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Penny abdomen > Ch. 5 Pancreas > Flashcards

Ch. 5 Pancreas Flashcards

1
Q

True or False: the pancreas develops initially in the embryo from two separate parts that eventually fuse together to constitute its typical comma-shaped appearance.

A

True

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2
Q

Anatomically, where is the pancreas located in the body?

A

It is located within the epigastrium between the C loop of the duodenum and the splenic hilum

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3
Q

What are the 4 parts of the pancreas?

A

head, neck, body, tail

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4
Q

True or False: the pancreas is both and exocrine and endocrine gland.

A

True

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5
Q

The pancreas is an ___________ gland that aids in digestion.

A

Exocrine gland

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6
Q

The ________ ______ of the pancreas carry out the exocrine function because they produce vital digestive enzymes, such as amylase and lipase

A

Acinar cells

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7
Q

Released by the pancreas to digest carbohydrates and converts starch into sugar

A

Amylase

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8
Q

The pancreas functions as both

A

endocrine and exocrine gland

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9
Q

What is the posteromedial extension of the pancreatic head?

A

uncinate process

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10
Q

Pancreas uses ducts to transport digestive juices, is this the (exocrine or endocrine function)

A

exocrine gland

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11
Q

Pancreas releases hormone directly into the bloodstream, is this the (exocrine or endocrine function)

A

endocrine gland

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12
Q

Released by the pancreas to digest fats and converts fats into fatty acids and glycerol

A

Lipase

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13
Q

Released by the pancreas to neutralize stomach acid

A

Sodium bicarbonate

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14
Q

Released by the pancreas to digest proteins

A

Trypsin, chymotrypsin, carboxypolypeptidase

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15
Q

Other term for main pancreatic duct

A

Duct of Wirsung

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16
Q

accessory duct of pancreas

A

Duct of Santorini

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17
Q

the pancreas is a ______ organ

A

retroperitoneal

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18
Q

Islets of Langerhands is composed of:

A

Alpha, beta, and delta cells

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19
Q

From the main pancreatic duct (duct of Wirsung) the enzymes collect into the

A

ampulla of Vater

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20
Q

Pancreatic digestive enzymes are mixed with bile at the liver and released into duodenum through a major sphincter called

A

sphincter of Oddi

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21
Q

Relaxation and the consequent opening of the sphincter of Oddi is triggered by ___ released by the duodenum because the presence of chyme.

A

cholecystokinin

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22
Q

What cause the contraction of the gallbladder?

A

cholecystokinin

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23
Q

What causes the relaxation of the sphincter of Oddi?

A

cholecystokinin

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24
Q

What is the endocrine function of the pancreas performed by?

A

islets of Langerhans (composed of alpha, beta, delta cells)

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25
Q

What vital hormones do the islets of Langerhans produce?

A

insulin and glucagon

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26
Q

What hormone promotes the release of glucose by the liver increasing sugar levels?

A

glucagon (alpha cells, islets of langerhan)

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27
Q

What hormone stimulates the body to use up glucagon to produce energy?

A

insulin (beta cells, islet of Langerhans)

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28
Q

What hormone restrains insulin and glucose level?

A

somatostatin (delta cells, islet of Langerhans)

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29
Q

Where does the head of the pancreas get arterial blood supply?

A

Gastroduodenal artery

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30
Q

Where does the body and tail of the pancreas receive their blood supply?

A

Splenic and superior mesenteric arteries

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31
Q

Venous drainage of pancreas is achieved by?

A

splenic vein, superior mesenteic vein, inferior mesenteric, portal vein

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32
Q

What can be done to improve the visualization of the pancreatic head?

A
  1. Patient drinking a small cup of water for it to go to the duodenum to provide a delineated view of the pancreatic head
  2. Left lateral decubitus position
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33
Q

What can be done to improve the visualization of the pancreatic tail?

A

Scan through the left kidney and spleen while in the left lateral decubitus position

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34
Q

What is the normal echogenicity of the pancreas?

