(精选)Right Upper Quadrant Pain and Abnormal LFTs教学课件.pptVIP

Pancreatic Carcinoma Pain is a late presentation Abnormal LFTs / Jaundice U/S: Dilated CBD Possible Early Symptoms: New onset or worsening diabetes Pancreatic Exocrine Insufficiency: diarrhoea, pale motions, weight loss ‘Double Duct’ on U/S or CT is pancreatic / periampullary carcinoma until proven otherwise. Pancreatic Duct Dilatation requires referral to exclude pancreatic cancer. Chronic Pancreatitis Central upper abdominal pain with radiation to back, exacerbated by eating / alcohol Investigation to exclude pancreatic cancer, U/S, CT, MRCP, EUS. Exocrine Insufficiency: Check Faecal Elastase. Replacement therapy can improve pain Pain Management: Opiates, Coeliac Plexus Block Dilated Pancreatic duct: suitable for surgery or pancreatic duct stent. Radiological Findings (U/S, CT, MRCP, EUS: Heterogenous pancreas, pancreatic calcification, side duct ectasia, dilated PD, PD stones Chronic Pancreatitis and Pancreatic Cancer Chronic pancreatitis is a risk factor for pancreatic cancer Deterioration in symptoms of pain may be due to development of cancer Obstructive jaundice due to chronic inflammation or pancreatic cancer Worsening of diabetic control due to progressive PD obstruction Right Upper Quadrant Pain and Abnormal LFTs Mr Ian Pope, BA, MD FRCS (Gen Surg) Consultant Hepato-Pancreatico-Biliary (HPB) and General Surgeon Bristol Royal Infirmary; Spire Hospital, Bristol University and Surgical Training 1985-1988: Cambridge University BA 1988-1991: Oxford University BM, BCh 1992-1995: Liverpool SHO Rotation FRCS 1995-1997: MD University of Liverpool MD 1997-2005: Edinburgh Surgical Rotation: General Surgery and HPB and Multi Organ Transplant Surgery (FRCS Gen Surg) 2005: Consultant General and HPB Surgeon, University Hospitals, Bristol Clinical Interests Liver Cancer (HCC), Colorectal Liver Metastases, Bile Duct Cancer, Gallbladder Cancer, Pancreatic Cancer Gallstones, Pancreatitis, Liver Cysts, Pancreatic Cysts, Bile Duct i