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
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
3
Q
What are the 4 parts of the pancreas?
A
head, neck, body, tail
4
Q
True or False: the pancreas is both and exocrine and endocrine gland.
A
True
5
Q
The pancreas is an ___________ gland that aids in digestion.
A
Exocrine gland
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
7
Q
Released by the pancreas to digest carbohydrates and converts starch into sugar
A
Amylase
8
Q
The pancreas functions as both
A
endocrine and exocrine gland
9
Q
What is the posteromedial extension of the pancreatic head?
A
uncinate process
10
Q
Pancreas uses ducts to transport digestive juices, is this the (exocrine or endocrine function)
A
exocrine gland
11
Q
Pancreas releases hormone directly into the bloodstream, is this the (exocrine or endocrine function)
A
endocrine gland
12
Q
Released by the pancreas to digest fats and converts fats into fatty acids and glycerol
A
Lipase
13
Q
Released by the pancreas to neutralize stomach acid
A
Sodium bicarbonate
14
Q
Released by the pancreas to digest proteins
A
Trypsin, chymotrypsin, carboxypolypeptidase
15
Q
Other term for main pancreatic duct
A
Duct of Wirsung
16
Q
accessory duct of pancreas
A
Duct of Santorini
17
Q
the pancreas is a ______ organ
A
retroperitoneal
18
Q
Islets of Langerhands is composed of:
A
Alpha, beta, and delta cells
19
Q
From the main pancreatic duct (duct of Wirsung) the enzymes collect into the
A
ampulla of Vater
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
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
22
Q
What cause the contraction of the gallbladder?
A
cholecystokinin
23
Q
What causes the relaxation of the sphincter of Oddi?
A
cholecystokinin
24
Q
What is the endocrine function of the pancreas performed by?
A
islets of Langerhans (composed of alpha, beta, delta cells)
25
What vital hormones do the islets of Langerhans produce?
insulin,glucagon,somatostatin
26
What hormone promotes the release of glucose by the liver increasing sugar levels?
glucagon (alpha cells, islets of langerhan)
27
What hormone stimulates the body to use up glucagon to produce energy?
insulin (beta cells, islet of Langerhans)
28
What hormone restrains insulin and glucose level?
somatostatin (delta cells, islet of Langerhans)
29
Where does the head of the pancreas get arterial blood supply?
Gastroduodenal artery
30
Where does the body and tail of the pancreas receive their blood supply?
Splenic and superior mesenteric arteries
31
Venous drainage of pancreas is achieved by?
splenic vein, superior mesenteic vein, inferior mesenteric, portal vein
32
What can be done to improve the visualization of the pancreatic head?
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
33
What can be done to improve the visualization of the pancreatic tail?
Scan through the left kidney and spleen while in the left lateral decubitus position
34
What is the normal echogenicity of the pancreas?
Greater than the liver or equal to/greater than the spleen
35
Normal echogenicity of pediatric pancreas
more hypoechoic because of lack of fat surrounding
36
In some adults, the pancreas may appear peculiarly diffusely hyperechoic, representing ______.
pancreatic steatosis- fatty infiltration of the pancreas; may be classified as alcoholic or nonalcholic; may also be referred to as a fatty pancreas.
37
In the transverse plane of the pancreas, what are the two anechoic structures may be noted within the pancreatic head?
1. Gastroduodenal artery
2. CBD
38
The anterioposterior diameter of the main pancreatic duct should not exceed in what measurement?
2mm
39
What is the normal measurement of the pancreatic head and body?
Between 2 and 3cm
40
What is the normal measurement of the pancreatic tail?
Between 1 and 2cm
41
The two most common congenital anomalies of the pancreas:
1. Pancreatic divisum
2. Annular pancreas
42
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
pancreatic divisum
43
__________ _______ can lead to both acute and chronic pancreatitis.
Pancreatic divisum
44
What is the result of having pancreatic divisum?
