Periampullary Tumors. Charles M. Vollmer Jr., MD Professor of Surgery Director of Pancreatic Surgery. Resident s Teaching Conference July 20, 2017
|
|
- Shona Wood
- 6 years ago
- Views:
Transcription
1 Periampullary Tumors Charles M. Vollmer Jr., MD Professor of Surgery Director of Pancreatic Surgery Resident s Teaching Conference July 20, 2017
2 What are the periampullary tumors?
3 What is their expected survival?
4 How do they present?
5 How do you manage jaundice?
6 Role of a biopsy?
7 Our job is to ask two questions Can we do it?
8 Staging Assessment of resectability by CT- Angiography or MRI M,N,T Absence of metastasis Distant lymph node involvement Local relationships of tumor
9 Three Classes of Tumors Clearly Resectable
10 Three Classes of Tumors Clearly Unresectable (LA)
11 Three Classes of Tumors Borderline Resectable Or is it Borderline Unresectable??? Hmmh???
12 What is Borderline Unresectability?
13 What is Borderline Resectability?
14 How do we manage this?
15 Two Tools For This Neoadjuvant Therapy Promise not yet fulfilled. Vascular Resections Veins - Yes Arteries - Rarely
16 A word about nutrition?
17 Our job is to ask two questions Should we do it?
18 High-Acuity Surgery Hurdles Co-morbidities Diabetes Metabolic Syndrome: HTN, Obesity It s CANCER Immunosuppression Prothrombotic state Malnutrition Age
19 Prediction Models ASA Charlson POSSUM Hopkins NSQIP (Surgical Calculator) FOTB
20 Counterindications O 2 Dependency Wheelchairs Cirrhosis Dementia
21 Pancreatic Surgery The Volume Effect Birkmeyer JD et al. N Engl J Med 2002
22 Lets go to the OR!
23 Laparoscopy anyone?
24 What s the first step?
25 Staging
26 HPB Malignancy Problem Operability Resectability
27 Staging Laparoscopy Considered Resectable Pre-Op % False-Negative Rate Resected Total Laparoscopy Lap US Laparotomy Conclusion: Patients can be spared useless laparotomy
28 Laparoscopic Staging Does EVERY patient need it? Is it still relevant today? Probably Not. Absolutely (maybe)
29 What s the purpose of the Kocher?
30 How do you find the SMV?
31
32 What lurks in Tiger Country? The Portal Triad
33 What is the Node of Importance?
34 Classical or PPPD? Why is/was the stomach resected for this operation?
35 Why resect the proximal jejunum?
36 How do we remove the head of the pancreas?
37 Dissection off the Vessels
38
39 Vein Resections
40 How much Lymphadenectomy?
41
42 How do you deal with this?
43 What constitutes pancreatic fistula risk?
44 How do we mitigate pancreatic fistula?
45 The KISS Principle
46 Afferent Limb Reconstruction - Pancreaticojejunostomy - Hepaticojejunostomy - Duodenojejunostomy Common Hepatic Duct Pancreatic Anastomosis
47 Antecolic vs Retrocolic
48 A Team Effort Interventional Endoscopy Pathology Radiology Medical Pancreatology Anesthesia Critical Care Interventional Radiology Nursing Social Work
49 Your Pathway To Recovery From Pancreatic Surgery Labs Pain Control Medications Antibiotics Nutrition Day of Operation POD #1 POD #2 POD #3 POD #4 POD #5 POD #6 POD #7+ Discharge CBC Chem 7 LFTs (AST/ALT/Bili/Amylase/Lipase) PT/PTT/INR Epidural Analgesia or Patient Controlled Analgesia (PCA) Pain Team Consult Anticoagulation: SQ Heparin 5000u q8h Ulcer Prophylaxis: Pepcid 20 mg IV BID Fistula Protection: Octreotide150 µg SQ q8h (Selectively - based on risk) Home Medications in IV form (Beta blockers, Synthroid, etc) Pre-operative Ancef & Flagyl; If PCN allergy then: Vancomycin + Flagyl + Gentamicin NPO IVF (Lacted 125/hr) CBC Chem 7 LFTs (AST/ALT/Bili/Amylase/Lipase) Epidural/PCA +/- IV Ibuprofen or Toradol (if renal function ok) Heparin 5000u SQ q8h Pepcid 20 mg IV BID Octreotide: 150 µg SQ q8h Home Medications IV CBC N/A N/A CBC Chem7 Blake Drain Amylase (after dinner) Epidural/PCA +/- IV Ibuprofen or Toradol Heparin 5000u SQ q8h Pepcid 20 mg IV BID Octreotide: 150 µg SQ q8h Home Medications IV Epidural/PCA +/- IV Ibuprofen or Toradol Cap epidural at midnight Heparin 5000u SQ q8h Pepcid 20 mg IV BID Octreotide: 150 µg SQ q8h Home Medications IV Remove Epidural PCA:(Morphine or Dilaudid) Heparin 5000u SQ q8h Zantac 150 PO BID Reglan 10mg PO q6h Colace/Senna PO Octreotide: 150 µg SQ q8h Pertinent Home Medications PO Oral pain medication (Dilaudid or Percocet) +/- Tylenol or Ibuprofen Heparin 5000u SQ q8h Zantac 150 PO BID Reglan 10mg PO q6h Colace/Senna PO Octreotide: 150 µg SQ q8h Pertinent Home Medications PO Vaccinations (x3) - if