A

Greater than the liver or equal to/greater than the spleen

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35
Q

Normal echogenicity of pediatric pancreas

A

more hypoechoic because of lack of fat surrounding

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36
Q

In some adults, the pancreas may appear peculiarly diffusely hyperechoic, representing ______.

A

pancreatic steatosis- fatty infiltration of the pancreas; may be classified as alcoholic or nonalcholic; may also be referred to as a fatty pancreas.

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37
Q

In the transverse plane of the pancreas, what are the two anechoic structures may be noted within the pancreatic head?

A
  1. Gastroduodenal artery
  2. CBD
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38
Q

The anterioposterior diameter of the main pancreatic duct should not exceed in what measurement?

A

2mm

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39
Q

What is the normal measurement of the pancreatic head and body?

A

Between 2 and 3cm

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40
Q

What is the normal measurement of the pancreatic tail?

A

Between 1 and 2cm

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41
Q

The two most common congenital anomalies of the pancreas:

A
  1. Pancreatic divisum
  2. Annular pancreas
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42
Q

Most common congenital variant of the pancreas, abnormal fusion of the pancreatic ducts during embryologic development, results from shortened duct of Wirsung that drains only the head

A

pancreatic divisum

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43
Q

__________ _______ can lead to both acute and chronic pancreatitis.

A

Pancreatic divisum

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44
Q

What is the result of having pancreatic divisum?

A

Shortening of main pancreatic duct

45
Q

Congenital anomaly of the pancreas that results in the maldevelopment of the two embryologic elements of the pancreas which the most ventral part of the pancreas encases the duodenum and may consequently lead to duodenal obstruction

A

annular pancreas

46
Q

Inflammation of the pancreas secondary to the leakage of pancreatic enzymes from the acinar cells into the parenchyma of the organ

A

acute pancreatitis

47
Q

Most common cause of acute pancreatitis are

A

alcohol abuse & biliary tract disease (ex. choledocolithiasis)

48
Q

Acute pancreatitis will cause a rise in _______ first and then a rise in _______.

A

amylase & lipase

49
Q

Between lipase and amylase, which is the most helpful laboratory finding for the diagnosis of acute pancreatitis?

A

Lipase

50
Q

With focal pancreatitis, it leads to the enlargement of the pancreas in what specific area?

A

The head of the pancreas appearing as a hypoechoic region

51
Q

With diffuse pancreatitis, it leads to the enlargement of what area of the pancreas?

A

All of the pancreas with a hypoechoic appearance

52
Q

________ ______ pancreatitis will result in a diffusely enlarged, hypoechoic gland

A

Diffuse acute pancreatitis

53
Q

a cyst surrounded by fibrous tissue that consists of pancreatic enzymes that have leaked from the pancreas

A

pancreatic pseudocyst

54
Q

One of the more common sites for a pancreatic pseudocyst is the ________ ______.

A

Lesser sac

55
Q

The peripancreatic fluid collection that results from the inflammation of the pancreas

A

plegmon

56
Q

Where is the lesser sac of the pancreas?

A

Located between the pancreas and the stomach

57
Q

What are the most common complications of thr pancreas?

A
  1. Splenic vein thrombosis
  2. Pseudoaneurysm of the splenic artery
58
Q

Pancreatitis associated with gallstone and concurrent obstruction of the pancreatic duct

A

gallstone pancreatitis

59
Q

Pancreatitis associated with bleeding within or around the pancreas, high rate of morbidity & mortality

A

hemorrhagic pancreatitis

60
Q

Form of chronic pancreatitis that results from the body’s immune system attacking the pancreas

A

autoimmune pancreatitis

61
Q

Uncommon form of chronic pancreatitis found in the head of the pancreas with associated inflammation of the CBD & second portion of the duodenum

A

groove pancreatitis

62
Q

Form of acute pancreatitis resulting in necrosis of the pancreatic parenchyma and the tissue surrounding the pancreas, high rate of mortality & morbidity

