is what to do to predict this.

those that are not in this carb have distant mets or invasion of superior mesenteric artery or vein.

Front 6

Resectable, borderline and unresectable

Back 6

Resectable - fat plane btwn tumor and SMA, celiac artery, and portal vein/SMV

Borderline - abuts these structures or involves > 180 degrees of portal vein

Unresectable - surrounds these struc or occludes portal vein.

Front 7

Can you graft portal vein?

Back 7

Yes, but not the SMA.

Front 8

Gemcitabine

Back 8

A chemo agent that is well tolerated by pts.

Combo with other chemo agents has not helped.
(marginal improvement with EGFR target called erlotinib but it is not worth the price)

Front 9

Palliative tx for these pts

Back 9

Stent to relieve jaundice from biliary obstruction

Pain - obliteration of celiax plexus nerves (impingement on them) or radiation therapy.

Front 10

Whipple procedure

Back 10

for tumors in head of pancreas.

a pancreaticoduodenectomy.

distal pancreas and islet cells remain.

there is some morbidity from leaks from pancreaticojejunostomy, infection or poor gastric emptying.

Front 11

Surg tx for tumor in tail of pancreas

Back 11

distal pancreatectomy.

Front 12

Laparoscopy

Back 12

do this before surgery. detects small peritoneal or liver mets that CT can't catch.

Front 13

More number of operations on medicate patients per year...

Back 13

less 30 day mortality in the whipple procedure. makes sense.

Front 14

Things that help whipple procedure

Back 14

post-op radiation and chemo (5-FU)

chemo alone. (gemcitabine)

radiation after surgery - less local recurrence.

Front 15

intra-operative radiation therapy

Back 15

does not help

Front 16

potential improvements for pancreatic CA

Back 16

Decrease mortality of surgery

Improve systemic therapies

Increase the proportion of patients who come to surgery

Decrease local recurrences after surgery

Front 17

neoadjuvant therapy

Back 17

this is what his research is on...

provides time for distant mets to manifest. so thus more pts will get all components of multimodal therapy and both resectable and borderline resectable pts to undergo resection and not develop a local failure.

this also made some pts avoid unecc surgery that would nto have helped them.

less local recurrences in all patients!!! (borderline, unresect and resectable pts)

gave chemo first, then radiation with chemo, then they operated.

Front 18

Insulinoma

Back 18

pretty benign. almost always solitary.

hypoglycemic sx (confusion, weakness, sz, sweating, tremulousness)

Front 19

Dx of insulinoma

Back 19

monitored fast gets their glucosa below 50 and elevated insulin.

Front 20

Tx of insulinoma

Back 20

Localize (this part is hard) - CT, US, calcium stimulation of insulin secretion

Surgerize with intra-operative US, palpation and enucleate.

Front 21

gastrinoma

Back 21

Zollinger-Ellison syndrome.

Hypergastrinemia leads to gastric acid hypersecretion and ulcer disease.

1/2 malig

Front 22

location of gastrinomas

Back 22

Located in gastrinoma triange - duodenum, panc, lymph nodes.

Front 23

Sx of gastrinoma

Back 23

peptic ulcer and diarrhea

suspect in pts with recurrent ulcers after tx with PPIs and anti-H pylori therapy.

Front 24

Dx of gastrinoma

Back 24

fasting gastrin > 200 and basal acid output > 15

Front 25

Tx of gastrinoma

Back 25

control acid medically and operate to cure the CA

good 10 year surv.