post-splenectomy N/A Oral pain medication (Dilaudid or Percocet) +/- Tylenol or Ibuprofen Heparin 5000u SQ q8h Zantac 150 PO BID Reglan 10 mg PO q6h Colace/Senna PO Octreotide: 150 µg SQ q8h Pertinent Home Medications PO N/A N/A N/A N/A N/A N/A N/A NPO IVF (Lactated 125/hr) Ice chips IVF (D5 1/2nl Urinary Foley Catheter (Placed in OR) Foley Catheter Foley Catheter (D/C if no Epidural) Respiratory O2 by Nasal Cannula Nasal Cannula (Wean O2) Endocrine Tubes, Drains & Lines Fingersticks q6h Sliding Scale Insulin NG Tube Blake drain +/-Central Line Intermittent Compression Devices (ICDs) +/- Pancreatic stent OR Wound Dressing Incentive spirometer (10x/hr while awake) Fingersticks q6h Sliding Scale Insulin NG Tube (Remove for Distals) Blake drain +/-Central Line ICDs +/- Pancreatic stent OR Wound Dressing D/C Nasal Canula (Wean O2) Clear sips IVF (D5 1/2nl Foley Catheter (if Epidural) Clear Liquids Decrease IVF D/C Foley (6h after Epidural is capped) Regular diet (Drebin); GI soft (Vollmer) Boost/Ensure /Glucerna Shakes Heplock fluids Regular diet Boost/Ensure /Glucerna Shakes N/A Oral pain medication (Dilaudid or Percocet) +/- Tylenol or Ibuprofen Heparin 5000u SQ q8h Zantac 150 PO BID Reglan 10 mg PO q6h Colace/Senna PO Commode Commode Commode IS 10x/hr IS 10x/hr IS 10x/hr IS 10x/hr IS 10x/hr IS 10x/hr Fingersticks q6h Sliding Scale Insulin Remove NG Tube (Whipples) Blake drain +/-Central Line ICDs +/- Pancreatic stent Remove OR Wound Dressing Activity Bedrest Out of bed to chair Out of bed to chair Ambulate 1-3x Work with PT/OT Fingersticks q6h Sliding Scale Insulin Blake drain Remove Central Line (if 2 peripheral IVs) ICDs +/- Pancreatic stent Incision exposed to air Out of bed to chair Ambulate 1-3x Work with PT/OT Fingersticks q6h Sliding Scale Insulin Endocrine consult if sugars elevated Blake drain IVs ICDs +/- Pancreatic stent Incision exposed to air Out of bed to chair Ambulate 3-5x Work with PT/OT Fingersticks BID Sliding Scale Insulin Supplemental Insulin PRN Blake drain IVs ICDs +/- Pancreatic stent Incision exposed to air Out of bed to chair Ambulate all day Work with PT/OT Fingersticks BID Sliding Scale Insulin (May d/c if regular diet and glucose is normal) Supplemental Insulin PRN Remove Blake drain (If Drain Amy <300) Otherwise, if >300, high volume, or sinister appearance, check with the attending. +/- Pancreatic stent Incision exposed to air Out of bed to chair Ambulate all day Work with PT/OT Octreotide: 150 µg SQ q8h Pertinent Home Medications PO Regular diet Boost/Ensure /Glucerna Shakes Fingersticks BID Sliding Scale Insulin (May d/c if regular diet and glucose is normal) Supplemental Insulin PRN +/- Pancreatic stent Remove staples (unless on steroids) Out of bed to chair Ambulate all day Work with PT/OT Pain Control Oral Dilaudid or Percocet + Tylenol or Ibuprofen Medications Bowel Regimen: Colace/Senna Ulcer Prophylaxis: Zantac x 6months GI Motility: Reglan until office followup Enzymes: Creon 2-3 pills/meal (If panc stent -stays in 4-6 weeks) Antibiotics As necessary for acquired infections Diet Regular meals plus nutrition shakes (smaller, more frequent meals) Respiratory Use your Incentive Spirometer at home Diabetes Management +/- Glucometer Supplemental Insulin, as required Wound Care Packing BID (if necessary) Visiting Nurse to remove staples (if necessary) Drain Care Pancreatic stent to gravity bag (if necessary) Blake Drain to bulb suction (if necessary) Activity Frequent walking Climbing stairs Progress physical activity as tolerated
50 Today s Whipple Procedure Safer than ever esp. high volume centers Operative Mortality 1-2% Morbidity 20-25% Anastomotic Leak/Fistula 15% Long-Term Recovery 3 Months Diabetes (25%) Exocrine Insufficiency (25%) Ultimately, the quality of life (and palliation) is quite good, overall
51 Penn Outcomes Operability = Resectability Time 4-6 hours Leaks: 10% Reoperation: 4% ICU use: 9% Transfusion Rate: 13% Mortality: 1.5% LOS: Average 7-8 days Readmission Rate: 18% Simplify: Clinical Pathway (2/3 follow on course)
52 Predictors of Survival It s about tumor biology Preop Intraop Postop Pathology Coagulopathy Blood Loss ICU Admission Differentiation Dementia Blood Transfusion Duration of Stay Tumor Size Patient s Physiology Margins Sepsis T-Stage Charlson Score POSSUM Operative Ulcer N-Stage ASA Score Adjuvant Therapy # Positive Nodes LN ratio AJCC Stage LVI PNI
