1.
TUMORS OF THE HEAD
OF THE PANCREAS
 Sixty to eighty percent of pancreatic tumors occur in the head of the
pancreas.
 The tumors producing the obstruction may arise from the pancreas,
the common bile duct.
 The obstructed flow of bile produces jaundice, clay-colored stools, and
dark urine.
 Malabsorption of nutrients and fat-soluble vitamins may result from
obstruction by the tumor to entry of bile in the gastrointestinal tract.

2.
 Abdominal discomfort or pain and pruritus may be noted, along with
anorexia, weight loss, and malaise.
 If these signs and symptoms are present, cancer of the head of the
pancreas is suspected.
 The jaundice of this disease must be differentiated from that due to a
biliary obstruction caused by a gallstone in the common duct, which is
usually intermittent and appears typically in obese patients, most often
women, who have had previous symptoms of gallbladder disease.

3.
Assessment and Diagnostic Findings
 Diagnostic studies may include duodenography, angiography by
hepatic or celiac artery catheterization, pancreatic scanning,
percutaneous transhepatic cholangiography, ERCP, and percutaneous
needle biopsy of the pancreas.
 Results of a biopsy of the pancreas may aid in the diagnosis.

4.
Medical Management
 Diet high in protein along with pancreatic enzymes is often prescribed.
Preoperative preparation includes adequate hydration, correction of
prothrombin deficiency with vitamin K, and treatment of anemia to
minimize postoperative complications.
 Parenteral nutrition and blood component therapy are frequently
required.

5.
 A biliary-enteric shunt may be performed to relieve the jaundice and,
perhaps, to provide time for a thorough diagnostic evaluation.
 Total pancreatectomy (removal of the pancreas) may be performed if
there is no evidence of direct extension of the tumor to adjacent tissues
or regional lymph nodes.
 A pancreaticoduodenectomy (Whipple’s procedure or resection) is
used for potentially resectable cancer of the head of the pancreas

6.
 This procedure involves removal of the gallbladder, distal portion of
the stomach, duodenum, head of the pancreas, and common bile duct
and anastomosis of the remaining pancreas and stomach to the
jejunum.
 The result is removal of the tumor, allowing flow of bile into the
jejunum.
 When the tumor cannot be excised, the jaundice may be relieved by
diverting the bile flow into the jejunum by anastomosing the jejunum
to the gallbladder, a procedure known as cholecystojejunostomy.

7.
Pancreatoduodenectomy
(Whipple’s procedure or resection). End
result
of the resection of the carcinoma of the
head of the pancreas or the ampulla of Vater.
The common duct is sutured to the end of
the jejunum, and the remaining portion of
the pancreas and the end of the stomach are
sutured to the side of the jejunum.

8.
 Hemorrhage, vascular collapse, and hepato renal failure remain the
major complications of these extensive surgical procedures.
 A nasogastric tube and suction and parenteral nutrition allow the
gastrointestinal tract to rest while promoting adequate nutrition.
 Thanking you.