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CNIH > Abdo- pancreas > Flashcards

Abdo- pancreas Flashcards

1
Q

Where is the panc located?

A

retroperitoneal

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2
Q

what duct joins the pancreas. to the common bile duct?

A

duct of wiring

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3
Q

ampulla of vator?

A

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

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4
Q

sphincter of oddi?

A

small smooth muscle sphincter strategically placed at the junction of the bile duct, pancreatic duct, and duodenum

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5
Q

exocrine function?

A

Digestive enzymes secreted by the acinar cells drain into the duodenum through pancreatic ducts

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6
Q

exocrine consists of? (3)

A
  1. amylase
  2. lipase
  3. trypsin
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7
Q

amylase?

A

breaks down carbohydrates

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8
Q

lipase?

A

breaks down fats

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9
Q

trypsin?

A

breaks down proteins

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10
Q

endocrine function?

A
  • inslet cells of langerhand secrete hormones directly into the blood stream
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11
Q

what does endocrine consist of?

A
  • alpha cells

- beta cells

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12
Q

alpha cells?

A
  • secreate glucogen

- increases blood glucose

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13
Q

beta cells?

A
  • secreate insulin

- decrease blood glucose

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14
Q

serum amylase normal range?

A

25-125 U/L

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15
Q

serum amylase increases with? (4)

A
  • acute pancreatitis
  • pancreatic pseusocyst
  • intestinal obstruction
  • peptic ulcer disease
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16
Q

serum amylase decreases with? (2)

A

hepatitis and cirrohsis

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17
Q

how long does serum amylase remain elevated in acute pancreatitis?

A

24 hrs

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18
Q

urine amylase?

A

remains increased longer than serum amylase in episodes of acute pancreatitis

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19
Q

serum lipase normal range?

A

10-140 U/L

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20
Q

how long does serum lipase remain elevated?

A

up to 14 days

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21
Q

serum lipase increases with? (6)

A
  • pancreatitis
  • obstruction of the pancreatic duct
  • pancreatic carcinoma
  • acute cholecystitis
  • cirrhosis
  • severe renal disease
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22
Q

glucose normal range?

  • fasting
  • post prandial
A

fasting: <100 mg/dl

post prandial: <145 mg/dl

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23
Q

glucose increases with? (3)

A
  • severe diabetes
  • chronic liver disease
  • overactivity of endocrine glands
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24
Q

glucose decreases with?

A

tumors of islets of langerhanns in the pancreas

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25
Q

glucose decreases with?

A

tumors of islets of langerhanns in the pancreas

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26
Q

Normal Panc. size?

  • head
  • neck
  • body
  • tail
A

head: <3cm
neck: <2.5cm
body: <2.5 cm
tail: <2cm

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27
Q

what is acute pancreatitis and what is inflammation is caused by?

A
  • 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
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28
Q

actue pancreatitis S/S? and D/D?

A

S/S:

  • abdominal pain radiating to the back
  • nausea and vomiting
  • abdominal distension

D/D:

  • normal panc
  • neoplasm
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29
Q

acute pancreatitis lab values?

A
  • increases serum amylase and lipase
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30
Q

sono apperance of acute pancreatitis?

A
  • Normal 30% of time
  • may be enlarged
  • decreased echogenicity
  • extrapancratic fluid
  • may have dialated panc duct
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31
Q

acute pancreatitis complications?

A
  • pseudocyst
  • abscess
  • hemorrhage
  • phlegmon
  • biliary and duodenal obstruction
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32
Q

chronic pancreatitis etiology?

A
  • alcohol abuse

- biliary disease

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33
Q

chronic pancreatitis s/s?

A
  • abdominal pain
  • nausea and vomiting
  • abdominal distention
  • weight loss
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34
Q

chronic pancreatitis lab findings?

A
  • amylase and lipase not useful

- fat in feces

35
Q

sono apperance chronic pancreatitis?

A
  • normal or smaller in size
  • heterogenous
  • increased echogenicty
  • dialated pancreatic duct (may contain stones)
  • dialated common bile duct
36
Q

chronic pancreatitis complicaitons?

A
  • pseudocyst
  • dialation of biliary system
  • thrombosis of splenic/ portal vein
37
Q

true cyst arise from and are found in?

A
  • have epithilal lining
  • may be continuous with the duct or arise from panratic tissue
  • most commonly found in head
38
Q

pancreatic pseudocyst formed by?

A
  • pancreatic enzymes that escape the panc duct
  • fluid may spontaneously reabsorb or it may rupture
  • most commonly found in lesser sac
39
Q

cystadenoma?

A
  • benign
  • more common in females
  • found mostly in body and tail
40
Q

cystadenoma sono apperance?

A
  • anachoic masses with increased posterior enhancement
  • irragular margins
  • may have internal echos
41
Q

islet cell tumor (insulinoma) s/s?

A

hypoglycemia

42
Q

islet cell tumor (insulinoma) lab values?

A

elevated plasma insulin levels

43
Q

islet cell tumor (insulinoma) arises from?

A
  • B cells of the islets of langerhans

- usually found in body and tail

44
Q

islet cell tumor (insulinoma) sono apperance?

A
  • 1-2cm
  • homogenous solid masses
  • hypoechoic
  • may have areas of cystic degeneration
45
Q

adenocarcinoma s/s?