53 Adjuvant Therapy Chemo? XRT?
54 GI Disconnection The Whipple Procedure Biliary Disconnection Pancreatic Disconnection Lymphadenectomy Fierce Vascular Disconnection Reconstruction
55
56 Satisfaction of a Cancer Survivor
57 Surgery for Pancreatic Cancer Charles M. Vollmer Jr., MD Associate Professor of Surgery Director of Pancreatic Surgery 3 rd Focus on Pancreatic Cancer June 20, 2014
58 Underutilization of Surgery 28.6% of Clinical Stage 1 received surgery!!!!!!!!!! Most were resectable (96%) Why so few???? Unidentified Reason (52%) 38% Not offered & 14% unknown Refused Surgery (4%) Contraindications (9%) Comorbidities (6%) Predictors Medicare, Older, Black, Lower income, Less educated, Head Lesions, LV/Community Hospitals Bilimoria KY et al. Annals of Surgery, 2007
Enhanced Recovery Thoracic Surgery. Esophagus Pathway
Enhanced Recovery Thoracic Surgery Esophagus Pathway Preoperative Patient Education/Expectations for Hospital and Home Medical Risk Consultation: Cardiac Clearance and PFTs for All Patients Surgery Wellness
More informationAssessment. Consults & Referrals
University of Virginia Health System Clinical Pathway: Whipple Enhanced Recovery After () LOS: 4-5 days Date of Origin/Revision: June 29, 2016/September 6, 2017/January 31, 2018 : SAS : : : D1 D2 D 3/
More informationPresentation at ACS NSQIP National Conference in July Surgical Site Infection Reduction Strategies
Presentation at ACS NSQIP National Conference in July 2015 Surgical Site Infection Reduction Strategies PeaceHealth Sacred Heart Medical Center at RiverBend Level II Trauma Center 379 Beds 15,060 cases
More informationPhysician Orders PEDIATRIC: LEB Oral Maxillofacial Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Oral Maxillofacial Postop Phase, When to Initiate: LEB Oral Maxillofacial Post Op Phase Admission/Transfer/Discharge
More informationBRANDON REGIONAL HEALTH CENTER; WHIPPLE S PROCEDURE AND ESOPHAGECTOMY AUDIT
BRANDON REGIONAL HEALTH CENTER; WHIPPLE S PROCEDURE AND ESOPHAGECTOMY AUDIT By: Amy Cisyk Home for the Summer Program July, 2016 Brandon, Manitoba Supervisor: Dr. Marvin Goossen Whipple s Procedure Audit
More informationTHE CRITICAL COMPLCATIONS AND MANAGEMENTS AFTER PANCREATIC SURGERY 2013/12/21
THE CRITICAL COMPLCATIONS AND MANAGEMENTS AFTER PANCREATIC SURGERY Tsann-Long Hwang, MD, FACS Department of Surgery Chang Gung Memorial Hospital Chang Gung University Taipei, TAIWAN 2013/12/21 THE DIFFICULTY
More information1. Attending Physician: Dr Syn Pager: Cell: Co-Morbidities:
BARIATRIC SURGERY IMMEDIATE POST-OP PLAN (Includes Post Op Day 1) Denotes order requirement Antibiotic administered in the OR at: 1. Attending Physician: Dr Syn Pager: 740-6545 Cell: 438-9415 2. To remain
More information(Page 1 of 5) Diagnosis: Procedure: Right Total Knee Replacement Unicompartmental Knee Left Total Hip Revision Total Shoulder
(Page 1 of 5) Allergies/Sensitivities/Reactions: Height: Inches cm Weight: Kg Pounds = Automatic = Physician s option, Check off to Order Diagnosis: Procedure: Right Total Knee Replacement Unicompartmental
More informationEnhanced Recovery after Surgery
Enhanced Recovery after Surgery AKA ERAS What is Enhanced Recovery (ER)? Paradigm shift in surgery and surgical care of the patient Philosophy of care Perioperative continuum Multidisciplinary Patient
More informationClick to edit Master subtitle style
Does Enhanced Recovery Improve Outcomes? Click to edit Master subtitle style Kaare Weber, MD Director of Surgery Associate Medical Director, Surgery A MEMBER OF THE MONTEFIORE HEALTH SYSTEM mes? Click
More informationPhysician Orders ADULT: Kidney-Panc/PancTransplant Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Kidney-Panc/Panc Transp Post Op Phase, When to Initiate: Kidney-Panc/Panc Transp Post Op Phase Vital Signs Vital
More informationInitials * Page 1 of 6. (place patient label here) Patient Name: Diagnosis: Allergies with reaction type:
Patient Name: Diagnosis: Allergies with reaction type: Orthopedic Upper Ext Post Op Version 3 4/20/17 Patient Placement General Diagnosis/Procedure: Preferred Location/Unit Ortho/Neuro General Medical
More information1 of 5. Integrated Order Set Inpatient, Adult. Gynecological Surgery Enhanced Recovery Orders apply to patients 18 years and older.