Shortening of main pancreatic duct
45
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
annular pancreas
46
Inflammation of the pancreas secondary to the leakage of pancreatic enzymes from the acinar cells into the parenchyma of the organ
acute pancreatitis
47
Most common cause of acute pancreatitis are
alcohol abuse & biliary tract disease (ex. choledocolithiasis)
48
Acute pancreatitis will cause a rise in _______ first and then a rise in _______.
amylase & lipase
49
Between lipase and amylase, which is the most helpful laboratory finding for the diagnosis of acute pancreatitis?
Lipase
50
With focal pancreatitis, it leads to the enlargement of the pancreas in what specific area?
The head of the pancreas appearing as a hypoechoic region
51
With diffuse pancreatitis, it leads to the enlargement of what area of the pancreas?
All of the pancreas with a hypoechoic appearance
52
________ ______ pancreatitis will result in a diffusely enlarged, hypoechoic gland
Diffuse acute pancreatitis
53
a cyst surrounded by fibrous tissue that consists of pancreatic enzymes that have leaked from the pancreas
pancreatic pseudocyst
54
One of the more common sites for a pancreatic pseudocyst is the ________ ______.
Lesser sac
55
The peripancreatic fluid collection that results from the inflammation of the pancreas
plegmon
56
Where is the lesser sac of the pancreas?
Located between the pancreas and the stomach
57
What are the most common vascular complications of thr pancreas?
1. Splenic vein thrombosis
2. Pseudoaneurysm of the splenic artery
58
Pancreatitis associated with gallstone and concurrent obstruction of the pancreatic duct
gallstone pancreatitis
59
Pancreatitis associated with bleeding within or around the pancreas, high rate of morbidity & mortality
hemorrhagic pancreatitis
60
Form of chronic pancreatitis that results from the body's immune system attacking the pancreas
autoimmune pancreatitis
61
Uncommon form of chronic pancreatitis found in the head of the pancreas with associated inflammation of the CBD & second portion of the duodenum
groove pancreatitis
62
Form of acute pancreatitis resulting in necrosis of the pancreatic parenchyma and the tissue surrounding the pancreas, high rate of mortality & morbidity
necrotizing pancreatitis
63
Most common form of acute pancreatitis associated with inflammation of the pancreatic parenchyma and peripancreatic tissues, necrosis not present
interstitial edematous pancreatitis
64
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 (when biliary obstruction is present)
9. Severe acute pancreatitis may lead to hemorrhage & decreased hematocrit
acute pancreatitis
65
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
acute pancreatitis?
66
Repeated bouts of pancreatic inflammation can lead to
chronic pancreatitis
67
What is often the cause of chronic pancreatitis?
Alchohol abuse
68
What are the other causes of chronic pancreatitis besides chronic alcohol abuse?
Hyperparathyroidism
Congenital anomalies
Genetic disorders
Pancreatic duct obstruction
Trauma
69
When the destruction of the pancreatic tissue recurs, it can result to what?
1. Atrophy
2. Fibrosis with scarring
3. Development of calcification within the gland
70
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
chronic pancreatitis
71
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
chronic pancreatitis
72
40% of the time patient with chronic pancreatitis develop
pseudocyst
73
The most common primary pancreatic malignancy and it is the most commonly discovered in men
Pancreatic adenocarcinoma
74
What part in the pancreas does pancreatic adenocarcinoma usually occur?
The head of the pancreas
75
if pancreatic adenocarcinoma is located in the head, what does it most often lead to?
obstructed common bile duct
curvoisier gallbladder
76
What is the surgical procedure that is performed on patients with pancreatic adenocarcinoma?
Whipple procedure (aka pancreaticoduodenectomy)
77
The whipple procedure is also called
pancreaticoduodenectomy
78
This procedure is the removal of the head of the pancreas, gallbladder, some of the bile ducts, and proximal duodenum
Pancreaticeduodenectomy
79
Patient frequently has jaundice with pancreatic adenocarcinoma secondary to obstruction of the ____.
