Transplant and Hepato-Pancreato-Biliary (HPB) Institute

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   Transplant and Hepato-Pancreato-Biliary (HPB) Institute

Kidney-Pancreas Transplant

About St. Vincent Kidney-Pancreas Transplant Institute

St Vincent Pancreas Transplant Institute has been caring for the Los Angeles population since 1975 and continues to serve outlying cities from the Central Valley to San Diego and from the coast to Palm Springs.

Program Directors

The Multidisciplinary Team

In order to successfully guide you through the process, we have a full team of specialists to meet all of your medical and social needs. These include:

  • Transplant Surgeon
  • Transplant Nephrologists
  • Transplant Coordinators
  • Social Workers
  • Registered Dieticians
  • Pharmacists
  • Financial Counselors

Our campus is located near downtown Los Angeles with a satellite office in Bakersfield which serves our Central Valley population.

SVMC Building

St. Vincent Medical Center

2131 West Third Street
Los Angeles, CA 90057
(213) 484-7111
SVMCInfo@verity.org

Campus Map | Parking


Monday - Friday | Open 24 hours
Saturday - Sunday | Open 24 hours

St. Vincent Medical Center is located at the corner of Third and Alvarado streets in downtown Los Angeles.

  • From the South: Take the Harbor 110 Freeway north, exit at Third Street and proceed west approximately two miles to Alvarado Street. The medical center is on the corner of Third and Alvarado streets.
  • From the North: Take the Hollywood 101 Freeway south, exit at Alvarado Street, proceed south on Alvarado 3/4 of a mile. The medical center is on the corner of Third and Alvarado streets.
  • From the West: Take the Santa Monica 10 Freeway to the Harbor 110 Freeway north, exit at Third Street and proceed west approximately two miles to Alvarado Street.
  • From the East: Take the San Bernardino 10 Freeway to the Harbor 110 Freeway north exit at Third Street and proceed west approximately two miles to Alvarado Street.
Bakersfield building

Bakersfield Satellite

8501 Camino Media, Suite 100
Bakersfield, CA 93311
(661) 665-1500


Monday - Friday | 8 AM - 3 PM
Saturday - Sunday | Closed

The Transplant Process

The combined kidney and pancreas transplant surgery is indicated for patients who are on dialysis, but who are also diabetic and on insulin. The specifics of which dialysis dependent diabetics qualify for kidney and pancreas transplant are:

  • You must be insulin dependent
  • You should not be over weight (weight assessment on individual basis)
  • Your insulin requirements must be in excess (determined by your physicians)
  • Your doctors will have carefully assessed your condition and deemed your condition suitable for the pancreas surgery

In order to undergo pancreas transplantation, a number of steps and procedures must be followed to ensure a successful transplant process. These steps include:

  • 1. Referral

    Patients are usually referred to us by their nephrologist or endocrinologist. We do accept self-referrals! Patients are encouraged to seek transplant evaluation as soon as diagnosed with moderate hepatic insufficiency. This is to establish records, perform the appropriate workup, and proceed with transplant listing.

    Referral
  • 2. Workup

    The Work up Process

    After successfully completing your initial pre-transplant evaluation, your transplant coordinator will begin scheduling appointments for testing and procedures needed prior to transplant. Some of these tests or procedures will need to be updated annually. Your transplant coordinator will notify you when a test or procedure needs to be updated. It is important to keep up with your tests and procedures so that you can be transplanted when you get the call.

    The combined kidney and pancreas transplant surgery is indicated for patients who are dialysis dependent but are also diabetic and on insulin. The specifics of which dialysis dependent diabetics qualify for and pancreas are:

    • You must be insulin dependent
    • You should not be over weight (weight assessment on individual basis)
    • Your insulin requirements must be in excess (determined by your physicians)
    • Your doctors will have carefully assessed your condition and deemed your condition suitable for the pancreas surgery

    Required Testing

    • Simple blood tests including blood typing
    • EKG
    • Chest x-ray
    • Dental exam
    • Abdominal Ultrasound
    • Coronary Angiogram (for all patients over 45, diabetic, or risk factors/history of heart disease)
    • Cardiology consult (if you have risk factors, are diabetic or over age 45)
    • Colonoscopy (for all patients over the age of 50)
    • Mammogram and Pap smear for all women over the age of 40
    • Recent Prostate Specific Antigen (PSA) for all men over the age of 40
    blood tests
  • 3. Patient Selection Committee

    All patients will be presented at the Patient Selection Committee Meeting (PSC) after they have completed all their testing and have been seen by the multidisciplinary transplant team.

    The purpose of the PSC is to review the results of testing, discuss visits with the multidisciplinary team, and to determine if they qualify for placement on the transplant wait list.

    The results of the PSC discussion will be conveyed to the patient and referring physician within 10 days.

    patient selection
  • 4. Listing

    If you are approved and cleared by the multidisciplinary team in PSC, you will be added to the National Waiting List for pancreas transplant. You will be placed on the waiting list based on your blood type and antibody test.

    The national organ waiting list is managed by an organization called the United Network for Organ Sharing (UNOS), a private, nonprofit agency that works with the federal government. UNOS keeps track of all the people in the United States who need pancreas transplants, and matches them with donors.

    If you are not approved for listing at the time of PSC, your transplant coordinator will explain any additional testing or requirements to get you listed for transplant. On some occasions, you may not qualify for transplant. Your coordinator will explain in detail as well as send a letter to your primary doctor explaining the reasons you cannot be transplanted at this time.

    patient waiting
  • 5. Day of Transplant

    When receiving a combined kidney and pancreas transplant, both the kidney and pancreas come from the same donor. Both the kidney and pancreas will have been prepared by your doctor before you enter the operating room. This preparation usually takes 2-3 hours.

    If the organs are suitable, you will be escorted into the operating suite. The anesthesiologist will greet and evaluate you there. The process of anesthesia and IV line placement can be approximately 1-2 hours depending on your general health condition.

    During surgery, a catheter will be placed into your bladder to drain urine. This catheter in generally removed 3 or 4 days after surgery. On rare occasions, depending on your condition, the catheter may be left in place. You will have a voiding trial (test to make sure you can pass urine) later at the clinic before the catheter is taken out.

    The surgeon will make an 8-10 inch midline incision from below your chest to right above your pubic bone. In general, the pancreas is placed on the right side of your abdomen and the kidney is placed on the left side of your abdomen. Your own pancreas and kidneys are not removed during this surgery.

