17 - Pancreas Surgery

Endocrine

Which function of the pancreas is to produce insulin, glucagon, gastrin, and somatostatin by the islet cells?

Exocrine

Which function of the pancreas is to produce digestive enzymes by the acinar cells?

Pancreatic

Which excretory duct enters the duodenum with the common bile duct via the major duodenal papilla? It is the primary duct for cats.

Accessory

Which excretory duct enters via the minor duodenal papilla and is the primary duct for dogs?

Triaditis

What infective condition in cats occurs due to close association between the major pancreatic duct and the common bile duct, involving infection of the liver, pancreas, and duodenum? It occurs in cats.

Midline

Which approach is used to do surgery on the pancreas? It is done cranial almost to the xiphoid, and may extend caudally to the umbilicus.

Left

Which pancreatic lobe is found by retracting the stomach cranially, the transverse colon caudally, and bluntly dissecting the deep leaf of the omentum?

Body

Which part of the pancreas is found at the bend formed between the pylorus and the duodenum?

Dorsal

Which part of the right pancreatic lobe is reached by retracting the duodenum ventrally and toward the midline?

Ventral

Which part of the right pancreatic lobe is reached by retracting the duodenum laterally?

Yes

Can thorough examination, surgical removal, and biopsy of the pancreas, liver, and surrounding lymph nodes all be done during surgery?

Non-absorbable

Will absorbable or non-absorbable suture be used for ligation of the pancreatic ducts? In septic conditions, the other is used.

80

What percentage of the pancreas can be safely removed without causing endo- or exocrine insufficiency? This assumes that the blood supply and ducts are preserved.

Pancreatitis

What is the main post-operative complication of pancreas surgery, and is avoided by maintaining good perfusion during surgery and ensuring gentle tissue handling?

EPI

What condition (abbreviated) can occur if pancreatic drainage is obstructed or if over 80% of the pancreas is removed? If due to the second cause, diabetes can also result.

Pancreatectomy

A partial what surgical procedure is indicated by masses, focal trauma, abscesses, and pseudocysts? Methods can include blunt dissection and ligation, suture fracturing, and vessel sealing techniques.

Blunt Dissection

What method of partial pancreatectomy, plus ligation, can be performed to resect lesions anywhere on the pancreas? You pull apart the two pieces of the pancreas to expose the ducts and blood vessels, and then double ligate the tubes, transecting between the double ligation.

Suture Fracture

Which technique of partial pancreatectomy is only used for focal lesions on the margin of the pancreas? It is similar to the guillotine method on the liver. Suture is looped around the lesion area, a ligature is tied, and sharp dissection is used.

Yes

Can ligasure be used for partial pancreatectomy?

Right

Which lobe of the pancreas shares a blood supply with the duodenum (caudal pancreatico-duodenal artery)? Double ligation is done on the pancreatic branches.

Surgical

Which type of biopsy allows feeling for other lesions? Focal diseases use the Tru-cut or wedge method, and diffuse diseases use a sample of the caudal aspect of the right lobe. This is because it is away from the main ductal system, is more accessible, and does not share vascular supply with the duodenum.

Laparoscopic

Which type of biopsy uses double puncture or sternal recumbency, and is done on the edge of the pancreas? If the tissue appears normal, take multiple samples. This is done more often in cats.

No

Are pancreatic neoplasias common in dogs and cats?

Adenocarcinoma

What tumor of the exocrine pancreas is the most common neoplasia of the pancreas? Signs are often nonspecific, with weight loss, anorexia, vomiting, depression, vomiting, and icterus.

Insulinoma

What tumor of the pancreas is a functional tumor of B cells, and is less common than adenocarcinoma but is more frequently recognized antemortem?

Gastrinoma

What functional tumor of the pancreas is extremely rare and causes Zollinger-Ellison syndrome?

No

While cytology of peritoneal lavage and radiology/ultrasonography may be diagnostic for an exocrine pancreatic adenocarcinoma, is definitive antemortem diagnosis very common?

Liver

Metastasis of an exocrine pancreatic adenocarcinoma is most often to the lymph nodes and what organ?

Total

What type of pancreatectomy requires the Bilroth II procedure and replacement of exocrine/endocrine hormones for the life of the patient? It is rare in animals.

Poor

Prognosis for exocrine pancreatic adenocarcinoma is what to grave? Metastasis is often in under 3 months, and has usually occurred by the time of diagnosis.

Insulinoma

What tumor is uncommon in dogs, but is the most common pancreatic tumor, and is rare in cats? It occurs often around 8.7 years old, in medium-large breed dogs, and especially in Irish setters, German shepherds, Boxers, miniature poodles, and others, and there is no sex predilection.

Hypoglycemia

Clinical signs of an insulinoma mainly relate to what blood glucose condition? Muscle fasciculation, weakness, rear limb ataxia, collapse, mental dullness, and seizures can all result. 29% of these dogs were treated with anticonvulsants prior to diagnosis. Clinical signs will also be intermittent.

Whipple’s Triad

Neurologic disturbance, resolution of neurologic disturbance after giving glucose, and hypoglycemia together make up what, which is pathognomonic for insulinoma?

No

Will hyperinsulinemia always be seen in insulinoma cases?

Glucose

The main factor in managing an insulinoma patient in surgery is stabilizing blood what? Multiple feedings per day with high protein and complex carbohydrate diet, plus 5% dextrose 12-24 hours before surgery, and withholding food 8 hours before surgery are all important. 10% dextrose should be given during surgery, as well as blood monitoring.

24

Post-operatively after insulinoma surgery, the patient should be NPO for how many hours, and maintained on 5% dextrose? Pancreatitis is not common. Hypoglycemia, transient diabetes, and peripheral polyneuropathy may also be seen after surgery.

Medical

What type of management for insulinoma is reserved for cases with metastatic disease? This includes feeding high protein and complex carbs, with low sugar and oral hyperglycemic agents like prednisone or diazoxide.

90

What percentage of insulinomas are malignant? Over 50% will metastasize by the time of diagnosis and more than one may be present. They are most often in the left lobe. Prognosis depends on stage, and if macroscopic metastasis is seen, it is likely 3 months.