Angelchick prosthesis - Large silastic 'C'-shaped ring that can secured around the oesophago-gastric junction
- Previously used for GORD
- Not used any more due to risk of stenosis + obstruction
Pancreatic pseudocyst
- Circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue
- Lined with granulation tissue (not epithelium)
- Typically located in the lesser sac of the abdomen
- Causes: Pancreatitis, Abdominal trauma]
- Sequalae of acute pancreatic collection
- => More organized over several weeks => Walled-off within thick wall of granulation tissue and fibrosis
- Investigations:
- USS (but may be obscured by gas-filled stomach)
- CT (gold standard)
- MRCP (to establish relationship of the pseudocyst to the pancreatic ducts)
- Management:
- Connection is created between the cyst and an adjacent intestinal organ
- e.g. Cystogastrostomy/Cystjejunostomy (body or tail of pancreas), Cystduodenostomy (head of pancreas)
- Complications
- Infection, haemorrhage, obstruction, rupture
Whipples - AKA Pancreaticoduodenectomy, Pancreatoduodenectomy
- Paliative procedure (occasionally curative)
- For Ca head of the pancreas, CBD, duodenal papilla, duodenum near the pancreas, and/or pancreatitis with or without definitive cause
- Removal of the distal half of the stomach, gall bladder and its cystic duct, CBD, head of pancreas, duodenum, proximal jejunum, and regional lymph nodes
- Reconstruction: Pancreaticojejunostomy and hepaticojejunostomy
Notes - Picolax
- = Sodium picosulphate (stimulant laxative, activated by bacteria in colon) with magnesium citrate (osmotic laxative)
- Bowel-prep, NOT for constipation
- Take 2 sachets on the day before procedure
- Laxido
- = Macrogol (PEG)
- For long-standing constipation / faecal impaction
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