    Your pancreas has complex connections to your blood vessels and intestines. The pancreas is connected to the blood vessels that lead to your right thigh. The pancreas also has a drainage tube, through which a fair amount of digestive juices are produced. This new pancreas, like your own pancreas, will continue to make digestive juices. The tube draining it will need to be connected to your intestines or less preferably to your urinary bladder for drainage.

    The decision as to where your pancreas should drain will depend on your anatomy and the general condition of your intestines. Many times, there is no clear choice until surgery has begun.

    The kidney and pancreas transplant surgery will take between 4-6 hours. At the end of surgery, your kidney will have started to function and your pancreas will have started to normalize your blood glucose levels. You will leave the operating room with a tube to drain your stomach inserted through the nose and a catheter in your bladder to drain urine.

    happy patient in bed

    Getting the Call

    Once you have received a call from the coordinator and you have accepted the organ offer, you will then be instructed to arrive at St Vincent as soon as possible. Please drive to St Vincent with as many important members of your family as necessary.

    Your coordinator will ask you the following questions:

    • What time did you last eat or drink anything?
    • When was your last dialysis session?
    • Have you had any recent admissions to the hospital or new health problems?
    • Have there been any changes to your life situation (ie, support, financial, or emotional states that may impact your post-transplant care

    Once these questions have been answered, you coordinator will instruct you not to eat or drink anything and come to the hospital. If you are diabetic, please inform the coordinators so that instruction about medication dosing can be given. You should bring all current medications and a bag with a set of clothes and other essentials for hospital admission.

    Arrival to the Hospital

    We strive to proceed with transplant ASAP, however we realize there may be need for further evaluation and or need for dialysis. You will be directed to Admissions and then the floor for nursing assessment, have some additional testing done including blood work, EKG, and chest xray, and any other testing that needs to be updated since your last clinic visit. You may require dialysis prior to your transplant. The transplant surgeon will order dialysis if needed.

    On arrival to the hospital, you will be greeted by your surgeon. He will prefer to speak to you and your family members about the details of the process, including risks and benefits.

    happy patient getting phone call

    kidney transplantation prep
    Surgeons preparing the donor kidney for transplantation

    The Transplant Operation

    You will receive the kidney and pancreas from the same donor.

    Both the kidney and pancreas will have been prepared by your doctor before you enter the operating room. This prep work usually takes 2-3 hours.

    If the organ is suitable, you will be escorted into the operating suite. The anesthesiologist will greet and evaluate you. The process of anesthesia and IV line placement can be an interval of 1-2 hours depending on your general health condition. During surgery, a catheter will be placed into your bladder to drain urine. This catheter in generally removed on post-op day 3-4. On rare occasions, depending on your condition, the catheter may be left in place. You will have a voiding trial later at the clinic prior to removal.

    An 8-10 inch midline incision from below your chest to right above your pubic bone is made. In general, the pancreas is placed on the right and the kidney is placed on the left side of your abdomen. Your own pancreas and kidneys are not removed.

    Your pancreas has a complex blood vessel anatomy. The pancreas is connected to the blood vessels that lead to your right thigh. The pancreas also has a drainage tube, through which a fair amount of digestive juices are produced. This new pancreas, like your own pancreas, will continue to make digestive juices. The tube draining it will need to be connected to your intestines or less preferably to your urinary bladder for drainage. The decision as to where your pancreas should drain will depend on your anatomy and the general condition of your intestines. Many times, there is no clear choice until surgery has begun.

    The surgery will take between 4-6 hours. At the end of surgery, your kidney will have started to function and your pancreas will have started to normalize your blood glucose levels.

    You will leave the operating room with a tube to drain your stomach inserted through the nose and a catheter in your bladder to drain urine.

  • 6. Post-Transplant

    After successfully receiving a transplant, our job is not done. A transplanted organ requires periodic maintenance and follow-up care to make sure both the organ and the patient continue to thrive!

    • Hospital Recovery

      Once surgery is complete, you are then awakened and transported to the recovery room or directly to the Intensive Care Unit (ICU), which is located on the 4th floor.

      Your surgeon will have spoken to your family and they should be able to visit you within 1-2 hours of arriving at the ICU, Once your doctors consider your condition stable they will then transfer you to the 5th or 7th floor.

      In general by now you will be free from most IV lines and allowed to eat and ambulate. During surgery a catheter will be placed into your bladder to drain urine. This catheter is removed on post op day 3-4. On rare occasion depending on your condition- the catheter may stay longer or you may even be sent home with a catheter to have a voiding trial later at the clinic.

      By post-op day 4-5 you are ready for discharge. Instructions include:

      • Avoiding excess water intake.
      • Avoiding any food products with high potassium.
      • Resuming diabetic diet and care if diabetic.
      • Appropriate precautions for infection control.

      Possible complications following kidney/pancreas transplant include:

      • Clot in the pancreas or kidney: Usually noted within the first 24-48 hours post-op, and can present with sudden abdominal pain and an acute rise in your blood sugars. The treatment for this condition is unfortunately removal of the pancreas or kidney, and we are not able to salvage an organ under these circumstances. You may in the future qualify for a second transplant.
      • A break in the suture line of the bowel or bladder: This suture line break down leads to leakage of stool in the case of bowel drainage or urine and pancreatic juice. Both complications require urgent repair, which may or may not be successful, and may lead to multiple surgeries and/or eventual pancreas removal.
      • Delayed Graft function: Sometimes the transplanted kidney may not function immediately, and occurs in approximately 30-50 percent of deceased donor kidneys and less than 10% of live related or non-related kidneys. During this delay, the kidney is either making little urine or no urine at all, and you may need dialysis. Sometimes you may be discharged home on dialysis as we monitor improvement in your kidney function over time.
      • Post-op pain
      • Post-op bleeding requiring blood transfusion
      • Infections that may include large abscesses which require wash out procedures and placement of drains.
      • Urine leakage from the bladder suture line, for which you will be taken back to surgery for an attempt at correction.
      • Hernia formation requiring surgical intervention.

      We advise all patients interested in pancreas transplant there may be up to 30% chance of a second surgical procedure to repair or possibly remove the kidney and/or pancreas. The rate of pancreas clot nationally is 1-5% and we are proud to have better than expected pancreas results at St. Vincent.

      nurse and doctor talking to patient
    • Discharge from Hospital

      Going Home from Transplant

      During your admission to the hospital for pancreas transplant, the transplant coordinator will meet with you and your designated caregivers to discuss and educate you about how to take care of your new organ. A log book and manual will be given during your first teaching session.

