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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