0071643192.pdf

■ ARDS

■ Death predicted by Ranson criteria (see Table 11.15)

Pancreatic Cancer

Roughly 90% are pancreatic head adenocarcinomas. Risk factors include smok-

ing, chronic pancreatitis, a first-degree relative with pancreatic cancer, and a

high-fat diet. Pancreatic cancer is most commonly seen in men in their 60s.

SYMPTOMS

■ Presents with abdominal pain radiating toward the back as well as jaun-

dice, loss of appetite, nausea, vomiting, weight loss, weakness, fatigue, and

indigestion

EXAM

■ Exam may reveal a palpable, nontender gallbladder (Courvoisier sign) or

migratory thrombophlebitis (Trousseau sign).

DIAGNOSIS

■ Use CT to detect a pancreatic mass, dilated pancreatic and bile ducts, the

extent of vascular involvement, and metastases. If a mass is not visualized,

use ERCP or endoscopic ultrasound for better visualization and consider

fine-needle aspiration.

TREATMENT

■ Most patients present with metastatic disease, and treatment is palliative.

■ Some 10–20% of pancreatic head tumors have no evidence of metastasis

and may be resected using the Whipple procedure (pancreaticoduo-

denectomy).

■ Chemotherapy with 5-FU and gemcitabine may improve short-term survival,

but long-term prognosis is poor (<5% survive >5 years from diagnosis).

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

TABLE 11.15 Ranson Criteria for Acute Pancreatitis

ONADMISSION AFTER48 HOURS

GA LAW: C HOBBS:

Glucose >200 mg/dL Ca2+<8.0 mg/dL

Age >55 Hematocrit decrease by >10%

LDH >350 IU/L O 2 PaO 2 <60

AST >250 IU/dL Base deficit >4 mEq/L

WBC >16,000/mL BUN increase >5 mg/dL

Sequestered fluid >6 L

The classic presentation of

pancreatic cancer is painless,

progressive jaundice.

The risk of mortality in

pancreatitis is

<1% if 1—2 of Ranson

criteria;

20% with 3—4;

40% with 4—5;

near 100% with >6.