      You will be taught to monitor for:

      • Signs and symptoms of rejection or infection
      • How to record your weight, urine output, blood pressure, heart rate, and temperature
      • The education sessions take place immediately after transplant, throughout your hospital stay, and upon discharge.

      Medications

      A transplant Pharmacist will review all of your new life-long medications to prevent rejection. All other medications you are taking will also be reviewed with you before discharge.


      discharged happy

      24-Hour Nursing Care

      A nurse is available 24 hours a day, 7 days per week including weekends and holidays. They can be reached at (213) 484-5551. The nurse can answer any questions you have related to transplant and call your doctors with any urgent needs.

      nursing care on call
    • The First 90 Days

      After leaving the hospital, you will follow up in the transplant clinic closely, as frequently as daily until you are stabilized. Labs are done every clinic visit in the morning before you take your medications. The transplant team will monitor your lab results, urinary output, vital signs, and incision closely to assure no complications arise.

      What to bring to your clinic visit

      • Your log book (tracks urine output, vital signs, and blood sugar if necessary)
      • Medication list
      • All your medication bottles
      • Snacks, comfort items (pillow, blanket, books, etc) while you are waiting

      At the end of your clinic visit, your transplant coordinator will review any medication changes and provide a new medication list, prescriptions and lab orders for the next visit. It may be necessary to call you at home with lab results. Keep your medication list with you and be prepared to write down any changes to your medications.

    • The First 5 Years

      Once you are more stable, you will be seen less frequently in the transplant clinic. You will need to follow up with your primary doctor 90 days after transplant and regularly after that. Your primary doctor will manage any related health issues such as high blood pressure and diabetes, and your regular annual health exam and cancer screenings. You will also need to follow up with any specialist physicians regularly such as Endocrinology and Cardiology.

      What to bring to clinic

      • Medication list
      • Any new medications or changes prescribed by another doctor
      • Any requests or orders from your primary or other doctor(s)
    • Five Years and Beyond

      Your transplant doctors will continue to watch for any signs of problems with your pancreas. These can include:

      1. Chronic Rejection: this occurs when your transplanted pancreas slowly stops working. Usually, this type of damage may be caused by your immune system attacking the organ. Sometimes, other issues such as high blood pressure, diabetes, high cholesterol, or high levels of immunosuppressants, or the original cause of your pancreas disease, may also slowly damage your new organ.

      2. Some of the most common symptoms of rejection include:

        • Fever
        • Tenderness over the pancreas
        • Elevated pancreas function tests and blood sugars
        • High blood pressure
        doctor looking through microscope
        A needle biopsy may be needed to find the reasons for ongoing problems with the pancreas transplant. Possible treatments for chronic rejection include different types of immunosuppression, steroids, or other medications.

      3. Coronary heart disease

      4. Cancers, including skin, breast, vulvar, cervical and colon cancer

Understanding Your Pancreas

Your pancreas is located in your upper abdomen, behind your stomach and on top of your spine. It is divided into 3 parts: the head, which is located next to the small intestine, the body, and the tail, which is close to your spleen.

The pancreas has 2 main functions:

  1. Production of juices to help digest food.
  2. Production of hormones, like insulin.

Pancreas system
Pancreas

Problems with your Pancreas

Diseases of the pancreas can present with a variety of symptoms including abdominal pain, diarrhea, diabetes, or jaundice (yellowing of the eyes and skin).


Animated pancreas
Pancreatitis

Pancreatitis

Pancreatitis occurs when the pancreas becomes inflamed, which can be due to a variety of sources including alcohol use, gallstones, or medications.

  • About Pancreatitis

    What is pancreatitis?

    Pancreatitis is inflammation of your pancreas which can cause leakage of pancreatic fluid into other parts of the pancreas or surrounding areas.

    What are the signs and symptoms of pancreatitis?

    Pancreatitis often presents with sudden severe pain in your upper belly. You may also experience nausea, vomiting, fevers, chills and upper back pain.

    Why do I get pancreatitis?

    The most common causes of pancreatitis are gallstones and alcohol. Other, less common reasons are certain medications and diseases that run in your family. If you have one sudden attack, you have acute pancreatitis. Multiple attacks are called chronic pancreatitis, and lead to permanent damage of your pancreas and its function.

  • Diagnosis of Pancreatitis

    How is pancreatitis diagnosed?

    If you have symptoms of pancreatitis, your doctor may order blood tests or scans of your abdomen. Sometimes you may also need a procedure.

    Blood tests

    • Your doctor may check blood tests to look for an infection and check he function of your liver and pancreas.
    Blood Tests

    Imaging

    • Abdominal Ultrasound to look for gallstones in your gallbladder.
    • CT or MRI scan of your belly (or of the abdomen and pelvis) to look for gallstones and inflammation of the pancreas.
    Imaging

    Procedures

    • An Endoscopic Retrograde Cholangiopancreatography (ERCP) can remove gallstones that cause pancreatitis. Your doctor can perform and ultrasound at the same time called EUS, which can look at your pancreas.
    ERCP
  • Treatment of Pancreatitis

    How is pancreatitis treated?

    • Hospital admission and supportive care
    • Surgery for Pancreatitis

    Hospital Admission

    Some patients with pancreatitis have to be admitted to the hospital. You will receive intravenous fluids and pain medications until your pain has gone away.

    Some patients have more severe episodes of pancreatitis and might spend some time in the intensive care unit. Sometimes the treatment involves not eating which may require a feeding tube through your nose into your intestines until you get better.

     

    Surgery for Pancreatitis

    If you have gallstones, your gallbladder will be removed with an operation called a laparoscopic cholecystectomy after you have recovered from pancreatitis.

    Remove Gallbladder
    Gallbladder

    If your pancreas has been severely damaged, you can develop a pocket of fluid or infection which may require an endoscopy procedure or a surgery to drain it.



Darkspots in pancreas

Pancreatic Cysts

Pancreatic cysts are usually benign, but can sometimes lead to problems which require treatment. Some cysts can have the potential to turn into cancer.

  • Pancreatic Cysts

    What are pancreatic cysts?

    Pancreatic cysts are fluid filled masses within the pancreas. They can appear after an attack of pancreatitis, or found on A CT scan. Since some cysts are pre- cancers, accurate diagnosis is very important.

    What are the signs and symptoms of pancreatic cysts?

    Most pancreatic cysts are silent, but patients may experience:

    • Upper belly or back pain
    • Nausea/Vomiting
    • Acute onset of Diabetes

    What is my risk for getting pancreatic cysts?

