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Surgery of the Pancreas Quiz

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Adenocarcinoma of the beta cells of the pancreatic islets (insulinoma) ... What are the clinical signs of pancreatic ... Pre-operative insulin concentration ... – PowerPoint PPT presentation

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Title: Surgery of the Pancreas Quiz


1
Surgery of the Pancreas Quiz
  • Elaina Turner

2
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)

3
Which one is most common?
  • Adenocarcinoma of the exocrine pancreas

4
Which is most frequently diagnosed ante mortem?
  • Insulinoma

5
What are the clinical signs of pancreatic
exocrine adenocarcinoma?
  • Often non-specific
  • Weight loss, anorexia
  • Depression
  • Vomiting
  • Jaundice

6
Name a diagnostic technique that has very high
specificity but lower sensitivity.
  • DPL diagnostic peritoneal lavage

7
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

8
What other surgical procedures may be required to
resect an exocrine adenocarcinoma located in the
body of the prancreas?
  • Duodenectomy, Billroth II and cholecstojejunostomy

9
Why is diagnosis of adenocarcinoma of the beta
cells of the pancreatic islet (insulinoma) often
delayed?
  • Signs are intermittent

10
What other conditions does this tumor mimic?
  • Epilepsy

11
Explain Whipples Triad what is it, and how
does it help in diagnosis of insulinoma.
  • Neurological disturbance associated with
    hypoglycemia
  • Fasting plasma glucose lt40mg/dl
  • Relief of neurological disturbance following
    feeding or parenteral administration of glucose

12
What is the single most diagnostic blood
chemistry result for this tumor?
  • Documentation of hypoglycemia

13
Why is blood glucose concentration unpredictable
during surgery to remove insulinoma?
  • Hypoglycemia may be induced by tumor manipulation
  • Stress gluconeogenesis induced by anesthesia and
    sx counteracts increased insulin release in most
    cases

14
Explain factors that act to increase or to
decrease blood glucose.
15
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
    vessels

16
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 gt 1 month (range 1 24 mths)
    and require insulin therapy
  • Postoperative pancreatitis not common

17
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

18
Insulinomas in dogs are always malignant and the
rate of recurrence of cs is approximately 100.
Why is sx recommended?
  • To control clinical signs

19
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 (lt50 at 6mths, lt20 at 28mths)
  • Stage 3 (lt20 at 9mths)

20
What is the expected outcome after surgical
removal of insulinomas of various stages?
  • See previous slide

21
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 death
  • Pre-operative insulin concentration
  • Indirect relationship between insulin
    concentration and survival, 10uml/dl 6
    increase, 100uml/dl 82

22
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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