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