CBD
80
What stage of pancreatic adenocarcinoma is the mass only confined to the pancreas?
Stage I
81
What stage of pancreatic adenocarcinoma involves local lymph node involvement?
Stage II
82
What stage of pancreatic adenocarcinoma with evidence of distant metastasis?
Stage III
83
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
pancreatic adenocarcinoma
84
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
pancreatic adenocarcinoma (aka pancreatic ductal adenocarcinoma)
85
Pancreatic cystadenocarcinoma of the pancreas is most often found where
body & tail
86
A cystadenoma within the pancreas may be referred to as either ______ or _____.
microcystic serous cystadenoma (benign) or macrocystic mucinous cystadenoma (potential malignant)- found most often in body & tail
87
Clinical findings of ______
1. may be asymptomatic initially
2. epigastric pain
3. weight loss
4. palpable mass
5. jaundice
cystadenomas and cystadenocarcinomas
88
Sonographic finings of ______
1. Cystic mass
2. May acutally appear solid and echogenic secondary to the small size of the cyst
serous cystadenoma
89
Sonographic findings of ______
1. multilocular cystic masses that may contain mural nodules and calcifications
2. there may be associated dilation of the pancreatic duct
mucinous cystadenoma and cystadenocarcinoma:
90
What are the two types of islet cell tumors?
insulinoma and gastrinoma
91
Between insulinoma and gastrinoma, which one is more common?
Insulinoma
92
Islet cell tumor of the pancreas, gastrinoma can produce ____ which is excessive secretion of acid by the stomach that leads to peptic ulcers.
Zollinger-Ellison syndrome
93
Group of clinical indicators of a functional insulinoma including hypoglycemia, low fasting glucose and relief with intravenous glucose administration is referred to as
Whipple triad
94
von Hippel-Lindau disease is associated with ___ on the pancreas
cysts
95
Insulinomas are usually ______, while gastrinomas are often ______ and difficult to image.
Solitary; multiple
96
Functional gastrinomas can produce
Zollinger-Ellison syndrome
97
Clinical findings of ______
1. Insulinoma - low blood sugar symptoms(hypoglycemia,low fasting glucose, relief w/ IV glucose administration(Whipple triad))
2. Gastrinoma - Zollinger-Ellison syndrome
islet cell tumors
98
Sonographic findings of _____
1. Hypoechoic mass that may contain calcifications
2. Visualization is hard because of their small size
3. Hypervascularity may be present with color Doppler
islet cell tumors
99
cysts noted within the pancreas may be seen with _____.
Von Hippel-Lindau disease or autosomal dominant polycystic kidney disease
100
Clinical findings of _____
1. possible history of von Hippel-Lindau disease or cystic fibrosis
2. possible history of ADPKD
true pancreatic cysts
101
Sonographic findings of _____
1. well-defined, anechoic mass with posterior enhancement
true pancreatic cysts
102
What are the two common types of transplantation techniques of the pancreas?
Exocrine bladder drainage
Exocrine enteric drainage
103
The more common pancreatic transplantation is referred to as
exocrine enteric drainage
104
List the pancreatic transplant fluid collections?
1. Abscess
2. Ascites
3. Hematoma
4. Urinoma
5. Pseudocysts
105
What are the sonographic findings of acute pancreatic transplant rejection?
1. Hypoechoic or heterogeneous gland
2. Elevated resistive indices
106
List the pancreatic ______ vascular complications
1. Arterial stenosis
2. Arterial thrombosis
3. Graft thrombosis
4. Pseudoaneurysms
5. Splenic vein thrombosis
6. Strictures/Turbulent flow
transplant
107
What are the sonographic findings of ______
1. Hyperechoic echotexture
2. Atrophy
3. Pancreas may contain calcifications
chronic pancreatic transplant rejection
108
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 ___.
right side, left
109
Which of the following would be the least likely complication of a pancreatic transplant?
biloma
