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Term 2 > Abd (pancreas) > Flashcards

Abd (pancreas) Flashcards

1
Q

Where is the pancreas located?

A
  • retroperitoneal

- pararenal space

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2
Q

Where are the CBD and GDA located int he pancreas head?

A

GDA- anterior

CBD- posterior

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3
Q

Where is the IVC in relation to the pancreas head?

A

-posterior

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4
Q

Endocrine Function

A

-islet cells of langerhans secrete hormones directly into bloodstream

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5
Q

What do alpha cells secrete?

A

-glucagon

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6
Q

What do beta cells secrete?

A

-insulin

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7
Q

What does failure to secrete sufficient insulin lead to?

A

-diabetes

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8
Q

Exocrine Function

A

-digestive enzymes secreted by acini cells drain into the duodenum through pancreatic ducts

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9
Q

What does amylase break down?

A

-carbs

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10
Q

What does lipase break down?

A

-fats

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11
Q

What does trypsin break down?

A

-proteins

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12
Q

Normal Serum Amylase Range

A

25-125 U/L

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13
Q

What does serum amylase increase with?

A
  • acute pancreatitis
  • pancreatic pseudocyst
  • intestinal obstruction
  • peptic ulcer disease
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14
Q

What does serum amylase decrease with?

A
  • hepatitis

- cirrhosis

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15
Q

How long do serum amylase levels remain elevated for in episodes of acute pancreatitis?

A

-24 hours

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16
Q

Does urine amylase or serum amylase remain increased for longer in episodes of acute pancreatitis?

A

-urine amylase

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17
Q

Normal Range of Serum Lipase

A

10-140 U/L

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18
Q

How long do serum lipase levels remain elevated for?

A

-up to 14 days

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19
Q

What does serum lipase increase with?

A
  • pancreatitis
  • obstruction of pancreatic duct
  • pancreatic carcinoma
  • acute cholecystitis
  • cirrhosis
  • severe renal disease
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20
Q

Normal Glucose Range (fasting)

A

< 100 mg/dL

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21
Q

Normal Glucose Range (2 hours post prandial)

A

< 145 mg/dL

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22
Q

What does glucose increase with?

A
  • diabetes
  • chronic liver disease
  • overactive endocrine glands
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23
Q

What does glucose decrease with?

A

-tumors of islets of langerhans

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24
Q

Normal Size of Pancreas Head

A

2-3 cm

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25
Q

Normal Size of Pancreas Neck

A

1-2 cm

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26
Q

Normal Size of Pancreas Body

A

1-3 cm

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27
Q

Normal Size of Pancreas Tail

A

2-3 cm

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28
Q

If the pancreas body exceeds ___cm AP, this may indicate acute pancreatitis.

A

3

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29
Q

What should be the diameter of the pancreatic duct?

A

3mm or less

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30
Q

What % of the pop. has congenital anomalies/variants?

A

10%

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31
Q

What is the most common variant/congenital anomaly of the pancreas?

A

Pancreatic Divisum

  • ductal anomaly
  • increase in pancreatitis
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32
Q

Variants/Congenital Anomolies of Pancreas

A
  • pancreatic divisum
  • annular panceas
  • partial agenesis
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33
Q

Annular Pancreas

A
  • rare

- 2nd part of duodenum is surrounded by ring on pancreatic tissue (continuous with head of pancreas)

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34
Q

Indications for Exam

A
  • epigastric pain
  • elevated pancreatic enzymes
  • biliary disease
  • abd distension
  • pancreatitis
  • weight loss/anorexia
  • pancreatic neoplasm
  • evaluate mass seen on US
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35
Q

Acute Pancreatitis

A
  • acute inflammatory process
  • involvement of other tissue or organ systems
  • increased pancreatic enzyme levels in blood or urine
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36
Q

Causes/Risk Factors of Acute Pancreatitis

A

Gallstones- 40%
Alcoholism- 40%
Idiopathic- 10%
Other- 10%

  • choledocholithiasis
  • biliary sludge
  • neoplasm
  • infection
  • toxins
  • drugs
  • genetic
  • trauma
  • iatrogenic factors (endoscopy/post operative)
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37
Q

What is the most common and useful finding to diagnose pancreatitis?

A

-pancreatitis associated inflammation

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38
Q

Pancreatitis Associated Inflammation

A
  • hypoechoic/anechoic collections that conform to retroperitoneal/peritoneal space
  • ascites/complex fluid
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39
Q

What % of patients with acute pancreatitis develop acute fluid collections?

A

40%

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40
Q

Pseudocyst

A
  • fluid collections persists > 6 weeks
  • no epithelial lining
  • most commonly seen in chronic pancreatitis
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41
Q

Pseudocyst’s comprise ___ to ___ % of cystic lesions of the pancreas.