A

necrotizing pancreatitis

63
Q

Most common form of acute pancreatitis associated with inflammation of the pancreatic parenchyma and peripancreatic tissues, necrosis not present

A

interstitial edematous pancreatitis

64
Q

the clinical findings of _____
1. elevated amylase (within 24 hours)
2. elevated lipase (within 72 hours)
3. abdominal pain
4. back pain
5. fever, nausea
6. vomiting
7. leukocytosis
8. Elevated ALT and other liver functions labs
9. Severe acute pancreatitis may lead to hemorrhage & decreased hematocrit

A

acute pancreatitis

65
Q

the sonographic findings of _____
1. The pancreas may appear normal
2. Diffusely enlarged, hypoechoic pancreas
3. Focal hypoechoic area within the pancreas
4. Unencapsulated anechoic fluid collection surrounding all or part of the pancreas. (peripancreatic fluid)
5. Pancreatic pseudocyst
6. Abscess formation can occur and is seen as echogenic fluid containing gas bubbles
7. Biliary obstruction may be present
8. Vascular complications such as splenic vein thrombosis and pseudoaneurysm of the splenic artery

A

acute pancreatitis?

66
Q

Repeated bouts of pancreatic inflammation can lead to

A

chronic pancreatitis

67
Q

What is often the cause of chronic pancreatitis?

A

Alchohol abuse

68
Q

What are the causes of chronic pancreatitis?

A

Hyperparathyroidism
Congenital anomalies
Genetic disorders
Pancreatic duct obstruction
Trauma

69
Q

When the destruction of the pancreatic tissue recurs, it can result to what?

A
  1. Atrophy
  2. Fibrosis with scarring
  3. Development of calcification within the gland
70
Q

the clinical findings of _____
1. Asymptomatic
2. Persistent epigastric pain
3. Jaundice
4. Back pain
5. Possible elevation in amylase or lipase
6. Possible elevation in ALP
7. Anorexia
8. Vomiting
9. Weight loss
10. Constipation

A

chronic pancreatitis

71
Q

the sonographic findings of the ______
1. heterogeneous atrophic pancreas with poor margins
2. calcifications
3. pseudocyst
4. dilated pancreatic duct
5. stones within the pancreatic duct
6. possible portosplenic vein thrombosis

A

chronic pancreatitis

72
Q

40% of the time patient with chronic pancreatitis develop

A

pseudocyst

73
Q

The most common primary pancreatic malignancy and it is the most commonly discovered in men

A

Pancreatic adenocarcinoma

74
Q

What part in the pancreas does pancreatic adenocarcinoma usually occur?

A

The head of the pancreas

75
Q

if pancreatic adenocarcinoma is located in the head, what does it most often lead to?

A

obstructed common bile duct
curvoisier gallbladder

76
Q

What is the surgical procedure that is performed on patients with pancreatic adenocarcinoma?

A

Whipple procedure

77
Q

The whipple procedure is also called

A

pancreatoduodenectomy

78
Q

This procedure is the removal of the head of the pancreas, gallbladder, some of the bile ducts, and proximal duodenum

A

Pancreaticeduodenectomy

79
Q

Patient frequently has jaundice with pancreatic adenocarcinoma secondary to obstruction of the ____.

A

CBD

80
Q

What stage of pancreatic adenocarcinoma is the mass only confined to the pancreas?

A

Stage I

81
Q

What stage of pancreatic adenocarcinoma involves local lymph node involvement?

A

Stage II

82
Q

What stage of pancreatic adenocarcinoma with evidence of distant metastasis?

A

Stage III

83
Q

Clinical findings of ______
1. elevated amylase and/or lipase
2. loss of appetitie
3. weight loss
4. jaundice
5. courvousier GB
6. epigastric pain
7. Elevated ALP and possibly other liver function labs associated with biliary obstruction

A

pancreatic adenocarcinoma

84
Q

Sonographic findings of ______
1. hypoechoic mass in the head of the pancreas
2. dilated CBD and Pancreatic duct (double-duct sign)
3. Liver and other abdominal organs should be evaluated for possible metastasis
4. enlarged GB

A

pancreatic adenocarcinoma

85
Q

Pancreatic cystadenocarcinoma of the pancreas is most often found where

A

body & tail

86
Q

A cystadenoma within the pancreas may be referred to as either ______ or _____.

