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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
Normal Size of Pancreas Neck
1-2 cm
26
Normal Size of Pancreas Body
1-3 cm
27
Normal Size of Pancreas Tail
2-3 cm
28
If the pancreas body exceeds ___cm AP, this may indicate acute pancreatitis.
3
29
What should be the diameter of the pancreatic duct?
3mm or less
30
What % of the pop. has congenital anomalies/variants?
10%
31
What is the most common variant/congenital anomaly of the pancreas?
Pancreatic Divisum - ductal anomaly - increase in pancreatitis
32
Variants/Congenital Anomolies of Pancreas
- pancreatic divisum - annular panceas - partial agenesis
33
Annular Pancreas
- rare | - 2nd part of duodenum is surrounded by ring on pancreatic tissue (continuous with head of pancreas)
34
Indications for Exam
- epigastric pain - elevated pancreatic enzymes - biliary disease - abd distension - pancreatitis - weight loss/anorexia - pancreatic neoplasm - evaluate mass seen on US
35
Acute Pancreatitis
- acute inflammatory process - involvement of other tissue or organ systems - increased pancreatic enzyme levels in blood or urine
36
Causes/Risk Factors of Acute Pancreatitis
Gallstones- 40% Alcoholism- 40% Idiopathic- 10% Other- 10% - choledocholithiasis - biliary sludge - neoplasm - infection - toxins - drugs - genetic - trauma - iatrogenic factors (endoscopy/post operative)
37
What is the most common and useful finding to diagnose pancreatitis?
-pancreatitis associated inflammation
38
Pancreatitis Associated Inflammation
- hypoechoic/anechoic collections that conform to retroperitoneal/peritoneal space - ascites/complex fluid
39
What % of patients with acute pancreatitis develop acute fluid collections?
40%
40
Pseudocyst
- fluid collections persists > 6 weeks - no epithelial lining - most commonly seen in chronic pancreatitis
41
Pseudocyst's comprise ___ to ___ % of cystic lesions of the pancreas.
75 to 90%
42
Sono Appearance of Pseudocyst
- completely cystic or cystic collections - septations - internal echogenic debris Come From: - necrosis - hemorrhage - infection
43
How do you differentiate between a cystic neoplasm and a pseudocyst?
-clinical info
44
Modalities for Diagnosis of Acute Pancreatitis
- CECT (necrosis) - abd US (fluid collections, biliary system, dilated ducts) - MRCP - MRI
45
Why is ERCP (endoscopic retrograde cholangiopancreatography) usually only used for therapy and not diagnosis?
- expensive | - risk of pancreatitis
46
Chronic Pancreatitis
- intermittent pancreatic inflammation | - progressive irreversible damage to the gland
47
What is the main cause of chronic pancreatitis?
-alcoholism
48
Causes of Chronic Pancreatitis
- alcoholism (main cause) - pancreatic duct obstruction - hypertriglyceremia - auto immune pancreatitis - tropical pancreatitis - genetic mutations
49
S/S of Chronic Pancreatitis
- pain - malabsorption - diabetes
50
What does chronic pancreatitis lead to?
- fibrosis - cell damage - chronic inflammation - distorted/blocked ducts - permanent structural changes - deficient endocrine and exocrine function
51
Sono Findings of Chronic Pancreatitis (CP)
- altered parenchymal texture - glandular atrophy - gland enlargement - focal masses - dilation and beading of pancreatic ducts with calcifications - pseudocysts
52
Treatment of Uncomplicated CP
- aim to improve quality of life - alleviate pain - control malabsorption and diabetes
53
Treatment of Complicated CP
-surgery and endoscopy
54
Complications of CP
- pseudocyst - abscesses - malignancies - thrombosis of portals - pancreatic and bile duct obstruction
55
Where are CP masses usually found?
-head of pancreas
56
Up to ___ of patients with CP have a focal inflammatory mass in their pancreas.
1/3
57
What can CP masses in the head of pancreas cause?
-dilation of CBD and pancreatic duct
58
What are pancreatic masses associated with CP difficult to distinguish from?
-pancreatic carcinoma
59
What does the presence of calcifications suggest?
-CP (chronic pancreatitis)
60
Sinistral
- upper GI bleed from gastric varices - Lt sided portal hypertension - occurs in 22% of CP
61
What % of patients with chronic or acute pancreatitis will have portal vein thrombosis?
5%
62
Which vein most commonly thrombosis with chronic or acute pancreatitis?
-splenic vein
63
When do pseudo aneurysms form?
- when enzyme rich peripancreatic fluid - often with pseudocyst - leads to auto digestion and weakening of artery walls
64
Neoplasms of Pancreas
- periampullary - cystic - pseudopapillary - endocrine, lipoma and mets
65
Cystic Neoplasms
- simple - serous cystic - mucinous intraductal
66
Periampullary Neoplasms
- pancreatic ductal adenocarcinoma (66%) - ampullary carcinoma (15 to 25%) - duodenal carcinoma (10%) - distal cholangiocarcinoma (10%)
67
What is the survival rate of periampullary neoplasms?
