TY  - CHAP
M1  - Book, Section
TI  - Pancreas
A1  - Fisher, William E.
A1  - Andersen, Dana K.
A1  - Windsor, John A.
A1  - Saluja, Ashok K.
A1  - Brunicardi, F. Charles
A2  - Brunicardi, F. Charles
A2  - Andersen, Dana K.
A2  - Billiar, Timothy R.
A2  - Dunn, David L.
A2  - Hunter, John G.
A2  - Matthews, Jeffrey B.
A2  - Pollock, Raphael E.
PY  - 2015
T2  - Schwartz's Principles of Surgery, 10e
AB  - Incomplete  fusion  of  the  dorsal  and  ventral  pancreatic  ducts  results  in  pancreas  divisum,  but  a  variety  of  ductal  anomalies  can  be  seen.  Magnetic  resonance  cholangiopancreatography  as  well  as  endoscopic  retrograde  cholangiopancreatography  can  identify  these  ductal  anomalies,  and  clarification  of  the  ductal  pattern  of  the  pancreas  is  important  before  attempts  at  interventions.The  “replaced  right  hepatic  artery”  occurs  in  15%  of  patients  and  needs  to  be  identified  preoperatively  to  prevent  inadvertent  injury  with  resulting  hepatic  necrosis.  Anomalous  hepatic  arterial  anatomy  can  result  in  hepatic  ischemia  during  dissection  of  the  porta  hepatis  as  well.  “Thin  cut”  multidetector  com.puted  tomographic  images  are  usually  able  to  identify  the  relevant  arterial  and  venous  patterns  around  the  pancreas.Regardless  of  the  etiology,  the  management  of  the  early  phase  of  acute  pancreatitis  is  critical  to  achieve  a  successful  outcome.  Aggressive  fluid  resuscitation  and  early  enteral  feeding  both  reduce  the  risk  of  complications.  It  is  no  longer  considered  appropriate  to  “rest  the  pancreas”  if  the  patient  can  tolerate  enteral  nutrients.Surgical  intervention  in  acute  pancreatitis  is  reserved  for  patients  with  infected  collections  or  infected  necrosis  only,  or  to  relieve  an  impacted  gallstone  in  the  ampulla  if  endoscopic  or  radiologic  treatments  are  unavailable  or  unsuccessful.  Infection  is  usually  confirmed  by  a  pattern  of  air  in  the  retroperitoneum  on  computed  tomographic  scan,  or  by  documentation  of  bacteria  on  Gram’s  stain  or  culture  from  fine-needle  aspiration  of  a  suspected  infected  fluid  collection.  Fine-needle  aspiration  of  suspicious  fluid  collections  should  not  be  converted  to  percutaneous  drainage  unless  infection  is  confirmed,  and  the  consensus  decision  has  been  made  that  percutaneous  drainage  is  appropriate  for  the  individual  patient.The  appearance  of  chronic  pancreatitis  on  computed  tomographic  scan  varies  dramatically,  and  multiple  diagnostic  studies  are  usually  needed  to  establish  the  extent  of  disease.  Calcific  pancreatitis  is  not  a  marker  of  alcoholic  pancreatitis  alone,  and  rarely  indicates  autoimmune  pancreatitis.  Endoscopic  ultrasound  provides  a  better  assessment  of  the  disease  than  computed  tomography  and  is  useful  to  disclose  indolent  or  unsuspected  cancer,  which  can  occur  in  up  to  10%  of  patients.The  nidus  of  inflammation  in  chronic  pancreatitis  due  to  any  cause  is  the  head  of  the  gland.  Therefore,  treatment  approaches  that  address  the  disease  in  the  head  have  the  best  long-term  results.  The  Whipple  procedure,  the  Beger  procedure,  and  the  Frey  procedure,  with  or  without  longitudinal  duct  drainage,  are  the  best  surgical  options,  as  all  three  approaches  remove  all  or  most  of  the  disease  in  the  head  of  the  gland.The  precursor  lesion  that  probably  leads  to  most  cases  of  ductular  adenocarcinoma  is  the  ductal  epithelial  hyperplasia/dysplasia  process  described  by  the  pancreatic  intra­epithelial  neoplasia  classification  system.  Pancreatic  intra­epithelial  neoplasia  2  and  pancreatic  intraepithelial  neoplasia  3  lesions  may  be  associated  with  other,  nonspecific  changes  in  pancreatic  morphology  seen  on  imaging  studies,  or  may  only  be  seen  histologically.  Resection  margins  for  pancreatic  neoplasms  should  be  examined  for  advanced  pancreatic  intraepithelial  neoplasia  stage  patterns  of  ductal  hyperplasia  to  ensure  adequate  resection  status.Intraductal  papillary  mucinous  neoplasms  are  small  macroscopic  polypoid  or  plaque-like  adenomas  that  develop  in  the  main  pancreatic  duct  or  in  side-branch  ducts,  and  secrete  mucin.  They  are  ...
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/16
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1117751013
ER  -