Orders apply to patients 18 years and older. All preprinted doses are based on normal renal and hepatic function and must be assessed for adjustment against the individual patient s renal and hepatic function
More informationINFORMATION ON PANCREATIC HEAD AND PERIAMPULLARY CANCER
INFORMATION ON PANCREATIC HEAD AND PERIAMPULLARY CANCER What is Pancreas? The pancreas is a gland located in the back of your abdomen behind the stomach. pancreas is divided into four parts: the head,
More informationCase Presentation. PMH: HTN, BPH, strabismus PSH: appendectomy Medications: norvasc, tamsulosin NKDA SH/FH: negative
Case Presentation 68yM referred for incidental finding of pancreatic head mass on CT scan for elevated PSA. No symptoms. Denied pruritus, jaundice, change in color of urine/stool, anorexia, or weight loss.
More informationOrthopedic Admission Hip Fracture Version 2 1/25/2017
Patient Name: Initial each page and Sign/Date/Time last page Diagnosis: Allergies with reaction type: Orthopedic Admission Hip Fracture Version 2 1/25/2017 Patient Placement Patient Status If the physician
More informationThe Whipple Operation Illustrations
The Whipple Operation Illustrations Fig. 1. Illustration of the sixstep pancreaticoduodenectomy (Whipple operation) as described in a number of recent text books by Dr. Evans. The operation is divided
More informationCard Open Heart POD1 POD3 Plan Post Op Day 1
Day 1 PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Transfer Patient Transfer to: Floor, Pt Status: Inpatient (LOS > 2 midnights) Vital Signs q2h, POD 1 Vital Signs q2h for 24 hours then per unit
More informationEMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES
EMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES Clifford Ko, MD, MS, MSHS, FACS, FASCRS Professor of Surgery UCLA Director, ACS NSQIP, American College of Surgeons EVIDENCE Ban
More informationDisclosures. Personalized Approaches to Gastrointestinal Cancers. Objectives. What is personalized cancer care. Go through some genomic studies
Personalized Approaches to Gastrointestinal Cancers Emily Groves, MD Colorectal Surgery Assistant Professor, Division of Surgical Oncology Disclosures None Objectives What is personalized medicine and
More informationSurgical Management of Pancreatic Cancer
I Congresso de Oncologia D Or July 5-6, 2013 Surgical Management of Pancreatic Cancer Michael A. Choti, MD, MBA, FACS Department of Surgery Johns Hopkins University School of Medicine, Baltimore, MD Estimated
More informationPICU ADMIT DKA PLAN - Phase: Begin Immediately
- Phase: Begin Immediately Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: PICU, Pt Status: Inpatient (LOS > 2 midnights) Requested Location: PICU, Pt Status: Observation
More informationPhysician Orders ADULT: Head and Neck Postoperative Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Head and Neck Postoperative Phase, When to Initiate: Head and Neck Post Operative Phase, Monitor and Record T,P,R,BP,
More informationBariatric Surgery Post Op Day Version 2 Approved 11/13/2017
Patient Name: Diagnosis: Allergies with reaction type: Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017 Diagnosis Preferred Location/Unit Surgical ICU Code Status: Full Code Activity Ambulate
More informationPANCREATIC CANCER GUIDELINES
PANCREATIC CANCER GUIDELINES North-East London Cancer Network & Barts and the London HPB Centre PROTOCOL FOR MANAGEMENT OF PANCREATIC CANCER (SEPTEMBER 2010) I. PRE-REFERRAL GUIDELINES Screening 1. Offer
More informationAliu Sanni MD SUNY Downstate Medical Center August 16, 2012
Aliu Sanni MD SUNY Downstate Medical Center August 16, 2012 Case Presentation 60yr old AAF with PMH of CAD s/p PCI 1983, CVA, GERD, HTN presented with retrosternal chest pain on 06/12 Associated dysphagia
More informationSurgery for pancreatic cancer
Surgery for pancreatic cancer Andrew Smith 12 September 2018 Leeds Regional Study Day North & West Yorkshire Pancreas Department Pancreatic Surgery Range of pancreatic surgery Pre-op preparation Post op
More informationST. DOMINIC-JACKSON MEMORIAL HOSPITAL JACKSON, MISSISSIPPI
Date & Time Post-Op Inpatient General Orthopedic Page 1 of 5 Pharmacy Mnemonic: POIGOP1 1. Admit as inpatient to Dr. 2.Diagnosis: 3.Admit to PACU and then to floor ICU 4.Radiology: AP Pelvis in PACU AP
More informationWHS POSTOPERATIVE POWERPLAN CHANGES
Medications simplified and standardized to improve safety and effectiveness in the management of pain, itching, nausea/vomiting. Management: o The Anesthesiologist will continue to manage pain in the PACU.
More informationFAST TRACK MANAGEMENT OF PANCREATIC CANCER
FAST TRACK MANAGEMENT OF PANCREATIC CANCER Jawad Ahmad Consultant Hepatobiliary Surgeon University Hospital Coventry and Warwickshire NHS Trust Part 1. Fast Track Surgery for Pancreatic Cancer Part 2.
