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pancreatitis done (cause (autodigestive disease initiated by inappropriate…

- - - - opiate
    - - enteral / jejunostomy feeding
      - TPN
    - - cephalosporin
        
        cefotaxime, cefuroxime, ceftazadime
      - ofloxacin
      - metronidazole
      - amkiacin
      - imipenem
  - - - Pancreaticodudenoectomy Whipple procedure
        
        new PPPD pylorus -preserving pancreaticoduodenectomy
        
        require a pancreaticojejunostomy
        
        complication
        
        hemorrhage
        
        pancreatic fistula
        
        amylase drainage > 50ml/day
        
        biliary fistula
        
        indicated by bilirubin-rich drainage > 50ml/day
        
        or persistent bile secretion after D10
        
        delayed gastric emptying
        
        persistent high NG aspiration > 200ml/day
        
        or aspiration post D10
        
        unable to tolerate regular diet post D14
        
        bile reflux gastritis
        
        ab abscess
        
        infection
        
        leakage of anastomosis
        
        peritonitis
        
        impaired nutiriton
        
        endocrine insufficiency
        
        DM
        
        exocrine insufficiency
        
        pancreatic enzyme supplement
        
        Meds
        
        antibiotics
        
        cefuroxime & metranidazole
        
        sandostatin & octreotide (inhibitor of exocrine secretion & anti inflammation)
        
        prevent stress ulcer
        
        H2RA
    - - chronic pancreatitis with intractable pain
      - improve pancreatic exocrine secretion
    - - chemotherapy
      - radiotherapy
    - - stent insertion
        
        transhepatic approach by ERCP
        
        indication
        
        relieve bile obstruction
        
        complication
        
        cholangitis
        
        perforation
        
        stent occlusion
        
        leads to recurrent juandice
      - bypass choledocheoduoenostomy
- - - - glucagon
    - - insulin
    - - somatostatin
- - - - :arrow_up: liver enzyme
      - :arrow_up: bilirubin
  - - - detect small tumor, highly sensitve
    - - direct visualization of ampullary tumor
      - biopsy
      - brush cytology & histology
      - therapeutic biliary : stenting
    - - detect minute metastatic lesion