A

75 to 90%

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42
Q

Sono Appearance of Pseudocyst

A
  • completely cystic or cystic collections
  • septations
  • internal echogenic debris

Come From:

  • necrosis
  • hemorrhage
  • infection
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43
Q

How do you differentiate between a cystic neoplasm and a pseudocyst?

A

-clinical info

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44
Q

Modalities for Diagnosis of Acute Pancreatitis

A
  • CECT (necrosis)
  • abd US (fluid collections, biliary system, dilated ducts)
  • MRCP
  • MRI
45
Q

Why is ERCP (endoscopic retrograde cholangiopancreatography) usually only used for therapy and not diagnosis?

A
  • expensive

- risk of pancreatitis

46
Q

Chronic Pancreatitis

A
  • intermittent pancreatic inflammation

- progressive irreversible damage to the gland

47
Q

What is the main cause of chronic pancreatitis?

A

-alcoholism

48
Q

Causes of Chronic Pancreatitis

A
  • alcoholism (main cause)
  • pancreatic duct obstruction
  • hypertriglyceremia
  • auto immune pancreatitis
  • tropical pancreatitis
  • genetic mutations
49
Q

S/S of Chronic Pancreatitis

A
  • pain
  • malabsorption
  • diabetes
50
Q

What does chronic pancreatitis lead to?

A
  • fibrosis
  • cell damage
  • chronic inflammation
  • distorted/blocked ducts
  • permanent structural changes
  • deficient endocrine and exocrine function
51
Q

Sono Findings of Chronic Pancreatitis (CP)

A
  • altered parenchymal texture
  • glandular atrophy
  • gland enlargement
  • focal masses
  • dilation and beading of pancreatic ducts with calcifications
  • pseudocysts
52
Q

Treatment of Uncomplicated CP

A
  • aim to improve quality of life
  • alleviate pain
  • control malabsorption and diabetes
53
Q

Treatment of Complicated CP

A

-surgery and endoscopy

54
Q

Complications of CP

A
  • pseudocyst
  • abscesses
  • malignancies
  • thrombosis of portals
  • pancreatic and bile duct obstruction
55
Q

Where are CP masses usually found?

A

-head of pancreas

56
Q

Up to ___ of patients with CP have a focal inflammatory mass in their pancreas.

A

1/3

57
Q

What can CP masses in the head of pancreas cause?

A

-dilation of CBD and pancreatic duct

58
Q

What are pancreatic masses associated with CP difficult to distinguish from?

A

-pancreatic carcinoma

59
Q

What does the presence of calcifications suggest?

A

-CP (chronic pancreatitis)

60
Q

Sinistral

A
  • upper GI bleed from gastric varices
  • Lt sided portal hypertension
  • occurs in 22% of CP
61
Q

What % of patients with chronic or acute pancreatitis will have portal vein thrombosis?

A

5%

62
Q

Which vein most commonly thrombosis with chronic or acute pancreatitis?

A

-splenic vein

63
Q

When do pseudo aneurysms form?

A
  • when enzyme rich peripancreatic fluid
  • often with pseudocyst
  • leads to auto digestion and weakening of artery walls
64
Q

Neoplasms of Pancreas

A
  • periampullary
  • cystic
  • pseudopapillary
  • endocrine, lipoma and mets
65
Q

Cystic Neoplasms

A
  • simple
  • serous cystic
  • mucinous intraductal
66
Q

Periampullary Neoplasms

A
  • pancreatic ductal adenocarcinoma (66%)
  • ampullary carcinoma (15 to 25%)
  • duodenal carcinoma (10%)
  • distal cholangiocarcinoma (10%)
67
Q

What is the survival rate of periampullary neoplasms?

A

-poor

68
Q

Is it easy to distinguish the different types of periampullary neoplasms from each other?

A

-no, it is difficult

69
Q

What is the most common presentation of periampullary neoplasms?

A

-jaundice

70
Q

How are periampullary neoplasms managed?

A

-whipples procedure (pancreaticoduodenectomy)

71
Q

What is the most common primary pancreatic neoplasm?

A

-pancreatic ductal adenocarcinoma (85 to 90% of malignancies)

72
Q

What is the 4th most common cause of cancer death?

A

-pancreatic ductal adenocarcinoma

73
Q

What is the 5 year survival rate for pancreatic ductal adenocarcinoma?

A

2-5%

74
Q

Is a cure common for pancreatic ductal adenocarcinoma?

A

-no, it is rare

  • US or CT can detect advanced disease
  • few patients have potentially resectable disease
75
Q

Risk Factors of Adenocarcinoma

A
  • male
  • 60 to 80 years old
  • smoking
  • obesity
  • chronic pancreatitis
  • diabetes
  • cirrhosis
  • family hx of pancreatic CA
76
Q

S/S of Ductal Adenocarcinoma

A
  • jaundice
  • pain
  • weight loss
77
Q

What is ductal adenocarcinoma associated with?

