Abdo- pancreas Flashcards
Where is the panc located?
retroperitoneal
what duct joins the pancreas. to the common bile duct?
duct of wiring
ampulla of vator?
conical structure at the confluence of the common bile duct (CBD) and the main pancreatic duct that protrudes at the major duodenal papilla into the medial aspect of the descending duodenum
sphincter of oddi?
small smooth muscle sphincter strategically placed at the junction of the bile duct, pancreatic duct, and duodenum
exocrine function?
Digestive enzymes secreted by the acinar cells drain into the duodenum through pancreatic ducts
exocrine consists of? (3)
- amylase
- lipase
- trypsin
amylase?
breaks down carbohydrates
lipase?
breaks down fats
trypsin?
breaks down proteins
endocrine function?
- inslet cells of langerhand secrete hormones directly into the blood stream
what does endocrine consist of?
- alpha cells
- beta cells
alpha cells?
- secreate glucogen
- increases blood glucose
beta cells?
- secreate insulin
- decrease blood glucose
serum amylase normal range?
25-125 U/L
serum amylase increases with? (4)
- acute pancreatitis
- pancreatic pseusocyst
- intestinal obstruction
- peptic ulcer disease
serum amylase decreases with? (2)
hepatitis and cirrohsis
how long does serum amylase remain elevated in acute pancreatitis?
24 hrs
urine amylase?
remains increased longer than serum amylase in episodes of acute pancreatitis
serum lipase normal range?
10-140 U/L
how long does serum lipase remain elevated?
up to 14 days
serum lipase increases with? (6)
- pancreatitis
- obstruction of the pancreatic duct
- pancreatic carcinoma
- acute cholecystitis
- cirrhosis
- severe renal disease
glucose normal range?
- fasting
- post prandial
fasting: <100 mg/dl
post prandial: <145 mg/dl
glucose increases with? (3)
- severe diabetes
- chronic liver disease
- overactivity of endocrine glands
glucose decreases with?
tumors of islets of langerhanns in the pancreas
glucose decreases with?
tumors of islets of langerhanns in the pancreas
Normal Panc. size?
- head
- neck
- body
- tail
head: <3cm
neck: <2.5cm
body: <2.5 cm
tail: <2cm
what is acute pancreatitis and what is inflammation is caused by?
- Escape of pancreatic juices into the parenchymal tissues of the gland
- digestive enzymes cause destruction of the acini, ducts, small blood vessels, and fat
- may extend beyond the gland to peripancreatic tissues
Causes by?
- alcohol abuse
- biliary disease
actue pancreatitis S/S? and D/D?
S/S:
- abdominal pain radiating to the back
- nausea and vomiting
- abdominal distension
D/D:
- normal panc
- neoplasm
acute pancreatitis lab values?
- increases serum amylase and lipase
sono apperance of acute pancreatitis?
- Normal 30% of time
- may be enlarged
- decreased echogenicity
- extrapancratic fluid
- may have dialated panc duct
acute pancreatitis complications?
- pseudocyst
- abscess
- hemorrhage
- phlegmon
- biliary and duodenal obstruction
chronic pancreatitis etiology?
- alcohol abuse
- biliary disease
chronic pancreatitis s/s?
- abdominal pain
- nausea and vomiting
- abdominal distention
- weight loss
chronic pancreatitis lab findings?
- amylase and lipase not useful
- fat in feces
sono apperance chronic pancreatitis?
- normal or smaller in size
- heterogenous
- increased echogenicty
- dialated pancreatic duct (may contain stones)
- dialated common bile duct
chronic pancreatitis complicaitons?
- pseudocyst
- dialation of biliary system
- thrombosis of splenic/ portal vein
true cyst arise from and are found in?
- have epithilal lining
- may be continuous with the duct or arise from panratic tissue
- most commonly found in head
pancreatic pseudocyst formed by?
- pancreatic enzymes that escape the panc duct
- fluid may spontaneously reabsorb or it may rupture
- most commonly found in lesser sac
cystadenoma?
- benign
- more common in females
- found mostly in body and tail
cystadenoma sono apperance?
- anachoic masses with increased posterior enhancement
- irragular margins
- may have internal echos
islet cell tumor (insulinoma) s/s?
hypoglycemia
islet cell tumor (insulinoma) lab values?
elevated plasma insulin levels
islet cell tumor (insulinoma) arises from?
- B cells of the islets of langerhans
- usually found in body and tail
islet cell tumor (insulinoma) sono apperance?