    Pancreatic Pseudocysts can develop after an attack of pancreatitis. Mucinous Neoplasms of the pancreas have been linked to diabetes and chronic pancreatitis. They are sometimes more common in patients with a family history of pancreatic cancer.

    Pancreas Cyst

    Cysts We Treat

    • Pseudocysts
    • Serous cystadenomas
    • Mucinous Cystic neoplasms (MCN)
    • Intraductal Mucinous Neoplasms (IPMN)
    • Cystic Islet cell tumors
  • Diagnosis of Pancreatic Cysts

    How are pancreatic cysts diagnosed?

    If you have any symptoms of a pancreatic cyst, your doctor will order blood tests and pictures (imaging) of your belly. You will also need a biopsy to confirm the diagnosis.

    Blood tests

    • Blood counts and liver function tests
    • Ca19-9 and CEA levels. These blood tests are called “tumor markers,” and are often ordered, when patients have a “mass” in the pancreas.
    Blood Tests

    Imaging

    • CT or MRI scan of your belly (or of the abdomen and pelvis) to look at the cyst in the pancreas. Often cysts are discovered on a CT scan, which was done for a different reason. This test will allow your doctor to evaluate, if your cyst needs to be removed with surgery
    Imaging

    Procedures

    • Endoscopic Ultrasound (EUS): Your doctor inserts a camera into your intestines through your mouth, so your pancreas can be seen. Usually a needle biopsy and some fluid is taken for analysis.
    ERCP
  • Treatment of Pancreatic Cysts

    How are pancreatic cysts treated?

    TIf you have a cysts which is concerning for cancer, you will be presented in our multidisciplinary tumor board, where your doctors will discuss your case. You might need to have your cyst removed with surgery. If surgery is not recommended, your doctor may repeat evaluation every 3-6 months to follow the cyst.

    How are pancreatic cysts from pancreatitis treated?

    If you have a pancreatic cyst due to pancreatitis, you might not need any treatment, unless you have symtoms. If you cannot eat and your cyst does not get smaller, your doctor might recommend a procedure or surgery called cystgastrostomy.



Pancreas Tumor
Pancreatic Cancer

Pancreas Tumors

Tumors in the pancreas can be either benign or cancerous.

  • Pancreas Tumors and Pancreatic Cancer

    What is pancreatic cancer?

    Pancreatic Cancer occurs when the cells of the pancreas grow out of control. The pancreas has cells that form ducts and cells that produce hormones like insulin. Both types of cells can turn into cancer cells.

    Ampullary

    What are the signs and symptoms of pancreatic cancer?

    Pancreatic Cancer is often silent in early stages. Patients may present with:

    • Abdominal and back pain
    • Poor appetite, nausea, vomiting, weight loss
    • Jaundice (yellow skin and eyes)
    • Bowel blockage
    • High blood sugars and Diabetes

    What is my risk for getting pancreatic cancer?

    Smoking, diabetes, obesity and pancreatitis increase your risk of getting pancreatic cancer. There are diseases that run in families, which increase the risk of pancreatic cancer.

    Pancreatic Cancer

    Tumors We Treat

    Cancers

    Pre-Cancers

  • Diagnosis of Pancreatic Cancer

    How is pancreatic cancer diagnosed?

    If you have any symptoms of pancreatic cancer, your doctor may order blood tests and pictures (imaging) of your belly. You will also need a biopsy to confirm the diagnosis.

    Blood tests

    • Complete blood count (CBC) to check your blood count.
    • Comprehensive Metabolic Panel (CMP) to check your electrolytes and liver function.
    • Ca19-9 and CEA levels. These blood tests are called “tumor markers,” and will give your doctor a chance to follow your response to treatment.
    Blood Tests

    Imaging

    • CT or MRI scan of your belly (or of the abdomen and pelvis) to look for a mass in the pancreas. This test will allow your doctor to evaluate, if your tumor can be removed with surgery.
    Imaging

    Procedures

    • Endoscopic Ultrasound (EUS): Your doctor inserts a camera into your intestines through your mouth, so your pancreas can be seen. Usually a small needle biopsy is taken at that time for diagnosis.
    • An Endoscopic Retrograde Cholangiopancreatography (ERCP) is another form of endoscopy that allows your doctor to place a stent into the bile duct for patients with jaundice. This can be done at the same time as the EUS.
    ERCP
  • Treatment of Pancreatic Tumors and Cancer

    How is pancreatic cancer treated?

    The treatment of pancreatic cancer depends on the stage of the tumor, and involves a multidisciplinary team of doctors, nurses and medical support staff:

    • Medical Oncology
    • Gastroenterology
    • Surgery
    • Radiation
    • Dietary and Social work, Palliative care.

    Every patient seen here will be presented in our multidisciplinary tumor board, where we will devise your individual treatment plan. This plan may include:

    We strongly encourage and support all of our patients to participate in clinical trials. We are happy to talk to you about clinical trials during your clinic visit.

Cystgastrostomy

A cystgastrostomy is a procedure or surgery, which allows the fluid from your pancreatic cyst to drain into the stomach.

This can be done by your gastroenterologist during endoscopy or surgeon with laparoscopic surgery. A small hole will be made in your stomach right over the cyst, and the edge of the stomach and cyst will be sewn together. You will be able to eat and drink normally after your surgery.

Radiation Therapy

Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is therapy using ionizing radiation, generally as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator.

Chemotherapy

Chemotherapy is a type of cancer treatment that uses one or more anti-cancer drugs as part of a standardized chemotherapy regimen. Chemotherapy may be given with a curative intent, or it may aim to prolong life or to reduce symptoms.

Multidisciplinary Tumor Board

A Multidisciplinary Tumor Board is a team of doctors and nurses who discuss your individual case to recommend the best treatment options for you based on your specific information. The members of Tumor Board include:

  • Surgeons
  • Oncologists
  • Radiologists
  • Pathologists
  • Gastroenterologists
Tumor Board
Tumor Board Meeting

When does Tumor Board meet?

Usually once a week

When will I be presented at Tumor Board?

The Tumor Board needs to have the latest imaging available to make accurate recommendations. Patients are typically presented after all of the appropriate tests are completed.

Am I allowed to participate in Tumor Board?

Because multiple patients are presented at a single Tumor Board, having patients attend is discouraged for privacy concerns. However, you will learn the recommendations of the Tumor Board at your next clinical appointment.