A
  • increased bilirubin and ALP
  • dark urine
  • pale stool
  • pruritis
78
Q

Where is the pancreas does ductal/periampullar adenocarcinoma occur?

A
  • 60 to 70% in head
  • 25 to 35% in body/tail
  • 3 to 5% are diffuse
79
Q

Ductal/Periampullar Adenocarcinoma on US

A
  • double duct sign (CBD and pancreatic duct dilation)
  • solid mass in pancreatic head
  • variable echotexture
80
Q

What can ductal/periampullar adenocarcinoma lead to?

A

-curovoisier GB

81
Q

Courvoisier GB

A
  • enlarged palpable GB
  • in patient with carcinoma of pancreas head
  • associated with jaundice (due to obstruction of CBD)
82
Q

When is a ductal adenocarcinoma unresectable?

A
  • tumor > 2cm
  • extracapsular extension
  • lymphadenopathy
  • mets
83
Q

What makes up 75% of cystic lesions?

A

-pseudocysts

84
Q

If a doctor does not know the hx of a patient with a pseudocyst, what may they think that it is?

A
  • simple cyst

- cystic neoplasm

85
Q

What imaging is used to differentiate between cystic lesions?

A

CT and MRI- not helpful when small

US- follow up for cysts 3cm or less

86
Q

High Risk Features of Cystic Pancreas Lesion

A
  • symptomatic patient
  • growth on serial exam
  • > 3cm AP
  • internal soft tissue
  • mural/septal thickening
87
Q

What are 2 inherited diseased with high prevalence of cysts?

A
  • polycystic kidney disease (ADPKD)

- von hippel linteau disease (VHL)

88
Q

Simple cysts of the pancreas are ____, but are seen in patients with _____ _____.

A
  • rare

- cystic fibrosis

89
Q

Von Hippel Lindeau Disease

A
  • CT disorder

- multiple simple pancreatic cysts

90
Q

Other Lesions Associated with VHL

A
  • serous cystic neoplasm
  • pancreatic endocrine tumors
  • ducal adenocarcinoma
91
Q

Are cystic tumors usually benign or malignant?

A

-benign or low grade malignancy

92
Q

Are mucinous tumors usually benign or malignant?

A

-malignant

93
Q

What are the most common cystic neoplasms in order of prevalence?

A
  • serous cystic
  • intraductal papillary mucinous
  • mucinous cystic
  • solid pseudopapillary
94
Q

Serous Cystic Neoplasm

A
  • aka microcystic adenoma
  • benign
  • women
  • panc head
95
Q

Serous Cystic Neoplasm on US

A
  • myriad of tiny cysts
  • echogenic
  • posterior enhancement
  • fibrous pattern
  • central calcification (30 to 50%)
96
Q

Who is mucinous cystic neoplasm common in?

A

-perimenopausal women

97
Q

Where do mucinous cystic neoplasm’s occur?

A

-pancreas tail and body

98
Q

Mucinous Cystic Neoplasm on US

A
  • unilocular or multilocular
  • septations
  • internal debris
99
Q

What is the best way to manage a mucinous cystic neoplasm?

A

-as a malignant lesion (not all are benign)

100
Q

Solid Pseudopapillary Tumor

A
  • young females
  • 15% are malignant
  • resection (cure)
  • likelihood of malignancy increased with age
  • usually in tail
101
Q

Solid Pseudopapillary on US

A
  • round, encapsulated mass
  • necrotic, cystic and soft tissue foci within
  • anechoic/hypoechoic
  • variable echotexture
  • posterior enhancement
102
Q

Other Pancreas Masses

A
  • endocrine tumors
  • mets
  • lipoma
103
Q

Lipoma

A
  • hypoechoic fat

- internal echoes

104
Q

Mets Tumor

A

-most common pancreas neoplasm seen on autopsy (4x more than pancreatitis cancer)

105
Q

What are the primary sources of mets in pancreas?

A
  • renal cell carcinoma
  • breast
  • lung
  • colon
  • melanoma
  • stomach
106
Q

What is the best imaging modality for fatty infiltration of pancreas?

A
  • US is unreliable

- CT is best

107
Q

What does severe fatty replacement occur with?

A
  • cystic fibrosis
  • diabetes
  • obesity
  • NASH
  • old age
108
Q

What can a pseudocyst mass in the uncinate process be caused by?

A

-fatty sparing

109
Q

Who is fatty infiltration of the pancreas common in?

A

-middle aged women

Term 2 (19 decks)

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