More informationDO DRAINS HELP OR HURT IN HPB SURGERY? Henry A. Pitt, M.D. Chief Quality Officer Temple University Health System July 23, 2017
DO DRAINS HELP OR HURT IN HPB SURGERY? Henry A. Pitt, M.D. Chief Quality Officer Temple University Health System July 23, 217 DISCLOSURES Henry A. Pitt has nothing to disclose Leader of the ACS-NSQIP HPB
More informationForm 1: Demographics
Form 1: Demographics Case Number: *LMRN: *DOB: / / *Gender: Male Female *Race: White Native Hawaiian/Other Pacific Islander Black or African American Asian American Indian or Alaska Native Unknown *Hispanic
More informationSETTING Fudan University Shanghai Cancer Center. RESPONSIBLE PARTY Haiquan Chen MD.
OFFICIAL TITLE A Phase Ⅲ Study of Left Side Thoracotomy Approach (SweetProcedure) Versus Right Side Thoracotomy Plus Midline Laparotomy Approach (Ivor-Lewis Procedure) Esophagectomy in Middle or Lower
More informationDemographics. MBSAQIP Case Number: *ACS NSQIP Case Number: *LMRN: *DOB: / / *Gender: Male Female
Demographics MBSAQIP Case Number: *IDN: *ACS NSQIP Case Number: Name: *LMRN: *DOB: / / *Gender: Male Female *Race: White Black or African American American Indian or Alaska Native Native Hawaiian/Other
More informationTransplant Surgery. Patient Education Guide to Your Kidney/Pancreas Transplant Page 9-1. For a kidney/pancreas transplant. Before Your Surgery
Patient Education Page 9-1 Transplant Surgery For a kidney/pancreas transplant By the time you have your transplant surgery, you may have been waiting for some time. Reading this chapter before surgery
More informationOrders OR 1 Vulvectomy Post-op Orders
Orders OR 1 Vulvectomy Post-op Orders Immediate Post-op Admit to 8B Service: Attending: Diagnosis: S/P Complete Radical Vulvectomy Condition: Stable Allergies: Activity: Complete bedrest, do not elevate
More informationHaving an operation on the pancreas
Having an operation on the pancreas Let us assume you (the reader) are going to have a pancreatic resection. The following section attempts to answer some of the questions you may have in mind, and the
More informationPancreaticoduodenectomy
Pancreaticoduodenectomy A Valuable Surgery Paul Montero PGY-III September 11, 2006 Overview Brief History Perils of Early Pancreaticoduodenectomy (PD) Improvements Quality of Life after PD Widened Indications
More informationWhat to do and not do before seeking surgical consultation for a patient with suspected pancreatic cancer
What to do and not do before seeking surgical consultation for a patient with suspected pancreatic cancer 9 Th Annual Symposium on Gastrointestinal Cancers, St. Louis University School of Medicine Carlos
More informationAPPLYING ENHANCED RECOVERY PRINCIPLES: EARLY TESTING IN UPPER GI CANCER
APPLYING ENHANCED RECOVERY PRINCIPLES: EARLY TESTING IN UPPER GI CANCER William Allum Consultant Surgeon, Royal Marsden NHS Foundation Trust ? POSSIBLE Major procedure Painful Anastomotic complications
More informationManagement of Pancreatic Islet Cell Tumors
Management of Pancreatic Islet Cell Tumors Ravi Dhanisetty, MD November 5, 2009 Morbidity and Mortality Conference Case Presentation 42 yr female with chronic abdominal pain. PMHx: Uterine fibroids Medications:
More information1. Epidemiology of Esophageal Cancer 2. Operative Strategies 3. Minimally Invasive Esophagectomy 4. Video
Minimally Invasive Esophagectomy Guilherme M Campos, MD, FACS Assistant Professor of Surgery Director G.I. Motility Center Director Bariatric Surgery Program University of California San Francisco ESOPHAGEAL
More informationDepartment of Hepatobiliary and Pancreatic Surgery About Pancreatic Surgery A guide for patients and relatives
Department of Hepatobiliary and Pancreatic Surgery About Pancreatic Surgery A guide for patients and relatives page 2 This booklet has been written to provide information about the surgical procedures
More informationERAS. Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic
ERAS Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic Outline Definition Justification Ileus Pain Outline Specifics Data BMC Data Worldwide Data Implementation What is ERAS? AKA Fast-track
More informationEarly Recovery after Surgery (ERAS):
Early Recovery after Surgery (ERAS): Applying Consistently What We ve Known for 20 Years Dr. Kurt Heiss, MD Objectives Laying Foundation: Who, Why Explore Components: What Start a Program: How and When
More informationJOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES
JOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES THE PROBLEM DUODENAL / PANCREATIC INJURIES Difficult to diagnose Not very common Anatomic and physiologic challenges 90% rate of associated
More informationHenry A. Pitt, M.D., F.A.C.S. Chief Quality Officer Temple University Health System July 23, 2018 Orlando, Florida
Are All OSIs Pancreatic Fistulas? Henry A. Pitt, M.D., F.A.C.S. Chief Quality Officer Temple University Health System July 23, 2018 Orlando, Florida DISCLOSURES Leader, ACS-NSQIP HPB Collaborative Hepatectomy
