56-year-old lady with recurrent pancreatitis

Background

• ‘Grumbling’ chronic pancreatitis over last 3 years
• Monthly symptoms and hospital presentations
• Lipase and LFT’s elevated
• Previous cholecystectomy

Issues

• Severe COPD and asthma- 26 pack year smoking history
• Severe mixed obstructive and restrictive defect on formal spirometry: FEV1/FVC = 0.71/1.66, Bronchodilator reversibility. TLCO 69%
• Multiple admissions with infective exacerbations of COPD
• Mild OSA
• NYHA Class 3 dyspnoea, walks 200-300m on flat
• Attended JHH for EUS pancreas a few weeks ago, waking from RNC to JHH door to gain entry to hospital and was dyspnoeic. A passing Dr noticed her respiratory distress and stopped to help her, called the gastroenterologist and the procedure was cancelled.

Discussion

Opportunities for optimisation

• Discussed with regular respiratory physician, optimised from respiratory perspective, but suggests there may be room to improve dyspnoea with diuretics.
• Recent admission with infective exacerbation of COPD, she responded to a small dose of furosemide.
• BNP during admission = 982.
• Post-discharge, Sestamibi and TTE were normal.
• Awaiting appointment with cardiologist

Proceed to surgery?

• Patient at her baseline best, states that the dyspnoea she was experiencing was normal for her.
• Cardiology opinion useful in the long-term
• Cardiac investigations reassuring
• No benefit to repeating BNP, unlikely to change anaesthetic management
• Needs to be assessed for fluid status on DOS

Plan

• Proceed to surgery
• Discuss at cardiology MDT