Cholecystectomy

cholecystectomy

Patients, who have recovered from pancreatitis due to gallstones, may need to have their gallbladder removed surgically. The procedure is called a cholecystectomy, and can be done with a camera and small incisions (laparoscopic) or through a larger cut (open). During the operation the cystic duct and artery have to be clipped and cut. The gallbladder will be separated from the liver, and removed.

Patients can usually leave the hospital the day after the operation after laparoscopic surgery. They able to eat a regular diet, and will be given medication for pain at their incision (cut).

Pancreatic Surgery

If surgery is part of your treatment plan, your doctor will likely suggest one of two surgical procedures:


Whipple Procedure
(also called Pancreaticoduodenectomy)

Before whipple
Before
after whipple
After

During surgery, the head of the pancreas, the gallbladder, the first part of the bowel called the duodenum, part of the stomach and bile duct are removed. New connections called “anastomoses” are made between the bile duct and the bowel, the pancreas and the bowel and the stomach and the bowel. These new connections are necessary for you to eat and digest your food.


Distal Pancreatectomy

The body or tail of the pancreas and the spleen are removed. No new connections or “anastomoses” are made. You will need vaccinations before surgery, because your spleen usually eliminates certain types of bacteria.

distal pancreatectomy

Vein resection and reconstruction

If your tumor grows into the portal vein, which is the main blood vessel to liver passing behind the pancreas, your surgeon might have to remove a small piece, when removing a tumor. The portal vein can be repaired.

venin resection and reconstruction
Vein Resection & Reconstruction

Insulinoma

This is a tumor of pancreatic island cells, which make insulin. Insulin controls the blood sugar. If there is too much insulin in the blood, the blood sugar will drop to a dangerously low level. Most insulinomas are benign (not cancer). Some are associated with a genetic disease called MEN 1. Those tumors have a higher chance of being a cancer (malignant).

Signs and symptoms

Patients with an insulinoma may feel light-headed, confused, weak, sweaty, always hungry and have blurry vision.

Diagnosis

In addition to the workup for any pancreatic tumor, there is a specific blood test for an insulinoma. The patient’s blood will be checked for blood sugar and insulin levels after fasting for at least 24 hours.

Treatment

Insulinomas will always be removed by surgery, even if they have spread beyond the pancreas. If the tumor is small, it can be enucleated.

Enucleation means that only the part of the pancreas containing the tumor will be removed. This is almost always done by laparoscopy, which involves a camera and surgical instruments being inserted into the abdomen through small cuts. The tumor can be taken out of the abdomen through one of these small incisions.

For larger tumors in the head or tail of the pancreas, that patient will need a Whipple procedure or distal pancreatectomy.

What is a Whipple Procedure?

The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.

Distal Pancreatectomy

A distal pancreatectomy (pan-krea-tek-tuh-me) is a surgery that removes a tumor from the body or tail of your pancreas.

Glucagonoma

This is a tumor of the islet cells that make Glucagon. Glucagon helps regulate the blood sugar by releasing sugar into the blood. Patients with excess glucagon will have a high blood sugar (hyperglycemia), which cannot be controlled with medication. Glucagonomas are often malignant (cancer).

Signs and symptoms

Patients with a glucagonoma can have a rash on their arms and legs, blood clots in their legs or lungs and experience all the effects of having a high blood sugar such as extreme thirst, dry mouth and skin, frequent urination, weakness and fatigue.

Diagnosis

In addition to the standard workup for a pancreatic tumor, glucagon levels can be measured in the blood after at least 8 hours of fasting.

Treatment

Glucagonomas will be removed with surgery. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.

What is a Whipple Procedure?

The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.

Distal Pancreatectomy

A distal pancreatectomy (pan-krea-tek-tuh-me) is a surgery that removes a tumor from the body or tail of your pancreas.

Somatostatinoma

This is a tumor of the islet cells that make somatostatin, which plays an important role in regulating blood sugar and other aspects of digestion. Somatostatinomas are often malignant.

Signs and symptoms

Patients with a somatostatinoma can experience all the effects of having a high blood sugar such as extreme thirst, dry mouth and skin, frequent urination, weakness and fatigue. They may have diarrhea, foul-smelling, fatty stools (steathorrhea) and gallstones.

Diagnosis

In addition to the standard workup for a pancreatic tumor, somatostatin levels can be measured in the blood after at least 8 hours of fasting. A special imaging test called an octreotide scan can be helpful, when a small tumor cannot be found on CT scan, MRI or Endoscopic Ultrasound.

Treatment

Somatostatinomas will be removed with surgery. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.

What is a Whipple Procedure?

The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.

Distal Pancreatectomy

A distal pancreatectomy (pan-krea-tek-tuh-me) is a surgery that removes a tumor from the body or tail of your pancreas.

Gastrinoma

This is a tumor of the islet cells that make gastrin. Gastrin stimulates the stomach to release acid, which helps with the digestion of food. Patients with too much gastrin and acid will have diarrhea and stomach ulcers. Gastrinomas are often malignant (cancer) and the most common pancreas tumors in patients with a genetic disease called MEN1.

Gastrinoma

Signs and symptoms

Patients with gastrinoma can have ulcers that cannot be treated with medication, acid reflux diarrhea and abdominal and back pain.

Diagnosis

In addition to the standard workup for pancreatic tumors, gastrin levels in the blood can be measured after fasting for at least 8 hours. A hormone named secretin can be given, and the amount of acid in the stomach can be measured, if the gastrin blood test is not conclusive. A special imaging test called an octreotide scan can be helpful, when a small tumor cannot be found on CT scan, MRI or Endoscopic Ultrasound.

Treatment

Gastrinomas will be removed with surgery. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.

What is a Whipple Procedure?

The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.

Distal Pancreatectomy

A distal pancreatectomy (pan-krea-tek-tuh-me) is a surgery that removes a tumor from the body or tail of your pancreas.

VIPomas

This is a tumor of the islet cells that make vasoactive intestinal peptide (VIP), which plays an important role in regulating other hormones and the body’s salt and water balance in digestions. VIPomas are often malignant.

Signs and symptoms

Patients with a Vipoma will have watery diarrhea and dehydration. The potassium levels in the blood will be low, and they may experience muscle weakness, cramps, tingling or numbness.

Diagnosis

In addition to the standard workup for a pancreatic tumor, VIP levels can be measured in the blood. While potassium will be low in the blood, potassium and sodium will be high in the stool.

Treatment

Somatostatinomnas will be removed with surgery. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.

