ARRT abdomen 5 Flashcards
Charcot triad
pain, fever, jaundice
Clinical symptoms of acute cholangitis include
Charcot triad, elevated ALP and bilirubin, nausea/vomiting
Sonographic appearance of acute cholangitis
thickened bile duct walls >5mm, stones, sludge
Chronic complications of acute cholangitis
sclerosing cholangitis
sclerosis =
hardening and thickening
Chronic type of fibrotic thickening of bile ducts
sclerosing cholangitis
What kind of cholangitis increases the risk for cholangiocarcinoma?
sclerosing
Pneuma =
air
air or gas formation within the biliary tree
pneuomobilia
Pneumobilia is caused by:
recent surgery or trauma
Sonographic appearance of pneumobilia
comet-tail or ring down artifacts scattered throughout the liver
parasites in bile ducts
ascariasis
What confirms the presence of ascariasis?
movement of worm in real time
most common cancer of biliary tract
gallbladder carcinoma
Gallbladder carcinoma is suspected when polyps measure over
1 cm
Clinical symptoms of gallbladder carcinoma
weight loss
RUQ pain
jaundice if obstructive
Sonographic appearance of gallbladder carcinoma
non-mobile mass along wall larger than 1 cm
cancer within the bile ducts
cholangiocarcinoma
Most common tumor associated with cholangiocarcinoma
Klatskin tumor
Where is the Klatskin tumor located?
junction of the right and left hepatic ducts
Ductal dilatation will occur ___ cholangiocarcinoma
above
Clinical symptoms of cholangiocarcinoma include
weight loss
RUQ pain
jaundice
pruritis
history of sclerosing cholangitis
Pruritis
excessive itching
Sonographic appearance of cholangiocarcinoma
dilated intrahepatic ducts the abruptly terminate
Most common location of pancreatic carincoma mass
pancreatic head
Pancreatic carcinoma causes:
biliary obstruction
clinical symptoms of pancreatic carcinoma
jaundice (direct bilirubin)
elevated ALP
dilated ducts: CBD and proximal pancreatic duct
“born with it”
congenital
narrowing or absence of the biliary tree
biliary atresia
Biliary atresia is only seen in ____ and is not compatible with life
newborns/infants
Biliary atresia will eventually cause ____ and ___ if not corrected
liver failure
death
Clinical symptoms of biliary atresia
neonatal jaundice
liver failure
Sonographic appearance of biliary atresia
absent ducts
absent cord appearance at porta hepatis
most common type of choledochal cyst
cystic dilatation of CBD
Clinical signs of choledochal cyst
biliary obstruction signs
Sonographic appearance of choledochal cyst
cystic dilatation of CBD
segmental dilatation of intrahepatic ducts
Caroli disease
Clinical signs of Caroli disease include:
may eventually have biliary obstruction signs
Sonographic appearance of Caroli disease
central dot sign
segmental dilatation located in one part of the liver
The pancreas is a ____peritoneal organ
retro
The pancreas is located in the:
anterior pararenal space
Is the pancreas an endocrine or exocrine gland?
both
The exocrine enzymes are produced by the ____ in the pancreas.
acinar
The enzymes produced by the acinar cells in the pancreas include ____, _____, _____, and ____.
amylase
lipase
sodium bicarbonate
trypsin
The endocrine hormones of the pancreas are made by the:
islets of Langerhaans
The islets of Langerhaans consist of ___, ___, and ___ cells
alpha
beta
delta
The hormones produced by the islets of Langerhaans include ____, ____, and ____.
insulin
glucagon
somatostatin
The main pancreatic duct is also known as:
Duct of Wirsung
The main pancreatic duct travels the length of the pancreas and terminates when it meets with the ___ at the ____.
