Surgery of the Pancreas Quiz by mwqG6M


									Surgery of the Pancreas Quiz

         Elaina Turner
What are the three types of neoplasia
seen in the pancreas of dogs and cats?

  • Adenocarcinoma of the exocrine pancreas
  • Adenocarcinoma of the beta cells of the
    pancreatic islets (insulinoma)
  • Adenocarcinoma of the non-beta cells of the
    pancreatic islets (gastrinoma)
   Which one is most common?

• Adenocarcinoma of the exocrine pancreas
     Which is most frequently
     diagnosed ante mortem?

• Insulinoma
     What are the clinical signs of
        pancreatic exocrine

•   Often non-specific
•   Weight loss, anorexia
•   Depression
•   Vomiting
•   Jaundice
Name a diagnostic technique that
  has very high specificity but
       lower sensitivity.

• DPL– diagnostic peritoneal lavage
     If you treat this tumor by total
pancreatectomy, what is the postoperative
      management of the patient?

  • After total pancreatectomy, must replace
    exocrine and endocrine pancreatic
    hormones for life of patient
 What other surgical procedures may be
     required to resect an exocrine
adenocarcinoma located in the body of the

  • Duodenectomy, Billroth II and
Why is diagnosis of adenocarcinoma of
 the beta cells of the pancreatic islet
     (insulinoma) often delayed?

  • Signs are intermittent
 What other conditions does this
         tumor mimic?

• Epilepsy
    Explain Whipple’s Triad – what
     is it, and how does it help in
       diagnosis of insulinoma.

• Neurological disturbance associated with
• Fasting plasma glucose <40mg/dl
• Relief of neurological disturbance following
  feeding or parenteral administration of glucose
    What is the single most
diagnostic blood chemistry result
         for this tumor?

• Documentation of hypoglycemia
 Why is blood glucose concentration
unpredictable during surgery to remove

  • Hypoglycemia may be induced by tumor
  • Stress gluconeogenesis induced by
    anesthesia and sx counteracts increased
    insulin release in most cases
Explain factors that act to increase or to
       decrease blood glucose.
In removing the right limb of the
pancreas, what vessels(s) must be
 preserved? How is this done?

• Blood supply to the duodenum – caudal
  pancreaticoduodenal artery
• This is done by bluntly dissecting from the
Discuss postopertaive management of
      the dog with insulinoma.

• Withhold food and water for 24hrs (5% dextrose
  IV maintenance fluids)
• 25% have transient DM
• 15% hyperglycemic > 1 month (range 1 – 24
  mths) and require insulin therapy
• Postoperative pancreatitis not common
Why do some of these patients have
 DM after removal of an insulin-
        secreting tumor?
 • The cells were so used to abnormal amounts
   of insulin the normal cells slow their
   production of insulin
 • Disuse atrophy
    Insulinomas in dogs are always
malignant and the rate of recurrence of
cs is approximately 100%. Why is sx

  • To control clinical signs
     Describe staging of insulinoma.
• 2 types: hypoglycemic-free interval vs. clinical stage and
  survival time following sx
• Hypoglycemic-free interval vs. clinical stage
   – Stage 1 (up to 36mths) 50% of patients hypoglycemic-free at
     15mths post sx
   – Stage 2 (up to 30mths) 20% of patients HG-F at 15mths post sx
   – Stage 3 – less than 18mths
• Survival time following sx
   – Stage 1 (50% survival at 16mths, 20% at 24mths)
   – Stage 2 (<50% at 6mths, <20% at 28mths)
   – Stage 3 (<20% at 9mths)
  What is the expected outcome
     after surgical removal of
  insulinomas of various stages?

• See previous slide
   What are 2 significant risk factors
associated with survival time following
 diagnosis of insulinoma? Explain why
   these 2 factors may be significant.
 • Age of pateint
    – Direct relationship between age and survival, each
      increase of 1yr in age = decrease of 28% in risk of
 • Pre-operative insulin concentration
    – Indirect relationship between insulin concentration and
      survival, 10uml/dl = 6% increase, 100uml/dl = 82%
What is the most common cs seen in dogs
with adenocarcinoma of the non-beta cell
  of the pancreatic islet (gastrinoma)?

  • Gastric ulcer

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