Chapter 12- Pancreas Flashcards
Extrapancreatic fluid collections are often seen in cases of severe acute pancreatitis. Where are they most commonly located and when do they occur?
lesser sac or around the kidney. They typically occur 4 weeks after infection.
Does the pancreas have a true capsule
No
What happens at 6 weeks embryonic age to create the final pancreas
The ventral bud rotates 270 degrees to fuse with the dorsal bud.
Where is agenesis of the pancreas typically located?
Agenesis of the body and tail. Sometimes with hypertrophy of head.
Explain pancreas divisum. What is it associated with?
Lack of fusion between dorsal and ventral buds. Dorsal drains through minor and ventral through major papilla. Increased association with pancreatitis.
What is the most common anomaly of the pancreas?
Ectopic pancreatic tissue- found in various locations in the GI tract.
What is an annular pancreas? Who is most at risk?
The head of the pancreas surrounds the duodenum. It is rare but there is a male prevalence.
50 percent of the population has a complete regression of what pancreatic duct?
The accessory duct of Santorini
The pancreas has two functions. What do they do and what percent of the function are they?
Endocrine function is 1-2% and secretes hormones to regulate metabolism. Exocrine function is 90% and secretes enzymes to digest food.
What is it called when pancreatic enzymes digest their own tissues? When might this occur
autodigestion might occur with pancreatitits
What are the classifications of acute pancreatitis?
Mild: No organ failure, Moderate: Some systemic complications without failure, Severe: persistent organ failure
What are the symptoms of acute pancreatitis
severe pain radiating to back, elevated amylase, lipase, WBC, sometimes bilirubin.
In cases of pancreatitis, which enzyme is elevated for a longer period of time? Which elevates faster.
Lipase stays elevated longer and elevates earlier.
What is a pancreatic pseudocyst? Who is at risk and when?
A pseudocyst is an acquired collection of amylase developing in 10-20% of patients with acute pancreatitis. It develops 4-6 weeks after the onset.
Where are pseudocysts most commonly found?
most common location is the lesser sac. Second most common is the anterior pararenal space.
What are the clinical symptoms of a pseudocyst? What percent rupture? Is rupture fatal?
asymptomatic, abdominal pain, palpable mass, elevated amylase, lipase, and possibly alk phos if obstruction occurs. 5% rupture with a 50% mortality rate.
Areas of necrosis can lead to rupture of pancreatic vessels and hemorrhage. What are symptoms of this?
Severe ab pain, elevated amylase and lipase, drop in hematocrit. Grey Turner’s sigh- discoloration of flanks
Phlegmonous Pancreatitis is a severe complication of acute pancreatitis. What is it? What percent of patients have extension outside of the pancreas?
Extension of inflammation into other tissues. Most commonly the lesser sac, left ant pararenal space, transverse colon. extension occurs in 18-20% of patients.
When would a pancreatic abscess occur?
As a result of infection of a necrotic pancreas, 2-4 weeks after acute pancreatitis.
Are pancreatic cysts congential or acquired?
Both.
What is autosomal dominant polycystic disease
Multiple cysts found in the liver and kidney that (rarely) extends into the pancreas or spleen
What is cystic fibrosis
A hereditary exocrine disorder resulting in thick mucous secretions that plugs ducts and causes pancreatic dysfunction.
What are symptoms and the appearance of cystic fibrosis
salty sweat, wheezing, fatty stool, increase in echogenicity, gb sludge, calcifications or cysts
What is Von-Hippel-Lindau Syndrome and what is it associated with?
An inherited disorder with formation of tumors and cysts throughout the body. It is associated with hemangioblastomas.
Is Von-Hippel-Lindau Syndrome benign or malignant? When do symptoms typically manifest?
It could be cancerous. Symptoms typically manifest in young adulthood.
How does Von-Hippel-Lindau Syndrome appear sonographically?
Well-defined mass with thick
fluid and calcifications. Single or multiple cysts varying in size in kidney, pancreas, or GI tract,
What accounts for 10-15% of all
pancreatic cysts and less than 1% of all pancreatic malignancies?
Cystic pancreatic neoplasms
What patient populations and other diseases is serous cystadenoma associated with?
