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Q1: Courvoisier and clinical patterns (2 min)
- Painless progressive jaundice + palpable non-tender GB → malignant distal obstruction until proven otherwise
- Head: jaundice early; body/tail: pain, weight loss, late
- Trousseau migratory thrombophlebitis; new-onset diabetes
Q2: Work-up (2 min)
- Pancreas-protocol multiphase CT first-line staging
- CA 19-9 (false low in Lewis-negative; interpret after drainage)
- EUS-FNA for tissue before chemo/non-surgical Rx
- MRCP anatomy; staging laparoscopy if high CA 19-9/borderline
Q3: Resectability language (2 min)
- Resectable: no arterial contact, patent SMV-PV, no mets
- Borderline: limited venous involvement reconstructible; limited arterial abutment definitions per NCCN
- Locally advanced: >180° arterial encasement; metastatic = unresectable for cure
Q4: Whipple detail (3 min)
- Resection list + three anastomoses (PJ, HJ, GJ)
- Complications: POPF, DGE, haemorrhage, bile leak
- Sentinel bleed after POPF → urgent angio for GDA stump pseudoaneurysm
- Centralisation: mortality <3–5% high-volume vs higher low-volume
Q5: Systemic therapy (3 min)
- Adjuvant fit: mFOLFIRINOX (PRODIGE 24)
- Metastatic fit: FOLFIRINOX (PRODIGE 4/ACCORD 11); else gem + nab-paclitaxel
- Supportive: PERT, stents, coeliac plexus block, VTE management
Q6: Genetics (2 min)
- KRAS >90%; CDKN2A, TP53, SMAD4 common
- Germline BRCA/PALB2/Lynch — therapeutic and family implications
- Chronic pancreatitis, smoking, obesity, new DM as risks
Q7: Differential of pancreatic head mass (2 min)
- Chronic pancreatitis, AIP (IgG4, sausage gland), ampullary ca, distal CCA, lymphoma, metastasis
Q8: Operative complications detail (2 min)
- POPF grades A to C; drain amylase
- Delayed gastric emptying common after Whipple
- Early vs late haemorrhage; angiography for pseudoaneurysm
- Need for high-volume centre and MDT