A
  • malignant
  • symptoms occur late in disease
  • pain
  • weight loss
  • painless jaundice
46
Q

adenocarcinoma lab values?

A

incresed serum amylase, bilirubin, alkaline phosphate, AST

47
Q

most common panc. tumor?

A

adenocarcinoma

48
Q

adenocarcinoma arises from? most commonly found in?

A
  • arises from exocrine tissue

- most commonly found in the head

49
Q

cystadenoma-carcinoma?

A
  • malignant

- rare

50
Q

cystadenomacarcinoma s/s?

A

epigastric pain

51
Q

cystadenomacarcinoma usually found in?

A

body or tail

52
Q

cystadenomacarcinoma sono apperance?

A
  • cystic masses
  • irregular borders
  • thick walls
  • may have solid components
53
Q

pseudocyst s/s?

A
  • elevated amylase and papable mass

- decrease in hematocrit indicates hemorrhage

54
Q

D/D chronic pancreatitis? (3)

A
  • fatty replacement
  • neoplasm
  • cystic fibrosis
55
Q

whats associated with double duct sign?

A

adenocarcinoma

56
Q

adenocarcinoma sono apperance?

A
  • hypoechoic

- double duct sign

57
Q

adenocarcinoma d/d?

A
  • focal pancreatitis
  • adenoma
  • caudate lobe
58
Q

adenocarcinoma presents as?

A
  • obstruction of the CBD
  • jaudice
  • hydops of GB
  • Palpable, nontender gallbladder accompanied by jaundice (25%)
59
Q

what is courvoisier sign?

A

Palpable, nontender gallbladder accompanied by jaundice

60
Q

psedocyst D/D?

A
  • fluid filled stomach
  • neoplasm
  • dialated panc. duct
  • LRV
  • omental cyst
  • cystadenoma
61
Q

most common extrapancreatic sites for fluid collection?

A
  • lesser sac
  • anterior pararenal spaces
  • mesocolon
  • perirenal spaces
  • peripancreatic soft-tissue spaces
62
Q

Hemorrhagic Pancreatitis?

A

Rapid progression of acute pancreatitis with the rupture of pancreatic vessels and subsequent hemorrhage

63
Q

what can hemorrhagic pancreatitis cause?

A

cause focal areas of fat necrosis in and around the pancreas, which leads to rupture of pancreatic vessels and hemorrhage.

64
Q

what can hemorrhagic pancreatitis cause?

A

cause focal areas of fat necrosis in and around the pancreas, which leads to rupture of pancreatic vessels and hemorrhage.

65
Q

Phlegmonous Pancreatitis?

A

inflammatory process that spreads along fascial pathways, causing localized areas of diffuse inflammatory edema of soft tissue that may proceed to necrosis and suppuration

66
Q

what does phelgmonous pancreatitis involve?

A
  • lesser sac
  • lt anterior pararenal space
    transverse mesocolon
67
Q

what is pancreatic abscess related to?

A

tissue necrosis

68
Q

what might pancreatic abcess arise from?

A
  • infection
  • perforated peptic ulcer
  • actute pancreatitis
  • acute cholesystitis
69
Q

what does chronic pancreatitis result from?

A
  • recurrent attacks of actute pancreatitis
70
Q

Chronic pancreatitis : Patients Signs/Symptoms?

A
  • pain
  • malabsorption
  • diabetes
71
Q

Chronic Pancreatitis Leads to?

A 
Fibrosis
Cellular damage
Chronic inflammation
Distorted/blocked ducts
permanent structural changes
Deficient endocrine and exocrine function
72
Q

Sonographic Findings of Chronic Pancreatitis

A 
Altered parenchymal texture
Glandular atrophy
Or gland enlargement
Focal masses
Dilation and beading of pancreatic duct with calcifications
Pseudocysts
72
Q

Sonographic Findings of Chronic Pancreatitis

A 
Altered parenchymal texture
Glandular atrophy
Or gland enlargement
Focal masses
Dilation and beading of pancreatic duct with calcifications
Pseudocysts
73
Q

Treatment of uncomplicated Chronic pacreatitis

A
  • improve quality of life
  • alleviate pain
  • control malabsorption and diabetes
74
Q

Treatment of complicated Chronic panreatitis?

A
  • surgery

- endoscopy

75
Q

what is the most common vascular comlication of the panc?

A
  • splenic vein thrombosis
75
Q

what is the most common vascular comlication of the panc?

A
  • splenic vein thrombosis
76
Q

most common primary pancreatic neoplasm?

A

pancreatic ductal adenocarcinoma

77
Q

Pancreatic Ductal Adenocarcinoma

A
  • 85-90% of malignancies

- cure is rare

78
Q

Ductal Adenocarcinoma Risk Factors?

A
  • male
  • 60-80yrs
  • smoking
  • obesity
  • chronic pancreatitis
  • diabetes
  • cirrhosis
  • family history
79
Q

Ductal Adenocarcinoma: signs and symptoms

A
  • jaundice
  • pain
  • weight loss
80
Q

Ductal /Periampullar Adenocarcinoma sono signs?

A
  • Double- duct sign
81
Q

whipples procedure?

A

-kjhb

82
Q

Von Hippel Lindau Disease?

A
  • connective tissue disorder

- multiple simple pancreatic cysts

CNIH (69 decks)

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