More informationGENERAL SURGICAL ADULT POST-OPERATIVE ORDERS 1 of 4
down ADULT POST-OPERATIVE 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Admit to: Post Anesthesia Care Unit (PACU),
More informationProof 2. CLINICAL PATHWAY PLAN CLINIQUE GENERAL SURGERY CHIRURGIE GÉNÉRAL Enhanced Recovery After Surgery (ERAS) Bowel Surgery /
CLINICAL PATHWAY PLAN CLINIQUE GENERAL SURGERY CHIRURGIE GÉNÉRAL Enhanced Recovery After Surgery (ERAS) Bowel Surgery / Proof 2 Addressograph/Plaque Cancer Assessment Clinic (CAC) Date: yyaa mm dj Day
More informationA high-volume surgical unit experience with enhanced recovery after surgery (ERAS)
A high-volume surgical unit experience with enhanced recovery after surgery (ERAS) Catalina Mosquera, Nicholas J. Koutlas, Nasreen A. Vohra, Emmanuel E. Zervos, Timothy L. Fitzgerald East Carolina University,
More informationARROCase: Borderline Resectable Pancreatic Cancer
ARROCase: Borderline Resectable Pancreatic Cancer Resident: Jordan Kharofa, MD Staff: Beth Erickson, MD 8/2012 Medical College of Wisconsin Department of Radiation Oncology Case Presentation: 60 year old
More informationPancreas Quizzes c. Both A and B a. Directly into the blood stream (not using ducts)
Pancreas Quizzes Quiz 1 1. The pancreas produces hormones. Which type of hormone producing organ is the pancreas? a. Endocrine b. Exocrine c. Both A and B d. Neither A or B 2. Endocrine indicates hormones
More informationKaiser Oakland Urology
Kaiser Oakland Urology What is Laparoscopy? Minimally invasive surgical alternative to standard surgery How is Laparoscopy Performed? A laparoscope and video camera are used to visualize internal organs
More information9/21/15. Joshua Pruitt, MD, FAAEM Medical Director, LifeGuard Air Ambulance Iowa PA Society Fall CME Conference September 29, 2015
Unless they prove otherwise. ~Every ED attending ever Joshua Pruitt, MD, FAAEM Medical Director, LifeGuard Air Ambulance Iowa PA Society Fall CME Conference September 29, 2015 AAA with rupture Mesenteric
More informationCholangiocarcinoma (Bile Duct Cancer)
Cholangiocarcinoma (Bile Duct Cancer) The Bile Duct System (Biliary Tract) A network of bile ducts (tubes) connects the liver and the gallbladder to the small intestine. This network begins in the liver
More informationPEDIATRIC SPINE SURGERY POST-OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert IV to INT when tolerating
More informationGeneral. Code Status (Single Response) ( ) Full Code Details ( ) Full code - unverified Details ( ) DNRCC Allow additional therapies?
Post Operative Above and Below Knee Amputation Admission [3041300028] Consider adding Insulin Adult -- Subcutaneous Insulin and Hypoglycemia Management [3041300000] General Admission (Single Response)
More informationIndex (SIRS), 158, 173
Index A Acute pancreatitis surgery abdominal compartment syndrome, 188 adjuvant treatment, 194 anterior approach, 175 antibiotic prophylaxis, 166 167, 197 Atlanta classification, 181 classification of
More informationLAPAROSCOPIC PYELOPLASTY
LAPAROSCOPIC PYELOPLASTY Urology Clinic GW Medical Faculty Associates The George Washington University 2150 Pennsylvania Avenue, NW Washington, DC 20037 PURPOSE. Laparoscopic Pyeloplasty is a minimally
More informationThe Surgical Patient. Objectives:
The Surgical Patient Objectives: 1. Discuss the effect of surgery on the body systems. 2. Explain the etiological factors, nursing assessment, and management of potential problems during the postoperative
More informationBaptist Health Lexington. ERAS Protocols
Baptist Health Lexington ERAS Protocols Enhanced Recovery After Surgery BHLex Colorectal ERAS Protocol Preoperative Patient/Family Education: PAT and office, ERAS brochure & educational flyer/checklist
More informationENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAYS PARESH C. SHAH MD FACS VICE CHAIR OF SURGERY DIRECTOR OF GENERAL SURGERY
Department of Surgery Divison of General Surgery ENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAYS PARESH C. SHAH MD FACS VICE CHAIR OF SURGERY DIRECTOR OF GENERAL SURGERY December 2016 Disclosure Paresh
More informationPancreaticoduodenectomy the anatomy and the surgical approaches
Pancreaticoduodenectomy the anatomy and the surgical approaches Paul BS LAI Division of Hepato biliary and Pancreatic Surgery Department of Surgery The Chinese Univesity of Hong Kong Whipple s operation
More informationHip Hemiarthroplasty Post Op Version 2 4/20/17
Patient Name: Diagnosis: Allergies with reaction type: Hip Hemiarthroplasty Post Op Version 2 4/20/17 Patient Placement General Diagnosis/Procedure: Preferred Location/Unit Ortho/Neuro PCU ICU General
More information5/17/2013. Pancreatic Cancer. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Case presentation. Differential diagnosis
Overview Case presentation Postgraduate Course in General Surgery Differential diagnosis Diagnosis and therapy Eric K. Nakakura Koloa, HI March 26, 2013 Outcomes CASE 1: CASE 1: A 78-year-old man developed
