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* Pancreatitis/ Abcess Cyst CA CramQ/A
 #525876  
  spartans1 - 08/17/10 13:19
 
  Acute Pancreatitis – suspected in alcoholic . upper abdominal pain radiating to midback with N/V, alleviated c sitting up, jaundice sometimes fever. May be edematous hemorrhagic or suppurativr( pancreatic abcess.

Dx High amylase/lipase. c CT is Dx uncertain
. Tx c NPO, NGT, sucton an IV fluid

Analgesia, and then begin to consider ERCP and surgery if perforated, bleeding, abscess, pseudocyst or peritonitis.

Complication are:
Pancreatic Pseudocyst vs Abscess –
10 day after onset worsening of pain, n/v, fever high WBC and positive blood culture after initial improvement.
Dx c CT.
Tx surgical drainage

Pseudocyst is generally 5 weeks after initial symptoms when collection of pancreatic juice causes anorexia pain and palpable mass


Tx if < 6cm and present < 6 weeks Observe
If > 6 cm or present > 6 weeks , then percutaneous or endocospic drainage of abscess.
.

Pancreatic CA – vague abdm pain (doesn’t have to radiate to the back anymore), anorexia and weight loss with jaundice, n/v. Dx c CT. If negative do ERCP. Check CA 19-9. Tx: If only at pancreatic head c no spread, try resection. If not, do Whipple (pancreaticoduodenectomy) procedure.


2. A 62-year-old man comes to the physician for a follow-up examination. He has a 6-month history of increasingly severe, dull back pain and a 14-kg (30-lb) weight loss despite a normal appetite. Recent x-ray films of the thoracolumbar spine showed no abnormalities. He has no history of trauma or serious illness. He takes no medications. He is 173 cm (5 ft 8 in) tall and weighs 91 kg (200 lb); BMI is 30 kg/m2. Examination shows no other abnormalities. Test of the stool for occult blood is negative. A complete blood count, serum electrolyte levels, and urinalysis are within the reference range. Which of the following is the most appropriate next step in diagnosis?

A) Measurement of serum CA 19-9 level
B) Measurement of serum carcinoembryonic antigen (CEA) level
C) CT scan of the abdomen
D) Laparoscopy
E) Upper endoscopy
F) Mesenteric angiography

The correct answer is

C) CT. scan of the abdomen
If negative
2. do ERCP. The sensitivity of Magnetic resonance cholangiopancreatography MRCP with respect to diagnosing pancreatic cancer was 84% and its specificity 97%. The corresponding values for endoscopic retrograde cholangiopancreatography (ERCP) were 70% and 94%, respectively

A. Check CA 19-9. there is no evidence that screening for pancreatic cancer is effective in reducing mortality and the harms of screening for pancreatic cancer exceed any potential benefits

B. CEA – GI cancers;

D) Laparoscopy Diagnostic laparoscopy is recommended in select patients with primary tumors greater than 4 cm, tumors in the body or tail of the pancreas, patients with equivocal findings of metastasis on CT, ascites, or clinical or laboratory findings suggesting advanced disease such as marked weight loss, hypoalbuminemia, and elevated CA 19-9.

E ) Upper endoscopy Upper Endoscopy (EGD) will visualize only gastrointestinal tract. : :esophagus, stomach, and duodenum.

F) addition of Mesenteric angiography to preoperative staging has improved diagnosing vascular invasion by pancreatic cancer

Tx: If only at pancreatic head c no spread, try resection.

If not, do Whipple (pancreaticoduodenectomy) procedure.
 
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* Re:Pancreatitis/ Abcess Cyst CA CramQ/A
#2169538
  drlov - 08/17/10 13:25
 
  Rule of 5= for Aortic abdominal anyersim
Rule of 6= For pseudocyst
 
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* Re:Pancreatitis/ Abcess Cyst CA CramQ/A
#2169539
  spartans1 - 08/17/10 13:27
 
  Rule of 6 in management of Pseudocyst of Pancreas
Tx if < 6cm and present < 6 weeks Observe
If > 6 cm or present > 6 weeks , then percutaneous or endocospic drainage of abscess.
 
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* Re:Pancreatitis/ Abcess Cyst CA CramQ/A
#2169551
  spartans1 - 08/17/10 13:38
 
  Rule of 5
For AAA abdominal aortic aneurysms greater than about 5cm in diameter, surgery is typically
recommended. This cutoff was chosen because the risk of rupture increases dramatically at this diameter.

For pts with smaller AAAs, periodic imaging should be done to assess for aneurysm growth. Rapid growth itself can be an indication for surgical repair.
SMOKING is a major risk factor for aneurysm formation, enlargement, and rupture. Continued smoking increases the rate of growth by about 25%.
In most patients, atherosclerosis is the underlying precipitant for AAA formation, but altering other atherosclerotic risk factors has not been demonstrated to have as much impact as smoking cessation.

Thus it is the medical intervention with the greatest potential impact.
 
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