Pancreas: Surgery

The duodenum must be removed if the head of the pancreas is removed because they share the same blood supply - the gastroduodenal artery.

souce

surgical recall p.371

Kocher maneuver

The Kocher maneuver is the maneuver used to mobilize the duodenum and pancreas and evaluate the entire pancrease.

Kocher maneuver:

- incise the lateral attachments of the duodenum and then lift the pancreas to examine the posterior surface.

surgical recall p.371

Multiple choice questoins

An alcoholic man has been suffering excruciation pain recalcitrant to analgesics and splanchnic block. A surgeon recommends total pancreatectomy. A patient who has a total pancreatectomy might be expected to develop which of the following complications?

a. Diabetes mellitus

b. Hypercalcemia

c. Hyperphosphatemia

d. Constipation

e. Weight gain

The answer is a. (Blumgart, p1085)

The metabolic consequences of total pancreatectomy are manifold.

They include weight loss, malabsorption attended by hypocalcemia and hypophosphatemia, diabetes mellitus, diarrhea, and both iron deficiency and pernicious anemia.

In theory, total pancreatectomy should provide good surgical treatmnet fo pancreatic carcinoma; in reality, the severe metabolic problems that result from total removal of the pancreas make partial pancreaticoduodenectomy a frequently preferred treatment for most cases of pancreatitc carcinoma that are resectable.

pretest surgery p.231;262 qustion 366

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: COMPLICATIONS: ENDOCRINE IMPAIRMENT (NEED FOR AUTO-ISLET CELL TRANSPLANTATION)*

QUESTION

Given a patient in need of a total pancreatectomy, the resident can evaluate the future endocrine impairment of the patient, particularly the need for auto-islet cell transplantation.

[SCORE, 161634, L3D]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: CONTRAINDICATIONS

QUESTION

Given a patient with chronic pancreatitis, the resident can evaluate possible contraindications for total pancreatectomy based on the patency of the portal vein and ability of the patient to comply with the management of brittle diabetes postoperatively.

[SCORE, 161634, L1B]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: INDICATIONS: CHRONIC PANCREATITIS*

QUESTION

Given a patient with chronic pancreatitis, the resident can identify the indications for total pancreatectomy according to the clinical and radiological findings on cross-imaging.

[SCORE, 161634, L1A]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: PREOPERATIVE MANAGEMENT: BEHAVIOR MODIFICATION (ALCOHOL, SMOKING CESSATION)*

QUESTION

Given a patient who requires a total pancreatectomy, the resident can identify some necessary changes on the patient's behavior, particularly cessation of alcohol and tobacco products.

[SCORE, 161634, L3B]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: PREOPERATIVE WORKUP: GLYCEMIC CONTROL (DIABETES) ASSESSMENT*

QUESTION

Given a patient in need of a total pancreatectomy, the resident can identify the metabolic status of the patient with emphasis on the level of pancreatic insufficiency (steatorrhea) and glycemic control (diabetes).

[SCORE, 161634, L3A]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: PREOPERATIVE WORKUP: PANCREATIC INSUFFICIENCY ASSESSMENT*

QUESTION

Given a patient in need of a total pancreatectomy, the resident can identify the metabolic status of the patient with emphasis on the level of pancreatic insufficiency (steatorrhea) and glycemic control (diabetes).

[SCORE, 161634, L3A]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: PREOPERATIVE WORKUP: RULE OUT PORTAL VEIN THROMBOSIS OR SPLENIC VEIN THROMBOSIS*

QUESTION

Given a patient in need of a total pancreatectomy, the resident can evaluate the status of the portal vein and/or splenic vein, particularly excluding the inflammation-induced thrombosis in any of them.

[SCORE, 161634, L3C]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: STEPS: 1.0: CREATE THE ANASTOMOSES

QUESTION

Given a patient with chronic pancreatitis, the resident can anticipate the order and location of the anastomoses, particularly the position of the gastro/duodenal-jejunal anastomosis.

[SCORE, 161634, L4B]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: STEPS: 1.0: DETERMINE THE EXTENT OF RESECTION AND WHETHER TO PRESERVE THE PYLORUS

QUESTION

Given a patient with chronic pancreatitis, the resident can define the extent of resection, specifically the consideration of preserving the pylorus.

[SCORE, 161634, L4C]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: STEPS: 1.0: IDENTIFY AND DISSECT THE GASTRODUODENAL ARTERY*

QUESTION

Given a patient in need of a total pancreatectomy, the resident can independently assess the steps of the operation, specifically the identification and dissection of key structures (portal vein, gastroduodenal artery, splenic artery/vein).

[SCORE, 161634, L4A]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: STEPS: 1.0: IDENTIFY AND DISSECT THE PORTAL VEIN*

QUESTION

Given a patient in need of a total pancreatectomy, the resident can independently assess the steps of the operation, specifically the identification and dissection of key structures (portal vein, gastroduodenal artery, splenic artery/vein).

[SCORE, 161634, L4A]

OBE: SCORE: SURGERY: TOTAL PANCREATECTOMY: STEPS: 1.0: IDENTIFY AND DISSECT THE SPLENIC ARTERY AND VEIN*

QUESTION

Given a patient in need of a total pancreatectomy, the resident can independently assess the steps of the operation, specifically the identification and dissection of key structures (portal vein, gastroduodenal artery, splenic artery/vein).

[SCORE, 161634, L4A]

PROGRESS ON SCORE TOPICS "TOTAL PANCREATECTOMY"

"PANCREATECTOMY - TOTAL"

http://www.surgicalcore.org/modulecontent.aspx?id=161634

- I only did L1, L2, L3, and L4

- Continue from L5

6/19/16