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Chapter 4: Hepatobiliary Surgery (ii) Pancreatic Disease - Coggle Diagram
Chapter 4: Hepatobiliary Surgery (ii) Pancreatic Disease
Pancreatic ca
usually ductal carcinoma
other types: cystic carcinoma or endocrine tumours (iselt cell tumours)
tumour marker = CA 19-9
ERCP for bx
surgery - Whipples (removes head of pancreas, part of stomach, D1+2, CBD, GB, stomach anastomosed with jejunum)
chemo for palliation + mets
stent for palliation (relieves jaundice)
Chronic Pancreatitis
Due to repeated episodes of acute
progressive irreversible damage
common in alcohol abuse + CF
endocrine + exocrine insufficiency
DM
ADEK vit deficiency
steatorrhoea + diarrhoea
requires creon + vit supplements
amylase + lipase normal
low faecal elastase
opiate analgesia sometimes required, coeliac plexus block can be done
Surgery (whipples or pancreaticojejunostomy) when medical tx fails
risk of pancreatic ca
Acute pancreatitis
Causes
Idiopathic
Gallstones
ethanol
trauma
steroids
mumps + other viruses
AI
scorpion stings
hypercalcaemia + hypertriglyceridaemia
ERCP
drugs (e.g. thiazides)
epigastric pain radiates through to back + relived on leaning forward
Retroperitoneal haemorrhage: Cullen's + Grey turner's signs
comps: hypocalc, hyperglyc, ARDS, DIC, SIRS, necrosis (may require necrosectomy), abscess, pseudocyst, haemorrhage
amylase is not an indicator of severity
Scores
Modified glasgow imrie
PaO2<8
Age>55
neutrophils (high WCC)
ca low
raised urea
enzymes (AST + LDH raised)
sugar (hyperglyc)
if high score patient needs ICU
APACHE
Ransons
do on admission + 48hrs later
predicts mortality
Balthazar for CT findings