CBD
Ampulla of Vater
The Ampulla of Vater empties via the _____
sphincter of Oddi
The accessory duct of the pancreas is also known as the:
duct of Santorini
The branch of the accessory duct empties via the _____ into the _____
minor sphincter
duodenum
The vascular supply to the pancreas is from:
gastroduodenal artery
splenic artery
superior mesenteric artery
The gastroduodenal artery is a branch of the _____
common hepatic artery
The gastroduodenal artery supplies the_
head of the pancreas
The splenic artery and the superior mesenteric artery supply the:
body and tail
The sonographic appearance of an adult pancreas
normally echogenic to liver, isoechoic to spleen
The sonographic appearance of a pediatric pancreas
normally hypoechoic to the liver
The main pancreatic duct should measure less than
2 mm
The main pancreatic duct may be seen perpendicular to sound beam to level of
body
The gastroduodenal artery is located _____ to the head of the pancreas
anterolateral
The common bile duct is located ____ to the head of the pancreas
posterolateral
The IVC is located ____ to the head of the pancreas
posterior
The duodenum is located ____ to the head of the pancreas
lateral
The portal confluence of superior mesenteric vein is located ____ to pancreatic head
medial
The portal confluence of superior mesenteric vein is located ____ to uncinate process of the pancreas
anterior
The portal confluence or the superior mesenteric vein is located ____ to the neck of the pancreas
posterio
The splenic vein is located ____ to the body and tail of the pancreas
posterior
The splenic artery is located ____ to body and tail of the pancreas..
superior
The superior mesenteric artery is located ____ to the aorta
anterior
The superior mesenteric artery is located ____ to pancreas body and splenic vein
posterior
The left renal vein is located ____ to superior mesenteric artery
posterior
The left renal vein is located ____ to the aorta
anterior
The right renal artery is located ____ to IVC
posterior
The most common variant of the pancreas
divisum
shortened main pancreatic duct, forces accessory duct to become primary drainage
divisum of the pancreas
Patients with divisum of the pancreas are at an increased risk of ____ and ____
dilated ducts
pancreatitis
Most common cause of acute pancreatitis:
choledocholithiasis
Leakage of enzymes into pancreatic tissue causing inflammation
acute pancreatitis
In acute pancreatitis, ____ rises first
amylase
In acute pancreatitis, ____ rises within 72 hours and is more specific for pancreatitis
lipase
Clinical symptoms of acute pancreatitis include
fever
pain
leuko
elevated amylase and lipase
biliary obstruction labs if caused by a stone
Sonographic appearance of acute pancreatitis
initially normal
hypoechoic
enlarged
phlegmon (peripancreatic fluid)
pseudocyst
possible ductal dilatation
Pancreatic pseudocysts are most commonly found in the:
lesser sac
Most common vascular complications of acute pancreatitis:
splenic vein thrombosis
splenic artery pseudocyst
peripancreatic fluid
fluid surrounding edematous pancreas
not encapsulated
only found with acute pancreatitis
phlegmon
encapsulated fluid collection
most commonly found in lesser sac
can be found with acute and chronic pancreatitis
pseudocyst
repeated bouts of acute pancreatitis
chronic pancreatitis
Chronic pancreatitis is most commonly found in cases of pancreatitis caused by:
alcoholism
clinical symptoms of chronic pancreatitis
pain
jaundice
abnormal labs
weight loss
Sonographic appearance of chronic pancreatitis
heterogeneous, hyperechoic with calcs, possible pseudocyst, possible ductal dilatation
Pancreatic adenocarcinoma is also known as:
ductal adenocarcinoma
Most common location of pancreatic adenocarcinoma
head of pancreas
Pancreatic adenocarcinoma is related to:
biliary dilatation
enlarged, palpable gallbladder caused by pancreatic head mass
courvoisier gallbladder
Clinical symptoms of pancreatic adenocarcinoma include
weight loss
abnormal labs (ALP, conjugated bilirubin)
Sonographic appearance of pancreatic adenocarcinoma
hypoechoic mass, dilated ducts, possibly enlarged gallbladder
removal of pancreatic head, duodenum, gallbladder, and bile duct
whipple procedure
2 types of pancreatic cystadenomas
serous and mucinous
Cystadenomas are most commonly found in:
body and tail of pancreas
