Universidad de Guadalajara

Noviembre 2011

PancreaticPancreatic  NeoplasmsNeoplasms

Centro Universitario Ciencias de la Salud

Clínicas Quirúrgicas

Mayra C. Silva Camarena206558747

Dr. Benjamin Robles MariscalDr. Héctor Manuel Virgen Ayala

Endocrine

Exocrine

Functional

No functional

Neoplasms of the

endocrine Pancreas

++

Rare

Functional

Malignant

5/ 1000000/365

secreted peptide products

Insulinoma More frequentMore frequent

90% solitarysolitary beningnos

10% malignant

Head = Body = Tail

Profound syncopal episode Palpitations

 TremorsSweating

Confusion Seizures

Personality changes Memory loss

 Unconsciousness Weight gain

Clinical Manifestations

ββWhipple's triad

Diagnosis

Demonstration of fasting hypoglycemia with inappropriately

elevated insulin

0:3

Locate the tumor

TTreatment CT Endoscopic ultrasoundCT Endoscopic ultrasound

Surgical treatmentSimple enucleationPartial-pancreatomyPancreatoduodenectomy

Simple enucleationPartial-pancreatomyPancreatoduodenectomy

Medical Treatment DiaxozidoDiaxozido

70-90% Passaro's triangle

25% NEM 1

50% solitary malformations

50% malignantmalignant

GGastrinomaastrinoma

α1         δClinical Manifestations

Zollinger Ellison syndrome

Gastrin

Abdominal painPeptic ulcer disease Severe esophagitisMultiple ulcers Diarrhea

Abdominal painPeptic ulcer disease Severe esophagitisMultiple ulcers Diarrhea

Serum gastrin(1000pg/ml)

Secretin stimulation

Diagnosis

LocationSomatostatin receptor scintigraphy + TACEndoscopic ultrasound

Simple enucleation

Pancreatomia

Selective vagotomyvagotomy

Resection of liver metastases

Chemotherapy

TTreatment

VIPoma80% of tumors are solitary

50% of lesions are malignant

Average survival is one year

WDHA Syndrome

Clinical ManifestationsWatery diarrea Hipokalemia Aclorhidia

Metabolic acidosisHypercalcemia Extreme weakness

Serum concentrations of VIP

CTEndoscopic ultrasound

Diagnosis

PreoperativePreoperative

TTreatment

Somatostatin analogs

Fluids and electrolytes

SurgicalSurgical Extraction of the tumor

Streptozocin

GGlucagoma

20-70 years

25% benign lesionsα2

DDiabetes mellitus

Clinical Manifestations

Necrolytic migratory dermatitisWeight lossStomatitisHipoaminoacidemiaAnemia

Serum concentrations of glucagon (500pg/ml)

CT

Diagnosis

Preoperative

TTreatment Control of diabetes mellitusParenteral nutrition  Octreotide

Surgical treatment Extraction of the tumorExtraction of the tumor

Streptozocin

Somatostatinoma

Clinic: gallstones, diabetes  mellitus, steatorrhea, abdominal pain, jaundice and cholelithiasis. 

Diagnosis: somatostatin serum (10ng/ml)

Treatment: 

Complete tumor excision and cholecystectomy.

50% cure

Streptozocin

No functionalThey are found in the pancreatic head

Metastasis 80% of patients

Clinical: abdominal and back pain, weight loss, jaundice, palpable mass.

Clinical: abdominal and back pain, weight loss, jaundice, palpable mass.

Diagnosis:  elevated levels of  pancreatic polypeptide. CT.

Forecast: 5-year survival 15%

Neoplasms of the

exocrine Pancreas

5th cause of death from cancer

Risk factors

SmokingDiabetesChronic pancreatitis Alcohol consumption Coffee consumption, Diet high in fat and low in fiberFamily History

Ductal adenocarcinoma

40-60 years

75% Head

15% Body 10%Tail

CA 19-9

HEADHEAD

Clinical Manifestations

Jaundice-44kgAbdominal painHepatomegalyCoourvoisier sign

BODY-TAILBODY-TAIL

Abdominal painWeight loss

ALKALINE PHOSPHATASEBILIRUBIN

Dynamic helical CTPositron emission tomographyEndoscopic ultrasonography

Tomor Criter Unresectable-Invasion of the hepatic artery-Invasion of the superior mesenteric artery-Ascites-Distant metastases (liver)-Invasion to distant organs

Tomor Criter Unresectable-Invasion of the hepatic artery-Invasion of the superior mesenteric artery-Ascites-Distant metastases (liver)-Invasion to distant organs

Whipple procedure

Pancreatoduenoctomy

Cholecystojejunostomy

Percutaneous endoprostheses

Gastroyeyunostonia

Chemotherapy

Adenoma and adenocarcinoma

Vater’s ampulla

 jaundice gastrointestinal

bleeding weight loss

pain

33% adenoma

66%  adenocarcinoma

DIAGNOSIS

ERCP

PancreatoduodenectomySphincterotomy

Pancreatiancreaticc Injuries

4% of abdominal injuries

Mortality

37%36%%

26%

DiagnosisAbdominal painPeritoneal irritationSerum amylase UltrasoundComputed tomographyHelical CTEndoscopic retrograde cholangiopancreatography cholangiopancreatography 

Thickening of the anterior renal fascia, peripancreatic edema, diffuse enlargement of the gland, observation of the fracture, hematoma or the presence of pancreatic fluid separating the splenic vein or pancreatic body

TTreatmentExternal drainagesimple Pancreatorrafia using nonabsorbable suturesResection of part of the glanddistal Pancreatectomy and splenectomy

Complications

35-40%

8 -18%

Pancreatic fistulaPeripancreatic abscesses

Pancreatitis