What is a Whipple Procedure?

The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.

Distal Pancreatectomy

A distal pancreatectomy (pan-krea-tek-tuh-me) is a surgery that removes a tumor from the body or tail of your pancreas.

Nonfunctioning Pancreatic Neuroendocrine Tumors

Pancreatic neuroendocrine tumors, which arise from islet cells, but do not make hormones are called nonfunctional. They represent the majority of pancreatic neuroendocrine tumors, and can be benign (not cancer) or malignant (cancer).

Signs and symptoms

Patients with nonfunctioning pancreatic neuroendocrine tumors can have vague symptoms such as diarrhea, indigestion abdominal and back pain, which worsen as the tumor grows in size. If the tumor is in the head of the pancreas, patients may become jaundiced.

Diagnosis

In addition to the standard workup for a pancreatic tumor, the patient’s blood will be checked for chromogranin A levels.

Treatment

Nonfunctioning pancreatic neuroendocrine tumors will be removed with surgery. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.

What is a Whipple Procedure?

The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.

Distal Pancreatectomy

A distal pancreatectomy (pan-krea-tek-tuh-me) is a surgery that removes a tumor from the body or tail of your pancreas.

Surgical removal of the tumor in the pancreas might also be recommended, if patients have metastases in other organs i.e. the liver.

Cystic Neoplasms of the Pancreas

Cystic neoplasms of the pancreas are different types of fluid-filled masses, which are benign (not cancer), but can become cancer over time. The type of cystic neoplasm is important for treatment.

These are the different types:

  • Intraductal mucinous neoplasm (IPMN): This tumor s associated with the tubes (ducts) in the pancreas, which transport digestive juices to the intestine. The fluid is thick and called mucin. IPMN can become cancer.
  • Mucinous cystic neoplasm (MCN): This tumor is in the pancreas, but not associated with ducts. It is filled with mucin. MCN can become cancer.
  • Serous cystic neoplasm (SCN): This tumor is in the pancreas, but not associated with ducts. It is filled with thin (serous) fluid. SCN can become cancer.
  • Solid pseudopapillary tumor: This tumor can occur anywhere in the pancreas, and is dense and not always fluid-filled. It occurs more common in young women. It is not cancer, but can become cancer.

Signs and Symptoms

Most cystic neoplasms do not cause any symptoms, and are discovered by chance, when patients get a CT scan, MRI or ultrasound for another reason. As they grow, these tumors can cause pain, yellowing of the skin and diabetes.

Treatment

The patient’s care team will recommend if the pancreatic cyst needs to be removed. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.

What is a Whipple Procedure?

The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.

Distal Pancreatectomy

A distal pancreatectomy (pan-krea-tek-tuh-me) is a surgery that removes a tumor from the body or tail of your pancreas.

Pseudocysts

Pancreatic pseudocysts are fluid filled masses in the pancreas. They form as a result of injury to the pancreas after acute pancreatitis.

Signs and Symptoms

Large pseudocysts can cause pain and difficulty eating. When pseudocysts get infected, patients present with fevers, chills and low blood pressure, and require immediate treatment.

Treatment

Most pancreatic pseudocyst cause no symptoms, and require no treatment. If a cyst does not resolve without treatment, patients may require a cystgastrostomy. Infected pseudocysts are treated with antibiotics and need to be drained like an abscess.

A cystgastrostomy is a procedure or surgery, which allows the fluid from your pancreatic cyst to drain into the stomach.

This can be done by your gastroenterologist during endoscopy or surgeon with laparoscopic surgery. A small hole will be made in your stomach right over the cyst, and the edge of the stomach and cyst will be sewn together. You will be able to eat and drink normally after your surgery.

Tara Seery, MD

Seery's photo

Tara Seery, MD
Hematology/Oncology, Director of Pancreatic Cancer Oncology

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Locations

Chan Soon-Shiong Institute for Medicine

23961 Calle De La Magdalena, Suite 130
Laguna Hills, CA 92653
(949) 770-0797
(949) 770-0730

 

Education

  • University College, Dublin School of Medicine (Dublin)
  • Caritas St. Elizabeth Medical Center (Boston, MA)
  • Caritas St. Elizabeth Medical Center (Boston, MA)
  • Caritas St. Elizabeth Medical Center (Boston, MA)
  • University of Illinois at Chicago

 

Board Certifications

  • American Board of Internal Medicine, Medical Oncology
  • American Board of Internal Medicine, Hematology
  • American Board of Internal Medicine

 

Professional Society Memberships

  • American Society of Clinical Oncology
  • American Society of Hematology
  • SWOG
  • Alliance for Clinical Trials

 