More informationOperational Efficiency in Colon Surgery Enhanced Recovery Pathways: 23 hour laparoscopic colectomy
Enhanced Recovery Pathways: 23 hour laparoscopic colectomy Conor P. Delaney MD MCh PhD Chairman, Digestive Disease Institute Professor of Surgery, Cleveland, Ohio Disclosure Slide Conor Delaney MD PhD
More information1. Attending Physician: Resident/Fellow: 2. Consult
COLON POST OP PLAN A UMC Health System Performance Improvement Initiative for use in all units where surgical patients receive care in support of Surgical Care Improvement Program (SCIP). * Denotes guideline
More informationr*po1004*r PHYSICIAN S ORDERS Page 1 of 7 HOUR THORACOTOMY POSTOPERATIVE ORDERS General x Admit to Inpatient Status x Admitting Physician: Admit to:
PHYSICIAN S ORDERS Page 1 of 7 General x Admit to Inpatient Status x Admitting Physician: Admit to: SICU Telemetry Med/Surg room x Resuscitation status: see Resuscitation Status Order Activity x Bed rest
More information7/31/2015. Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice. Objectives. Enhanced Recovery Society
Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice Margaret Odhner MS, ANP-BC, COCN Kim Meacham, MSN FNP-C, CWON Objectives 1. Describe the Enhanced Recover After Surgery (ERAS) pathway.
More informationADMIT DIABETIC KETOACIDOSIS (DKA) PLAN - Phase: Begin Immediately/Emergency Center
- Phase: Begin Immediately/Emergency Center Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Requested Location: MICU, Pt Status: Inpatient (LOS > 2 midnights) Requested Location: 5E
More informationIR Central Venous Access [ ] Pre Procedure
IR Central Venous Access [1050200001] Pre Procedure Case Request/Scheduling Procedure Enter IR Case Request if not already completed (All hospitals except Grant Medical Center) [ ] Case Request IR Lab
More informationLumbar Fusion. Reference Guide for PACU CLINICAL PATHWAY. All patient variances to the pathway are to be circled and addressed in the progress notes.
Reference Guide for PACU Lumbar Fusion CLINICAL PATHWAY All patient variances to the pathway are to be circled and addressed in the progress notes. This Clinical Pathway is intended to assist in clinical
More informationCARD THORACOTOMY PRE-OP PLAN
CARD THORACOTOMY PRE-OP PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Perform Oral Care Perform night before surgery. Brush teeth with toothpaste, then swish and spit 15 ml chlorhexidine mouth
More informationDisclosures. Dr. Hall is a paid consultant to the American College of Surgeons (ACS) as Associate Director of ACS-NSQIP
Does Routine Drainage of the Operative Bed following Elective Distal Pancreatectomy reduce Complications? An Analysis of the ACS-NSQIP Pancreatectomy Demonstration Project Stephen W. Behrman, MD 1, Ben
More informationTotal Pancreatectomy and Islet Auto Transplantation (TPIAT)
Total Pancreatectomy and Islet Auto Transplantation (TPIAT) Dhiraj Yadav, MD MPH Professor of Medicine Division of Gastroenterology & Hepatology University of Pittsburgh Medical Center PSG Meeting Sept
More informationPOST-OP CARDIAC SURGERY PHYSICIAN S ORDER SHEET USE BALLPOINT PEN ONLY. CARDIAC INTENSIVE CARE UNIT
PHYSICIAN S SHEET Automatically Activate, if not in agreement, cross out and initial Activated by Checking Box ALLERGIES: None known YES Patient s Height: Patient s Weight: ALL MEDICATION and INTRAVENOUS
More informationPEDIATRIC SPINE SURGERY POST-OP PLAN - Phase: Pediatric Spine Surgery General Orders
- Phase: Pediatric Spine Surgery General Orders PHYSICIAN S Diagnosis Weight Allergies Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert
More informationQuality Improvement Updates Foley Discontinuation Protocol Surgical Care Improvement Project
Quality Improvement Updates Foley Discontinuation Protocol Surgical Care Improvement Project Barbara J Martin, RN, MBA Quality Consultant, Center for Clinical Improvement Indwelling Urinary Catheters Insertion,
More information3/28/2012. Periampullary Tumors. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Eric K. Nakakura Ko Olina, HI
Overview Postgraduate Course in General Surgery Case presentation Differential diagnosis Diagnosis and therapy Outcomes Principles of palliative care Eric K. Nakakura Ko Olina, HI March 27, 2012 CASE 1:
More informationStandardized Nurse Activated Protocols (SNAPs)
SNAPs by presenting complaint/problem help nurses initiate care before the patient is seen by a physician. SNAPs should be approved by ED team consensus If patient unstable in any way, immediately notify
More informationTo staple or to sew. Zeng Xuan Hu
To staple or to sew Zeng Xuan Hu Fast Track Surgery Multimodal Rehabilitation Accelerated recovery Accelerated rehabilitation Enhanced recovery Optimize perioperative care by reducing the expected stress
More informationPancreatic Benign April 27, 2016