It is associated with Von Hippel-Lindau and elderly females. It has a female prevalence of 4:1
What is microcystic cystadenoma? is it common? Is it malignant?
Microcystic is another name for serous cystadenoma. It is rare and benign.
serous cystadenoma is often asymptomatic. How does it appear sonographically?
Often in the body/tail, small cysts are echogenic and larger cysts appear with the cluter of grapes appearance and are more complex.
What patient population is mucinous cystadenoma associated with? Where does it come from?
Middle aged- elderly with a female prevalence 4:1. It arises from the pancreatic ducts
What is macrocystic cystadenoma? is it common? Is it malignant?
Mucinous cystadenoma it is uncommon and slow growing but has malignant potential.
mucinous cystadenoma is often asymptomatic when benign. How does it appear sonographically?
80% in body or tail, smooth walled, variable wals and content. usually more than 6 cysts >2 cm
At what point would a cyst cause increased suspicion for malignancy?
> 5cm with irregular walls or calcifications
What is an intraductal papillary mucinous tumor? Is it benign or malignant.
A mucinous cystic neoplasm that originates in the pancreatic duct. It is slow growing and could be benign or malignant.
What patient population is associated with intraductal papillary mucinous tumors? What are symptoms?
It is in elderly men and women. Often asymptomatic or with recurrent pancreatitis. Other symptoms indicate malignancy.
How might intraductal papillary mucinous tumors appear sonographically?
Non vascular tumors within ducts.
Solid Pseudopapillary neoplasms are rare. Who are they prevalent in and are they benign or malignant?
They are prevalent in young women and typically benign.
How might solid pseudopapillary neoplasms appear sonographically
Large, usually over 8 cm. Most occur in tail with necrosis or hemorrhage.
What percent of Endocrine Pancreatic Neoplasms are non-functional
1/3
85% of the non-functional endocrine neoplasms are what disease? Where does it come from?
Adenocarcinoma. It can be from islet cells but is more commonly from exocrine cells.
What is the most common functional tumor of the endocrine system and where does it occur?
The most common (60%) is Insulinoma. It occurs in the Beta cells.
What is the SECOND most common functional tumor of the endocrine system and where does it occur?
Gastrinoma is the second most common (18%) and it occurs in the Gamma cells.
What age group does Insulinoma affect and what percent are malignant.
Ages 40-60 and 10% are malignant.
What are some symptoms of Insulinoma and how might it appear sonographically?
Symptoms are the same as a hypoglycemic (dizziness, weak, sweating, confusion) and can be relieved with IV glucose. It is hypervascular.
What percent of Gastrinoma are malignant? How does it appear sonographically?
60% are malignant. They are multiple and extrapancreatic. 10-15% are in the duodenum making them difficult to see.
Gastrinoma is a cause of Zollinger Ellison Syndrome. What are symptoms.
Hypersecretion of gastric acid causing ulcers.
How do most non-functioning islet cell tumors present? Are they benign or malignant.
As a large tumor in the pancreas head. A large percent are malignant.
Pancreatic cancer is the 4th most deadly cancer. At what age is it most common?
Most occur after 60. It is rare before 40.
What is the most common primary neoplasm of the pancreas?
Adenocarcinoma
What Gallbladder pathology occurs in 25% of cases of pancreatic cancer
Courvoisier’s Gallbladder. Mass in the head obstructs the CBD and enlarges gallbladder.
Where does adenocarcinoma typically occur?
60-70% occur in the head, 20-30% in the body, and 5-10% in the tail.
Is metastasis to the pancreas common? Where does it spread from?
It is uncommon and occurs in about 10% of pancreatic cancer patients. It could spread from the breast, GI tract, lung, or melanoma.
What is the most common ParaPancreatic neoplasm?
Lymphomas in the lymphatic tissue surrounding the pancreas.
What is the whipple procedure and when might it be performed
The removal of a pancreas head due to a tumor. It is only performed in cases without metastasis.
What happens during the whipple procedure?
The gallbladder is removed, CBD and remaining pancreatic tissue are attached to the duodenum, the stomach is attached distal to the bile duct.