Selected Publications

  1. Villano, J.E., Seery, T.E., Bressler, L.R. Temozolomide in malignant gliomas: current use and future targets. Cancer Chemotherapy and Pharmacology, 2009 Mar; 64 (4), 647-655
  2. Seery, T.E., Ziogas, A., Lin, B., Pan, CG, Stamos, M., Zell, J. Mortality Risk After Preoperative versus Postoperative Chemotherapy and Radiotherapy in Lymph Node Positive Rectal Cancer. Journal of Gastrointestinal Surgery, 2013 Feb; 17, 374-381
  3. Tsang, W. Ziogas, A., Lin, B., Seery, T.E., Karnes, W., Stamos, M., Zell, J.  Role of Surgical Resection Among Chemotherapy-Treated Colorectal Cancer Patients with Stage IV Disease: A survival Analysis. Journal of Gastrointestinal Surgery; Mar 2014, Vol. 18 Issue 3, p592.
  4. Joon-II Choi, David Imagawa, Priya Bhosale, Puneet Bhargava, Temel Tirkes, Tara E Seery, Chandana Lall.  MRI following treatment of advanced HCC with sorafenib. Clinical and Molecular Hepatology, 2014. June; 20(2):218-222.
  5. M. Nayyar, D. Imagawa, T. Tirkes, A. Demirjian, R. Houshyar, K. Sandrasegaran, C. Nangia, T. Seery, P. Bhargava, J. Choi, C. Lall. Composite liver tumors: A Radiologic-Pathologic Correlation. Clinical and Molecular Hepatology 2014; 20:406-410.
  6. R.K. Ramanathan, S.L McDonough, H.F.Kennecke, S. Iqbal, J.C. Baranda, T. E. Seery, H.J. Lim, A. F. Hezel. G. M. Vaccaro, C. C. Blanke. A Phase II Study of MK-2206, an Allosteric Inhibitor of AKT as Second Line Therapy for Advanced Gastric and Gastroesophageal Junction Cancer, a SWOG Cooperative Group Trial (S1005). Cancer. 2015 Mar 30. Doi:10.1002/cncr.29363
  7. A. Le Rolle, S. Klempner, C. Garrett, T. Seery, E. Sanford, S. Balasubramanian, J. Ross, P. Stephenas, V. Miller, S Ali, V. Chiu.  Identification and Characterization of RET fusions in Advanced Colorectal Cancer.  Oncotarget. 2015 May 30
  8. R. Tang, T. Kain, J Herman, T. Seery. Durable Response using Regorafenib in An Elderly Patient with metastatic Colorectal Cancer: Case Report. Cancer Management and Research 2015:7 1-3.
  9. A. Grothey, J. Marshall, T. Seery. Current Options for Third Line Treatment of Metastatic Colorectal Cancer. Clinical Advances in Hematology & Oncology. Volume 14, Issue 3, Supplement 3 March 2016
  10.  V. Chung, S. McDonough, PA Philip, A. Wang-Gillam, L Hui, MA Tejani, T Seery, IA Dy, T. Al Baghdadi, AE Hendifar, LA Doyle, AM Lowy, KA Guthrie, CD Blanke, HS Hochster. Effect of Selumetinib and MK-2206 vs Oxaliplatin and Fluorouracil in Patients With Metastatic Pancreatic Cancer After Prior Therapy: SWOG S115 Study Randomized Clinical Trial. JAMA Oncol. 2016 Dec 15. Doi: 10.1001/jamaoncol.2016.5383. [Epub ahead of print]
  11. T. Seery, A. Choudhry, A Eapen, Y Cheng. Pancreatic Neuroendocrine Tumors Therapy. JOP. J Pancreas (Online) 2017 Dec 18;S(3):216-220.
  12. S. Hingorani, L. Zheng, A. Bullock, T. Seery, W. Harris, D. Sigal, F. Braiteh, P Ritch, M. zalupski, N Bahary, P Oberstein, A. Wang-Gillam, W. Wu, D. Chondros, P, Jiang, S. Khelifa, J. Pu, C. Aldrich, A. Hendifar. Halo 202: Randomized Phase II Study of PEGPH20 Plus Nab-Paclitaxel/Gemcitabine Versus Nab-Paclitaxel/Gemcitabine in Patients with  Untreated, Metastatic Pancreatic Ductal Adenocarcinoma. Journal of Clinical Oncology 36, no. 4 (February 1 2018) 359-366.

 

 

Arvind M. Shinde, MD, MBA, MPH

Shinde's photo

Arvind M. Shinde, MD, MBA, MPH
Director, Hepatopancreatobiliary (HPB) Hematology & Oncology

English, Spanish

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Locations

St. Vincent Medical Center

2200 West 3rd Street
Suite 200
Los Angeles, CA 900057

St. Francis Medical Center

3630 E Imperial Hwy
Lynwood, CA 90262

 

Education

  • University of Southern California, Los Angeles, CA
  • Cedars Sinai Medical Center/West Los Angeles Veterans Administration, Los Angeles, CA
  • Cedars Sinai Medical Center/West Los Angeles Veterans Administration, Los Angeles, CA
  • City of Hope/Harbor UCLA, Los Angeles, CA
  • UCSD/Scripps/San Diego Hospice and Institute for Palliative Medicine, San Diego, CA
  • Harvard University, Boston, MA
  • University of Southern California, Los Angeles, CA

 

Board Certifications

  • American Board of Internal Medicine - Internal Medicine
  • American Board of Internal Medicine - Medical Oncology
  • American Board of Internal Medicine - Hospice and Palliative Medicine

 

Professional Society Memberships

  • American College of Clinical Oncology
  • American Academy of Hospice and Palliative Medicine

 

Selected Publications

  1. Shinde A, Pal S, Hurria A. “Geriatric Oncology.” The American Cancer Society’s Principles of Oncology: Prevention to Survivorship. First Edition. Ed. American Cancer Society. Atlanta: John Wiley & Sons, Inc., 2018. 323-31.
  2. Gresham G, Schrack J, Gresham L, Shinde, A et al. “Wearable activity monitors in oncology trials. Current use of an emerging technology.” Contemporary Clinical Trials. 2018; 64: 13-21.
  3. Shinde A, Dashti A. “Palliative Care in Lung Cancer.” Lung Cancer. Cancer Treatment and Research. Vol 170. Ed. Reckamp K. Springer, Cham., 2016. 225-250.
  4. Gong J, Tuli R, Shinde A, Hendifar A. Meta-analyses of treatment standards for pancreatic cancer. Molecular and Clinical Oncology. 2016;4(3):315-325.
  5. Shinde AM, Zhai J, Yu KW, et al. “Pathologic complete response rates in triple-negative, HER2-positive, and hormone receptor-positive breast cancers after anthracycline-free neoadjuvant chemotherapy with carboplatin and paclitaxel with or without trastuzumab.” Breast. 2015;24(1):18-23. 
  6. O’Connor T, Shinde A, Doan C, Katheria V, Hurria A. “Managing Breast Cancer in the Older Patient.” Clinical advances in hematology & oncology. 2013;11(6):341-347.

 

 

Elise Diner PA-C

Diner's photo

Elise Diner, PA-C
Transplant & Hepatopancreatobiliary (HPB) Surgery

English

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Locations

St. Vincent Medical Center

2200 West 3rd Street
Suite 200
Los Angeles, CA 900057

St. Francis Medical Center

3630 E Imperial Hwy
Lynwood, CA 90262

Chang Soon-Shiong Institute for Medicine

2040 E Mariposa Ave
El Segundo, CA 90245

 

Education

  • University of Colorado, Boulder, CO
  • Midwestern University, Glendale, AZ

 

Board Certifications

  • National Commission on Certification of Physician Assistants

 

Professional Society Memberships

  • Americas Hepatopancreatobiliary Association
  • International Hepatopancreatobiliary Association

 

 

Jamie Taylor, MD

Taylor's photo

Jamie Taylor, MD
Director, Anesthesia/Critical Care

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Locations

St. Vincent Medical Center

2200 West 3rd Street
Suite 200
Los Angeles, CA 900057

St. Francis Medical Center

3630 E Imperial Hwy
Lynwood, CA 90262

 

Education

  • Louisiana State University School of Medicine
  • Harbor-UCLA - Anesthesiology
  • University of Pennsylvania - Critical Care Medicine

