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GIHEP Surgery - Pancreatitis + Pancreatic Carcinoma (iii) (Chronic…
GIHEP Surgery - Pancreatitis + Pancreatic Carcinoma (iii)
Chronic pancreatitis
strictures
CBD obstruction
ductal dilation
pseudocyst
protein precipitates form in pancreatic tubules, then Ca deposits - obstruction to acini
progressive course
episodic/continuous pain
patchy fibrosis - damages islets, glandular tissue + Ns (pain)
eventual exocrine + endocrine failure (DM)
seriously alters life
causes
recurrent acute pancreatitis
pancreatic duct obstruction
pancreatic head tumours/cysts
strictures
congenital abnormalities
CF
AI diseases
idiopathic
tx
tx causative agent (e.g. stop alcohol, cholecystectomy, AI disease)
dietary mods - reduce fat
enzyme supplementation - creon
analgesia
patients who continue to have intractable pain may be considered for endoscopic therapy, coeliac N block, surgery (Whipple's procedure aka pancreaticoduodenectomy - remove head of pancreas, 1st part duodenum, GB + CBD)
Pancreatic cancer
tumour doubling time = 60 days
85% = unresectable (e.g. due to encompassing SMA, or mets)
mean survival of bypassed patients (pancreatic bypass is only for symptom relief, if CBD/duodenum blocked) = 6 months
90% 1 yr mortality
adenocarc
cachexia v common (also in oeso + gastric cancers) - NB as can contraindicate surgery
risk factors
age (80% occur in 60s + 70s)
smoking
alcoholism
diabetes
chronic pancreatitis
clinical features
ascites (poor prognosis)
progressive jaundice
vomiting (duodenal obstruction)
back pain
anorexia
weight loss
Sr Mary Joseph nodule (palpable met deposit around umbilicus)
management
palliation
stent through tumour
gastrojejunostomy (not done much anymore)
coeliac axis block
surgery = Whipple's procedure (also clear draining lymph nodes)