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06-06-2008, 09:57 PM
Types:
(I)Exocrine gland tumours CA. head., CA. body and tail & Periampullary carcinoma.
(II) Endocrine tumours: of two types:
1- Non insuline secreting tumours e.g. "Zollinger Ellison syndrome" "See before".
ÄTreatment: If the site of the tumour can be localized resection is necessary. If it can not be localized the patients can be managed medically by omeprazol. If medical treatment failed, total gastrectomy may be needed.
2- Insuline secreting tumour e.g. "Insulinoma" which is characterized by Whipple's triad during attacks of fainting and convulsions:
a) Attack must occurs while fasting.
b) Blood Sugar less than 50mg/100ml during attack.
c) The attack must be relieved by ingestion or injection of glucose.



CANCER HEAD OF PANCREAS
Incidence: Usually old age male.
Pathology:
Ä Site: 75% of pancreatic cancer occurs in the head.
Ä Mac.: Small in origin infiltrating the pancreatic tissue giving hard mass in the concavity of the duodenum.
Ä Mic.: Adenocarcinoma of diff. grades of differentiation.
Ä Spread:
1- Direct
To pancreatic tissue
To surroundings C.B.D. obst. jaundice or to Duodenum pyloric obstruction.
2- Lymphatic:
Sup. pancreatico-duadenal Inf pancreatico-duodenal
Coeliac lymph nodes L.N. at porta hepatis.
3- Blood spread: Late to the liver
Cl. Picture: Old Male patient with:
1- Symptoms of obstructive jaundice of gradual onset and progressive course without biliary colic.
2- Dull aching pain in the epigastrium referred to the back "tends to be a constant feature".
3- G.B. is usually palpable according to Courvoisier's low. Except .....see before..
4- Pancreatic dysfunction Anorexia, Athenia, Anaemia.
5- In late cases the liver is enlarged with ascitis I.V.C. obstruction.
Investigation:
1- Barium meal
CA head widening of the curve of duodenum.
Pre-ampullary CA Filling defect in duodenum (inverted figure)
2- Ultrasonography detect the mass.
3- Computerized tomography identify operability.
4- MRCP: Delineate the biliary tree.
5- ERCP & PTC: For diagnosis and insertion of stents may be needed to relieve jaundice.
Treatment:
1- Operable cases:
Partial Pancreatico duodenectomy "Whipple's operation".
Ä Resection of head of pancreas, duodenum and distal part of C.B.D.
Ä Anastomosis of loop of jejunum with.
- Stomach - C.B.D. - pancreatic duct.
2- Inoperable cases: Bypass operation:-
ÄPotent analgesics to relieve pain.
ÄPalliative cholecystojejunostomy or choledochojejunostomy or hepaticojejunostomy to relieve jaundice.
ÄPalliative gastrojujenostomy to relieve duodenal obstruction.
SOURCE: DR. AYMAN SALEM'S BOOK
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