Final year‎ > ‎

14.03.11 Placement notes

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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