Preoperative Investigation and Preparation for the Procedure

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History: Search for a history of pancreatic trauma and previous/current alcohol abuse, chronic abdominal pain, steatorrhea, diabetes, family history of pancreatitis or pancreatic cancer, and usage of pain medication.

- If narcotic/alcohol dependency is active, encourage commitment to undergo detoxification in a controlled chemical dependency unit postoperatively.

Clinical evaluation: Abdominal tenderness or mass, splenomegaly (suspect splenic vein thrombosis)

Laboratory tests: CBC, glucose, serum calcium, triglycerides

Imaging: - CT, MRI or EUS: Assess the extent of parenchymal disease

(should be confined to body/tail); if splenomegaly and/or gastric varices are present-suspect splenic vein thrombosis.

- ERCP: Evaluate for a mid pancreatic ductal stricture and an intrapancreatic biliary stricture.

Preoperative - If splenectomy is planned, immunize with pneumococcal considerations: vaccine, Haemophilus influenzae type b vaccine, and meningo coccal vaccine 2weeks preoperatively.

- Entertain use of an epidural catheter for postoperative pain control (preoperative narcotic dependence is a relative contraindication, because the patient will need systemic levels of the narcotic).

- DVT prophylaxis with sequential compression devices and/or subcutaneous heparin (check with anesthesia regarding policy on heparin in patients with postoperative epidural analgesia).

- Prophylactic intravenous antibiotics are given 30min prior to incision.

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Alcohol No More

Alcohol No More

Do you love a drink from time to time? A lot of us do, often when socializing with acquaintances and loved ones. Drinking may be beneficial or harmful, depending upon your age and health status, and, naturally, how much you drink.

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