 

Board Certifications

  • Anesthesiology, Critcal Care Medicine

 

Professional Society Memberships

  • American Society of Anesthesiology
  • Society of Critical Care Medicine
  • Society of Critical Care Anesthesiologists
  • International Liver Transplant Society

 

 

Julio Gutierrez, MD

Gutierrez's photo

Julio Gutierrez, MD
Transplant Hepatology, Medical Director of Liver Transplant

English, Spanish

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Locations

St. Vincent Medical Center

2200 West 3rd Street
Suite 200
Los Angeles, CA 900057

St. Francis Medical Center

3630 E Imperial Hwy
Lynwood, CA 90262

 

Education

  • Mount Sinai School of Medicine (2007)
  • Internal Medicine, UCSD (2009)
  • Gastroenterology, UCSD (2013)
  • Transplant Hepatology, University of Miami/Jackson (2014)
  • BA, UC Berkeley (2000)
  • MS, Columbia University (2003)

Areas of Expertise

  • Cirrhosis
  • Liver Cancers
  • Ascites
  • Hepatitis C
  • Fatty Liver
  • Primary Biliary Cholangitis

 

Board Certifications

  • ABIM - Internal Medicine
  • ABIM - Gastroenterology
  • ABIM - Transplant Hepatology
  • ABOM - Obesity Medicine

 

Professional Society Memberships

  • American Society of Anesthesiology
  • Society of Critical Care Medicine
  • Society of Critical Care Anesthesiologists
  • International Liver Transplant Society

 

 

Brian Van Ness PA-C

no photo

Brian Van Ness PA-C
Anesthesia/Critical Care

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Locations

St. Vincent Medical Center

2200 West 3rd Street
Suite 200
Los Angeles, CA 900057

 

Education

  • Seton Hall University, Physician Assistant Program
  • Seton Hall University

 

Board Certifications

  • National Commission for the Certification of Physician Assistants

 

Professional Society Memberships

  • Society of Critical Care Medicine
  • Eastsern Association for the Surgery of Trauma
  • American Academy of Physician Assistants
  • California Academy of Physician Assistants
  • New Jersey State Society for Physician Assistants

 

 

Intensive Care Unit (ICU)

What can I expect if I am in the ICU after surgery?

Patients undergoing liver kidney, and pancreas surgery may require a short stay in our ICU on the 4th floor at St. Vincent Medical Center.  This is a common and expected part of your hospital course.

What to expect immediately after surgery in the ICU

In addition to the IV in your arm, the catheter in your bladder, tube that may be placed in your stomach and small tubes that may be placed into your abdomen during surgery that were previously described, the following are some other catheters that may need to be placed prior to or during your surgery and may be in place in the ICU.

Some patients after surgery may require their breathing tube to remain in place over night while in the ICU. If this occurs, you will receive continuous medications through your IV to alleviate anxiety and control pain until we are ready to remove the breathing tube.

Nurse Adjusting Patient's Pillow

Most patients will have a small catheter, the same size as the IV in your arm, placed into an artery in either of your wrists. This catheter will allow us to monitor your blood pressure every time your heart beats and also to draw blood samples from your arterial circulation as needed.

Nurse Attaching IV Drip On Male Patient's Hand

Some patients will require the placement of a larger intravenous catheter into a vein either on the side of your neck or just below your collarbone. This catheter will allow us to give medications that cannot be given in the IV in your arm and also allows us to monitor your heart during your procedure.

If your Anesthesiologist feels it would be beneficial, you may have a small catheter called an epidural placed into your back that will give you a continuous infusion of pain medication to alleviate the pain that accompanies surgery in your abdomen.

Woman Lies with Epidural Anesthesia

Each of these procedures is done in a sterile fashion, after you receive a local anesthetic and are done inside the operating room prior to starting your surgery. Each catheter will be removed once the ICU team and surgery team agree that it is time for them to be taken out.

As an alternate method of pain control, your anesthesiologist may start you on a patient controlled analgesia pump after surgery. This pump gives pain medication through your IV in your arm and allows you to control when you receive injections of pain medication, without having to request it from the Nurse.

Female patient with IV drip needle piercing in hospital room

After surgery some patients may have a tube that goes into bladder that allows it to drain during and after surgery. Your surgery team usually removes this tube once you are up and out of bed.

Closeup Of Urine Bag

Every hour while you are awake you will be exercising your breathing using an incentive spirometer (pictured below), which is used to prevent pneumonia and is an essential part of your ICU care. Additionally your Nurse will be getting you out of bed on your first day after surgery, which is another essential component of preventing problems with your lungs after surgery.

Breathing Exercise in Hospital
Nurse next to a patient with IV tower

When can my family visit?

Visiting hours in the ICU are from 8 AM to 7 PM and then from 8 PM to 7 AM. Patients are allowed to have two visitors at the bedside at any one time, with exceptions made on a case-by-case basis. We want our patients to have restful nights of sleep, so we encourage families to go home after 830pm each night but they are welcome to call the ICU for updates at any time. We do not allow fresh flowers in the ICU, but we do encourage families to bring in any assistive devices like glasses a patient may need to increase their comfort. We also encourage the use of eyeshades and earplugs for sleep or headphones with music as needed.

Who will manage my care in the ICU?

We have a team of trained Physicians, Physician Assistants and Nurse Practitioners that are in the ICU 24/7 who will manage the minute by minute care you receive while in the ICU, while remaining in contact with your Surgeon to discuss any changes and to give updates on your progress. Additionally, our hepatobiliary surgical team will see you each day to review findings of surgery, plans for each day and when you can expect to transfer out of the ICU.

Doctor and nurse talking to a patient

Dialysis

About Dialysis

A treatment that removes excess water and toxins from the blood for those whose kidneys who have lost the ablity to do so on their own.

There are 2 options for Dialysis.

Hemodyalisis

Uses a machine and a filter to remove the waste and water from the blood using a solution. It is done outside the body then returned to you. To get the blood into the machine, the doctor needs to make an entry into the blood vessels. This is done by joining an artery to a vein under the skin to make a bigger blood vessel called a fistula. Or a soft plastic tube can join an artery and a vein under the skin, called a graft.

hemodialysis

 

Peritoneal Dialysis

Uses a fluid (dialysate) that is placed into the abdominal cavity to remove the waste. The blood is cleaned inside your body. A catheter is placed into the abdomen to absorb the waste from the blood that passes in the abdominal cavity. The fluid is then drained away.

peritoneal dialysis