Medical Surgical Nursing

 Other surgical procedures may be performed for different degrees and types of

disease, ranging from revision of the sphincter of the ampulla of Vater, to

internal drainage of a pancreatic cyst into the stomach, to insertion of a stent,

to wide resection or removal of the pancreas. A Whipple resection

(pancreaticoduodenectomy) has been carried out to relieve the pain of chronic

pancreatitis.

 Autotransplantation or implantation of the patient‘s pancreatic islet cells has

been attempted to preserve the endocrine function of the pancreas in patients

who have undergone total pancreatectomy.

Pancreatic Cysts

 As a result of the local necrosis that occurs at the time of acute pancreatitis,

collections of fluid may form in the vicinity of the pancreas. These become

walled off by fibrous tissue and are calledpancreatic pseudocysts. They are the

most common type of pancreatic cysts. Less common cysts occur as a result of

congenital anomalies or are secondary to chronic pancreatitis or trauma to the

pancreas.

 Diagnosis of pancreatic cysts and pseudocysts is made by ultrasound,

computed tomography, and ERCP. ERCP may be used to define the anatomy

of the pancreas and evaluate the patency of pancreatic drainage. Pancreatic

pseudocysts may be of considerable size. Because of their location behind the

posterior peritoneum, when they enlarge they impinge on and displace the

stomach or the colon, which are adjacent. Eventually, through pressure or

secondary infection, they produce symptoms and require drainage

Cancer of the Pancreas

 The incidence of pancreatic cancer has decreased slightly over the past 25

years in non-Caucasian men. It is the fifth leading cause of cancer deaths in

the United States and occurs most frequently in the fifth to seventh decades of

life. Cigarette smoking, exposure to industrial chemicals or toxins in the

environment, and a diet high in fat, meat, or both are associated with

pancreatic cancer, although their role is not completely clear. The risk for

pancreatic cancer increases as the extent of cigarette smoking increases.

Diabetes mellitus, chronic pancreatitis, and hereditary pancreatitis are also

associated

 Cancer may arise in any portion of the pancreas (in the head, the body, or the

tail); clinical manifestations vary depending on the location of the lesion and

whether functioning, insulinsecreting pancreatic islet cells are involved.

Approximately 75% of pancreatic cancers originate in the head of the pancreas

and give rise to a distinctive clinical picture. Functioning islet cell tumors,