-poor
68
Is it easy to distinguish the different types of periampullary neoplasms from each other?
-no, it is difficult
69
What is the most common presentation of periampullary neoplasms?
-jaundice
70
How are periampullary neoplasms managed?
-whipples procedure (pancreaticoduodenectomy)
71
What is the most common primary pancreatic neoplasm?
-pancreatic ductal adenocarcinoma (85 to 90% of malignancies)
72
What is the 4th most common cause of cancer death?
-pancreatic ductal adenocarcinoma
73
What is the 5 year survival rate for pancreatic ductal adenocarcinoma?
2-5%
74
Is a cure common for pancreatic ductal adenocarcinoma?
-no, it is rare - US or CT can detect advanced disease - few patients have potentially resectable disease
75
Risk Factors of Adenocarcinoma
- male - 60 to 80 years old - smoking - obesity - chronic pancreatitis - diabetes - cirrhosis - family hx of pancreatic CA
76
S/S of Ductal Adenocarcinoma
- jaundice - pain - weight loss
77
What is ductal adenocarcinoma associated with?
- increased bilirubin and ALP - dark urine - pale stool - pruritis
78
Where is the pancreas does ductal/periampullar adenocarcinoma occur?
- 60 to 70% in head - 25 to 35% in body/tail - 3 to 5% are diffuse
79
Ductal/Periampullar Adenocarcinoma on US
- double duct sign (CBD and pancreatic duct dilation) - solid mass in pancreatic head - variable echotexture
80
What can ductal/periampullar adenocarcinoma lead to?
-curovoisier GB
81
Courvoisier GB
- enlarged palpable GB - in patient with carcinoma of pancreas head - associated with jaundice (due to obstruction of CBD)
82
When is a ductal adenocarcinoma unresectable?
- tumor > 2cm - extracapsular extension - lymphadenopathy - mets
83
What makes up 75% of cystic lesions?
-pseudocysts
84
If a doctor does not know the hx of a patient with a pseudocyst, what may they think that it is?
- simple cyst | - cystic neoplasm
85
What imaging is used to differentiate between cystic lesions?
CT and MRI- not helpful when small US- follow up for cysts 3cm or less
86
High Risk Features of Cystic Pancreas Lesion
- symptomatic patient - growth on serial exam - >3cm AP - internal soft tissue - mural/septal thickening
87
What are 2 inherited diseased with high prevalence of cysts?
- polycystic kidney disease (ADPKD) | - von hippel linteau disease (VHL)
88
Simple cysts of the pancreas are ____, but are seen in patients with _____ _____.
- rare | - cystic fibrosis
89
Von Hippel Lindeau Disease
- CT disorder | - multiple simple pancreatic cysts
90
Other Lesions Associated with VHL
- serous cystic neoplasm - pancreatic endocrine tumors - ducal adenocarcinoma
91
Are cystic tumors usually benign or malignant?
-benign or low grade malignancy
92
Are mucinous tumors usually benign or malignant?
-malignant
93
What are the most common cystic neoplasms in order of prevalence?
- serous cystic - intraductal papillary mucinous - mucinous cystic - solid pseudopapillary
94
Serous Cystic Neoplasm
- aka microcystic adenoma - benign - women - panc head
95
Serous Cystic Neoplasm on US
- myriad of tiny cysts - echogenic - posterior enhancement - fibrous pattern - central calcification (30 to 50%)
96
Who is mucinous cystic neoplasm common in?
-perimenopausal women
97
Where do mucinous cystic neoplasm's occur?
-pancreas tail and body
98
Mucinous Cystic Neoplasm on US
- unilocular or multilocular - septations - internal debris
99
What is the best way to manage a mucinous cystic neoplasm?
-as a malignant lesion (not all are benign)
100
Solid Pseudopapillary Tumor
- young females - 15% are malignant - resection (cure) - likelihood of malignancy increased with age - usually in tail
101
Solid Pseudopapillary on US
- round, encapsulated mass - necrotic, cystic and soft tissue foci within - anechoic/hypoechoic - variable echotexture - posterior enhancement
102
Other Pancreas Masses
- endocrine tumors - mets - lipoma
103
Lipoma
- hypoechoic fat | - internal echoes
104
Mets Tumor
-most common pancreas neoplasm seen on autopsy (4x more than pancreatitis cancer)
105
What are the primary sources of mets in pancreas?
- renal cell carcinoma - breast - lung - colon - melanoma - stomach
106
What is the best imaging modality for fatty infiltration of pancreas?
- US is unreliable | - CT is best
107
What does severe fatty replacement occur with?
- cystic fibrosis - diabetes - obesity - NASH - old age
108
What can a pseudocyst mass in the uncinate process be caused by?
-fatty sparing
109
Who is fatty infiltration of the pancreas common in?
-middle aged women

Term 2 (19 decks)

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