A

microcystic serous cystadenoma (benign) or macrocystic mucinous cystadenoma (potential malignant)- found most often in body & tail

87
Q

Clinical findings of ______
1. may be asymptomatic initially
2. epigastric pain
3. weight loss
4. palpable mass
5. jaundice

A

cystadenomas and cystadenocarcinomas

88
Q

Sonographic finings of ______
1. Cystic mass
2. May acutally appear solid and echogenic secondary to the small size of the cyst

A

serous cystadenoma

89
Q

Sonographic findings of ______
1. multilocular cystic masses that may contain mural nodules and calcifications
2. there may be associated dilation of the pancreatic duct

A

mucinous cystadenoma and cystadenocarcinoma:

90
Q

What are the two types of islet cell tumors?

A

insulinoma and gastrinoma

91
Q

Between insulinoma and gastrinoma, which one is more common?

A

Insulinoma

92
Q

Islet cell tumor of the pancreas, gastrinoma can produce ____ which is excessive secretion of acid by the stomach that leads to peptic ulcers.

A

Zollinger-Ellison syndrome

93
Q

Group of clinical indicators of a functional insulinoma including hypoglycemia, low fasting glucose and relief with intravenous glucose administration is referred to as

A

Whipple triad

94
Q

von Hippel-Lindau disease is associated with ___ on the pancreas

A

cysts

95
Q

Insulinomas are usually ______, while gastrinomas are often ______ and difficult to image.

A

Solitary; multiple

96
Q

Functional gastrinomas can produce

A

Zollinger-Ellison syndrome

97
Q

Clinical findings of ______
1. Insulinoma - low blood sugar symptoms
2. Gastrinoma - Zollinger-Ellison syndrome

A

islet cell tumors

98
Q

Sonographic findings of _____
1. Hypoechoic mass that may contain calcifications
2. Visualization is hard because of their small size

A

islet cell tumors

99
Q

cysts noted within the pancreas may be seen with _____.

A

Von Hippel-Lindau disease or autosomal dominant polycystic kidney disease

100
Q

Clinical findings of _____
1. possible history of von Hippel-Lindau disease or cystic fibrosis
2. possible history of ADPKD

A

true pancreatic cysts

101
Q

Sonographic findings of _____
1. well-defined, anechoic mass with posterior enhancement

A

true pancreatic cysts

102
Q

What are the two common types of transplantation techniques of the pancreas?

A

Exocrine bladder drainage
Exocrine enteric drainage

103
Q

The more common pancreatic transplantation is referred to as

A

exocrine enteric drainage

104
Q

List the pancreatic transplant fluid collections?

A
  1. Abscess
  2. Ascites
  3. Hematoma
  4. Urinoma
  5. Pseudocysts
105
Q

What are the sonographic findings of acute pancreatic transplant rejection?

A
  1. Hypoechoic or heterogeneous gland
  2. Elevated resistive indices
106
Q

List the pancreatic ______ vascular complications
1. Arterial stenosis
2. Arterial thrombosis
3. Graft thrombosis
4. Pseudoaneurysms
5. Splenic vein thrombosis
6. Strictures/Turbulent flow

A

transplant

107
Q

What are the sonographic findings of ______
1. Hyperechoic echotexture
2. Atrophy
3. Pancreas may contain calcifications

A

chronic pancreatic transplant rejection

108
Q

80% of patients that undergo transplantation of the pancreas also undergo a renal transplant at the same time, with the pancreas being placed on the ___ of the abdomen and the kidney placed on the ___.

A

right side, left

109
Q

Which of the following would be the least likely complication of a pancreatic transplant?

A

biloma

Penny abdomen (8 decks)

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