SURGERY OF LIVER AND PANCREAS
Another important surgical condition of the liver is liver injury. Injury to the liver can be due to a road traffic accident which causes blunt trauma or it can be due an assault, which can either be blunt trauma or penetrating trauma (due to stabbing with a knife or due to gun shot injury)
Most of the blunt liver injuries can be managed non operatively unless they are of high grade and the patient is loosing blood rapidly and significant drop in both blood pressure and hemoglobin level.
As a Surgical Gastroenterologist, the most common pancreatic problems that we come across are
This disease is characterized by severe pain in the upper abdomen, which radiates to the upper back and it may be associated with nausea,vomiting,breathlessness.
A classical presentation of a patient with acute pancreatitis includes
Severe upper abdominal pain which radiates to back like a stabbing type of pain
Raised Serum Amylase levels
Ultrasound or CT Scan evidence of pancreatic swelling/inflammation
Presence of two of any of the above three features is suggestive of acute pancreatitis
In patients with gall stones as the cause for pancreatitis, the gall bladder ahs to be removed depending on the severity of the pancreatitis
In patients with mild acute pancreatitis, laparoscopic cholecystectomy is recommended during the same admission.
In patients with severe gall stone pancreatitis, laparoscopic cholecystectomy is recommended after a period of six weeks.
Acute Pancreatitis is a life threatening disease of the pancreas and it has to managed in a multispeciality care hospital for proper management of the patients. This disease requires attention of a gastroenterologist, surgeon, radiologist, anaesthesia and critical care physician for optimal care
Chronic pancreatitis is characterized fibrous/fatty replacement of pancreas due to chronic, toxic insult to the pancreatic gland, which is an irreversible condition and the gland becomes hard and the function of the gland is lost to a varying extent.
These patients present with severe upper abdominal pain, radiating to the upper back, which is present for a long duration.
What is the treatment of Chronic pancreatitis?
Most of the cases are usually managed with medication initially for pain, with gradual escalation of medicine from a simple analgesic to an opioid analgesic.
Those who do not respond to medication and those who have a dilated main pancreatic duct, requires surgery and the surgery is known as Modified Puestow’s procedure (Lateral Pancreatico Jejunostomy).
In patients who do not respond to medication and do not have a dilated main pancreatic duct, their pain management can be made by blocking the nerve supply of the pancreas, which is known as Celiac Plexus Block
What are the complications of Chronic pancreatitis?
Thrombosis of surrounding veins and development of left sided portal hypertension.
Protein Energy Malnutrition
Obstruction of the common bile duct causing jaundice
Obstruction of the duodenum