chapter 12 Flashcards
Inflammation of the pancreas may be chronic or acute
Pancreatitis
Sudden onset of moderate to severe abdominal pain with radiation to back
Nausea and vomiting
History of gallstones (localized) or alcoholism
Mild fever
Increased pancreatic enzymes in blood (amylase, lipase)
Leukocytosis (increased white blood cells)
Abdominal distention
Acute pancreatitis clinical findings
Ranges from normal size to focal/diffuse enlargement
Hypoechoic texture (edema)
Borders distinct but irregular
Enlargement of head causes depression on inferior vena cava
40% to 60% have gallstones
Pancreatic duct may be enlarged
Parapancreatic fluid collections
Acute pancreatitis sonographic findings
Hemorrhagic pancreatitis
Pancreatic neoplasm
Lymphoma
Retroperitoneal neoplasm
Acute pancreatitis differential considerations
Decreased Hematocrit and serum calcium level
Intense, severe pain radiating to back, with subsequent shock and ileus
Hypotension despite volume replacement, with metabolic acidiosis and adult respiratory distress syndrome
Hemorrhagic pancreatitis Clinical findings
Depends on age of hemorrhage
Well defined homogeneous mass in area of pancreas
Hemorrhagic pancreatitis Sonographic findings
Chronic hemorrhage
Hemorrhagic pancreatitis differential considerations
See Acute pancreatitis
Phlegmonous pancreatitis clinical findings
Hypoechoic, ill defined mass
Phlegmonous pancreatitis sonographic findings
Chronic Hemorrhage
Phlegmonous pnacreatitis differential considerations
Fever, chills
Increased leukocytosis
Hypotension
Tender abdomen
Pancreatic abscess clinical findings
Hypoechoic mass with smooth borders
Thick walls
Echo-free to echogenic
Pancreatic abscess sonographic findings
Acute pancreatitis
chronic pancreatitis
Pancreatic abscess differential considerations
Seer abdominal pain radiating to back Malabsorption Fatt y stools Signs of diabetes Weight loss Jaundice Incrseaed amylase and lipase
Chronic pancreatitis clinical findings
Gland is small and fibrotic Irregular borders Mixed echogenicity Dilated pancreatic duct (string of pearls sign with dilated duct) Look for calculi within duct
Chronic pancreatitis sonographic findings
Acute pancreatits
Thrombosis of portal system
Pancreatic pseudocyst
Dilated common bile duct
Chronic pancreatitis differential considerations
Asymptomatic unless large enough to put pressure on other organs
Increased amylase and lipase
Increased Alkine Phos if obstruction develops
Pancreatic Pseudocyst clinical findings
Well-defined mass, usually in area of pancreas
Increased through transmission
Variable size (round or oval)
May have debris at bottom
Pancreatic Pseudocyst sonographic findings
True cyst
fluid filled cystadenoma
Pancreatic pseudocyst differential considerations
Asymptomatic, often found in patients with polycystic renal disease
Autosomal dominant polycystic kidney diseases clinical findings
Well-defined mass with serous fluid
Size varies from microscopic to several
Autosomal dominant polycystic kidney disease sonographic findings
Pseudocyst
Other cystic lesions of the pancreas
Autosomal dominant polycystic kidney disease Differential considerations
Asymptomatic
Patients may have CNS and retinal hemangioblastomas, visceral cysts, pheochromocytomas, and renal cell carcinoma
Von hippel lindau disease clinical findings
Well defined mass with thick fluid; calcification
Single or multiple
Size varies from microscopic to several centimeters
Von hippel lindau disease sonographic findings
Pseudocyst
Other cystic lesions of the pancreas
Von hippel lindau disease differential considerations
Asymptomatic
Cystic fibrosis clinical findings
Well defined mass with serous fluid
Size varies from microscopic to several centimeters
Cystic fibrosis sonographic findings
Pseudocyst
Other cystic lesions of the pancreas
cystic fibrosis differential considerations
Asymptomatic, often found in infants
True pancreatic cysts clinical findings
Well defined mass with serous fluid
Unilocular or multilocular
True pancreatic cysts sonographic findings
Pseudocyst
Other cystic lesions of the pancreas
True pancreatic cysts differential considerations
Depends on size and location of tumor (symptoms occur late if located in body/tail)
weight loss
Decreased appetite
Nausea, vomiting
Stool changes
Pain radiating to back
Painless jaundice if tumor is located in the head (hydrops of GB Courvoiser’s sign)
Metastasizes to lymph nodes, liver, lungs, bone, duodenum, peritoneum, and adrenal glands
Adenocarcinoma clinical findings
Loss of normal pancreatic parenchyma Hypoechoic poorly defined mass Focal mass with irregular borders Enlargement of pancreas If mass is located in head of pancreas, look for hydrops, compression of IVC and dilated ducts
Adenocarcinoma Sonographic findings
Pseudocyst
Cystadenoma
Lymphoma
Adenocarcinoma differential considerations
Increased amylase
Cystadenoma clinical findings
Anechoic mass with p posterior enhancement
May have internal septa
Thick walls
Small size of tumor makes it difficult to image
Single or multiple
Occur in body and tail
Hypoechoic
Cystadenoma sonographic findings
Pseudocyst
Metastases
Cystadenoma differential considerations
Epigastic pain for palpable mass
Abdominal pain
Cystadenocarcinoma clinical findings
Irregular lobulated cystic tumor
Thick walls hypoechoc mass
Cystadenocarcinoma sonographic findings
Pseudocyst
Cystadenoma
Adenocarcinoma
Islet cell tumor
Cystadenocarcinoma differential considerations
