Head - Whipple

Neck, body-central

Tail - distal pancreatectomy

Liver Metastasis (Biopsy to diagnose)

Single lobe disease

Diffuse disease

Single lobe disease

Lesion Resection if surgical

Not found candidate

Duodenotomy and Exploration, ± Blind Whipple

If not surgical candidate

Chemoembolization Cytotoxics Interferon Octreotide

1. Excise all lymph nodes in peripancreatic and periduodenal areas even if benign appearing.

2. Explore all other unusual locations for second primaries.

FIGURE 26-1. Algorithm for management of gastrinoma. IOUS = intraoperative ultrasonography.

with biochemically proven sporadic gastrinoma should undergo exploration even if localization tests fail to identify a tumor.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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