- 1-2cm
- homogenous solid masses
- hypoechoic
- may have areas of cystic degeneration
adenocarcinoma s/s?
- malignant
- symptoms occur late in disease
- pain
- weight loss
- painless jaundice
adenocarcinoma lab values?
incresed serum amylase, bilirubin, alkaline phosphate, AST
most common panc. tumor?
adenocarcinoma
adenocarcinoma arises from? most commonly found in?
- arises from exocrine tissue
- most commonly found in the head
cystadenoma-carcinoma?
- malignant
- rare
cystadenomacarcinoma s/s?
epigastric pain
cystadenomacarcinoma usually found in?
body or tail
cystadenomacarcinoma sono apperance?
- cystic masses
- irregular borders
- thick walls
- may have solid components
pseudocyst s/s?
- elevated amylase and papable mass
- decrease in hematocrit indicates hemorrhage
D/D chronic pancreatitis? (3)
- fatty replacement
- neoplasm
- cystic fibrosis
whats associated with double duct sign?
adenocarcinoma
adenocarcinoma sono apperance?
- hypoechoic
- double duct sign
adenocarcinoma d/d?
- focal pancreatitis
- adenoma
- caudate lobe
adenocarcinoma presents as?
- obstruction of the CBD
- jaudice
- hydops of GB
- Palpable, nontender gallbladder accompanied by jaundice (25%)
what is courvoisier sign?
Palpable, nontender gallbladder accompanied by jaundice
psedocyst D/D?
- fluid filled stomach
- neoplasm
- dialated panc. duct
- LRV
- omental cyst
- cystadenoma
most common extrapancreatic sites for fluid collection?
- lesser sac
- anterior pararenal spaces
- mesocolon
- perirenal spaces
- peripancreatic soft-tissue spaces
Hemorrhagic Pancreatitis?
Rapid progression of acute pancreatitis with the rupture of pancreatic vessels and subsequent hemorrhage
what can hemorrhagic pancreatitis cause?
cause focal areas of fat necrosis in and around the pancreas, which leads to rupture of pancreatic vessels and hemorrhage.
what can hemorrhagic pancreatitis cause?
cause focal areas of fat necrosis in and around the pancreas, which leads to rupture of pancreatic vessels and hemorrhage.
Phlegmonous Pancreatitis?
inflammatory process that spreads along fascial pathways, causing localized areas of diffuse inflammatory edema of soft tissue that may proceed to necrosis and suppuration
what does phelgmonous pancreatitis involve?
- lesser sac
- lt anterior pararenal space
transverse mesocolon
what is pancreatic abscess related to?
tissue necrosis
what might pancreatic abcess arise from?
- infection
- perforated peptic ulcer
- actute pancreatitis
- acute cholesystitis
what does chronic pancreatitis result from?
- recurrent attacks of actute pancreatitis
Chronic pancreatitis : Patients Signs/Symptoms?
- pain
- malabsorption
- diabetes
Chronic Pancreatitis Leads to?
Fibrosis Cellular damage Chronic inflammation Distorted/blocked ducts permanent structural changes Deficient endocrine and exocrine function
Sonographic Findings of Chronic Pancreatitis
Altered parenchymal texture Glandular atrophy Or gland enlargement Focal masses Dilation and beading of pancreatic duct with calcifications Pseudocysts
Sonographic Findings of Chronic Pancreatitis
Altered parenchymal texture Glandular atrophy Or gland enlargement Focal masses Dilation and beading of pancreatic duct with calcifications Pseudocysts
Treatment of uncomplicated Chronic pacreatitis
- improve quality of life
- alleviate pain
- control malabsorption and diabetes
Treatment of complicated Chronic panreatitis?
- surgery
- endoscopy
what is the most common vascular comlication of the panc?
- splenic vein thrombosis
what is the most common vascular comlication of the panc?
- splenic vein thrombosis
most common primary pancreatic neoplasm?
pancreatic ductal adenocarcinoma
Pancreatic Ductal Adenocarcinoma
- 85-90% of malignancies
- cure is rare
Ductal Adenocarcinoma Risk Factors?
- male
- 60-80yrs
- smoking
- obesity
- chronic pancreatitis
- diabetes
- cirrhosis
- family history
Ductal Adenocarcinoma: signs and symptoms
- jaundice
- pain
- weight loss
Ductal /Periampullar Adenocarcinoma sono signs?
- Double- duct sign
whipples procedure?
-kjhb
Von Hippel Lindau Disease?
- connective tissue disorder
- multiple simple pancreatic cysts