Department of Surgery Pancreatic Benign April 27, 2016 James Choi Dr. Hernandez Objectives Medical Expert: 1. Anatomy and congenital anomalies of the pancreas and pancreatic duct (divisum, annular pancreas
More informationACS-NSQIP Procedure Targeted Variables: Liver Resection. Thomas A. Aloia, MD, FACS Surgeon Champion
ACS-NSQIP Procedure Targeted Variables: Liver Resection Thomas A. Aloia, MD, FACS Surgeon Champion Goals of the Session Examine the History of PTVs in Liver Surgery Discuss proposed PTVs Additions Subtractions
More informationTotal Hip Replacement Post Op Version 4 4/20/17
Patient Name: Diagnosis: Allergies with reaction type: Total Hip Replacement Post Op Version 4 4/20/17 Patient Placement General Diagnosis/Procedure: Preferred Location/Unit Ortho/Neuro General Medical
More informationStandard Precautions Droplet Precautions Standard Precautions Contact Precautions Droplet Precautions Standard Precautions Neutropenic Precautions
Unique Plan Description: Neurosurgery Subarachnoid Hemorrhage Admission Adult Plan Selection Display: Neurosurgery Subarachnoid Hemorrhage Admission Adult PlanType: Medical Version: 10 Begin Effective
More informationR Sim, D Cheong, KS Wong, B Lee, QY Liew Tan Tock Seng Hospital Singapore
Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2- specific inhibitor as opioid-sparing analgesia in major colorectal resections R Sim,
More informationGENERAL SURGERY PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom Privileges
More informationSurgery. Patient Education Transplant Services. For a kidney/pancreas transplant
Patient Education Surgery For a kidney/pancreas transplant By the time you have surgery, you may have been waiting for some time. It will help to read this section before surgery so you will know what
More informationAdvances in Joint Replacement
Advances in Joint Replacement Seth Greenky, MD Chairman, Musculoskeletal Services, St. Joseph s Hospital Partner, Syracuse Orthopedic Specialists Associate Clinical Professor, Upstate Medical Center CoMedical
More informationTotal Hip Replacement: Your Guide to Preparation and Recovery
Total Hip Replacement: Your Guide to Preparation and Recovery Table of Contents Preparing For Your Surgery...................... 1 During Your Hospital Stay...................... 6 After Surgery.............................
More informationChronic Pancreatitis: Surgical Options. W. Charles Conway MD, FACS Upper GI/HPB Surgical Oncology Ochsner Medical Center New Orleans, LA
Chronic Pancreatitis: Surgical Options W. Charles Conway MD, FACS Upper GI/HPB Surgical Oncology Ochsner Medical Center New Orleans, LA Chronic Pancreatitis Recurrent, debilitating abdominal pain with
More informationADULT TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) TELEMETRY BED TRANSFER ORDERS 1 of 4
TELEMETRY BED TRANSFER 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Transfer to: 10 South Attending Physician: Diagnosis:
More informationDetermining the Optimal Surgical Approach to Esophageal Cancer
Determining the Optimal Surgical Approach to Esophageal Cancer Amit Bhargava, MD Attending Thoracic Surgeon Department of Cardiovascular and Thoracic Surgery Open Esophagectomy versus Minimally Invasive
More informationOutpatient Total Knee Arthroplasty: Anesthetic Implications
Outpatient Total Knee Arthroplasty: Anesthetic Implications Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of Orthopedic Anesthesia Disclosures None Objectives Examine current
More informationAlberta Surgical Fractured Hip Care Pathway Version 3: Last Updated February 9, 2018
Alberta Surgical Fractured Hip Care Pathway Assessment / Pain Mngmt EMS Transport Neurovascular assessment Vital signs Pain assessment Splint only (no traction) Position of comfort Start IV and use appropriate
More informationGastrointestinal Feedings Post Op: What s the deal on beginning oral feedings?
Gastrointestinal Feedings Post Op: What s the deal on beginning oral feedings? Kate Willcutts, DCN, RD, CNSC University of Virginia Health System Charlottesville, VA kfw3w@virginia.edu Objectives 1. Discuss
More informationPreoperative Workup for Pulmonary Resection. Kristen Bridges, M.D. Richmond University Medical Center January 21, 2016
Preoperative Workup for Pulmonary Resection Kristen Bridges, M.D. Richmond University Medical Center January 21, 2016 Patient Presentation 50 yo male with 70 pack year smoking history Large R hilar lung
More informationStellenwert der prä- und postoperativen Sicht des Chirurgen
Interdisziplinäre Chirurgie Stellenwert der prä- und postoperativen Ernährung Sicht des Chirurgen Kantonsspital Luzern 24.11.2005 Prof. L. Krähenbühl Chirurgische Klinik Hôpital Cantonal Fribourg Problems
More informationGeneral Surgery Service
General Surgery Service Patient Care Goals and Objectives Stomach/Duodenum and Bariatric assessed for a) Obesity surgery b) Treatment of i) Adenocarcinoma of the stomach ii) GIST iii) Carcinoid 2) Optimize
More information