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27 Cards in this Set

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What is the most common pancreatic carcinoma?
adenocarcinoma of the pancreas arising from duct cells
What are risk factors associated with pancreatic adenocarcinoma?
smoking = 3x risk
diabetes mellitus
heavy alcohol use
chronic pancreatitis
coffee
exposure to chemicals (benzidine, beta naphthylamine)
What is male:female ratio in pancreatic carcinoma? Avg age?
3:2

60+ yrs
What are the different types of pancreatic carcinoma?
90%+ are duct cell adenocarcinomas

others: cystadenocarcinoma, acinar cell carcinoma
What is distribution of pancreatic carcinoma?
2/3 in pancreatic head
1/3 in body and tail
Why are pancreatic head cancers caught earlier?
they cause symptoms due to biliary obstruction; tail cancers are not caught until too late
What are signs and symptoms of pancreatic head cancer?
painless jaundice (obtruction of common bile duct)
weight loss
abdominal pain
weakness
pruritis (bile salts in skin)
anorexia
palpable, nontender, distended gallbladder (Courvoisier's Sign)
acholic stools
dark urine
What % of pancreatic carcinoma pts will have Courvoisier's Sign?
33%
What is the classic presentation of pancreatic cancer in the head of the pancreas?
painless jaundice
What are the signs and sx associated with cancer in pancreatic body or tail?
weight loss and pain
migratory thrombophlebitis
jaundice
nausea and vomiting
fatigue
What are the lab findings in pancreatic carcinoma?
increased Dbili and alk phos (biliary obstruction)
increased LFTs
elevated pancreatic tumor cell markers
What are the diagnostic studies to explore pancreatic cancer?
abdominal CT
u/s
cholangiography (ERCP to rule out choledocholithiasis and cell brushings)
What is the treatment for carcinoma in the head of the pancreas?
Whipple procedure
What are contraindications for surgery?
vascular encasement (portal vein, SMV, SMA)
liver mets
peritoneal implants
distant lymph note mets (periaortic/celiac nodes)
distant mets
What is the Whipple procedure?
cholecystectomy
truncal vagotomy
antrectomy
pancreaticoduodenectomy
choledochojejunostomy
pancreaticojejunostomy
gastrojejunostomy
Complication rate after Whipple procedure?
25%
What is mortality rate in a Whipple procedure?
3%
What is the "pylorus-preserving Whipple"?
no antrectomy
anastomose duodenum to jejunum
What are possible post-Whipple complications?
delayed gastric emptying (with antrectomy)
anastomotic leak causing pancreatic/biliary fistula
wound infection
sepsis
pancreatitis
postgastrectomy syndromes
Why remove the duodenum if pancreatic head is removed?
share same blood supply
What is the pre-op and post-op adjuvant therapy for Whipple procedures?
chemotherapy (5-FU) and x-ray therapy
What is survival rate for resection at 5 years?
20%
What is prognosis at 1yr after diagnosis of pancreatic carcinoma?
90% of pts die within 1 year of diagnosis
Is the pancreas retroperitoneal?
All but the tail is.
What is the Duct of Wirsung?
The duct which collects the pancreatic enzymes to flow into the duodenum
Blood supply to the pancreatic head?
pancreaticoduodenal
[aorta - celiac - common hepatic - gastroduodenal - anterior superior and posterior superior pancreaticoduodenal]

[aorta - superior mesenteric - inferior pancreaticoduodenal]
Blood supply to the pancreatic body and tail?
[aorta - celiac - splenic]

[aorta - superior mesenteric - direct pancreatic branches]