Chapter 5: Pancreas Flashcards
What is the uncinate process
The posteriomedial extension of the pancreatic head that some people have
What are the enzymes secreted by the exocrine portion of the pancreas
Amylase, lipase, sodium bicarbonate, trypsin, chymotripsin, and carboxypolypeptidase
What is the function of amylase
Digest carbohydrates and converts starch to sugar
What is the function of lipase
Digest fats and convert them to fatty acids and glycerol
What is the function of sodium bicarbonate
Neutralizes stomach acid
What is the function of trypsin, chymotripsin and carboxypolypeptidase
Breaks down proteins
_____ cells carry the exocrine function of the pancreas
Acinar
The enzymes travel through the main pancreatic duct which is also called ____
Duct of Wirsung
What is the duct of Santorini
Accessory duct that branches off of the main duct, it also has its own little sphincter
What is the name of the area where the sphincter of Oddi rests
Major duodenal papilla
What hormone causes relaxation and opening of the sphincter of Oddi
Cholecystokinin
What hormones are released by the endocrine portion of the pancreas
Alpha cells- Glucagon
Beta cells- Insulin
Delta cells- Somatostatin
What is the function of the alpha cells (glucagon)
Promotes the release of glucose by the liver (increasing blood sugar)
What is the function of beta cells (insulin)
Stimulates the body’s use of glucagon
What is the function of delta cells (somastotatin)
Restrains insulin and glucose level
The endocrine function is performed by the islets of _____
Langerhans
What vessel supplies blood to the head of the pancreas
Gastroduodenal artery
What vessels supply blood to the body and tail of the pancreas
Splenic artery and SMA
What four vessels drain the pancreas
Splenic vein
Superior mesenteric vein
Inferior mesenteric vein
portal vein
Normal echogenicity of the pancreas is greater than the liver and _____ to the spleen
Equal
The diameter of the main pancreatic duct should not exceed __ mm
2
The pancreas head and body should measure between ___ and ___ cm
2-3
The pancreas tail should measure ___ cm
1-2
What is pancreatic divisum
The most common congenital anomaly.
Shortened main pancreatic duct that drains only the head.
What happens to the duct of Santorini in a pancreatic divisum
It is forced to drain the rest of the pancreas
What complications does pancreatic divisum brings
Obstruction, improper pancreas drainage, high risk of developing inflammation ( prone to pancreatitis)
What is an annular pancreas
Cuando la parte de alante del páncreas se enrosca en el duodenum. May cause obstruction
What is acute pancreatitis
Inflammation of the pancreas secondary to leakage of pancreatic enzymes
What are the most common causes for acute pancreatitis
Alcohol abuse and biliary tract disease
What is phlegmon
Peripancreatic fluid collection
What is the most helpful lab value to diagnose pancreatitis
Lipase
Acute pancreatitis will cause a rise in amylase first, then a rise in _____
Lipase
Acute pancreatitis is divided into interstitial edematous pancreatitis or necrotizing pancreatitis. What is the difference
Interstitial edematous pancreatitis is better managed.
Necrotizing pancreatitis is fatal
What are the lab values elevated with acute pancreatitis
Amylase (within 24 hrs), Lipase (within 72 hrs), leukocytes, ALT
What are the symptoms of acute pancreatitis
Abdominal pain (especially en supine)
Back pain, fever, nausea, vomiting. May lead to hemorrhage
What does acute pancreatitis look like on ultrasound
Pancreas may appear normal or hypoechoic (when diffuse), focal hypoechoic area (when focal)
Fluid collection around
Pseudocyst
Abscess formation
Biliary obstruction
Splenic vein thrombosis and pseudoaneurysm of splenic artery (sometimes)
What are the symptoms of chronic pancreatitis
Asymptomatic
Epigastric pain, jaundice, back pain, anorexia, vomiting, weight loss, constipation
What lab values are elevated with chronic pancreatitis
Por roble elevation in ALP and amylase/lipase
What does chronic pancreatitis look like on ultrasound
Heterogenous hyperechoic atrophic pancreas with poor margins and calcifications
What other things can me present with chronic pancreatitis
Pancreatic pseudocyst
Dilated pancreatic duct (may have stones in it)
Portosplenic vein thrombosis
What is the main cause of chronic pancreatitis
Alcohol abuse
Pancreatic adenocarcinoma is also called pancreatic ____ adenocarcinoma
Ductal
Pancreatic adenocarcinoma is most common in men or women
Men
Pancreatic adenocarcinoma is most common in what part of the pancreas
Head
Cancer of the pancreas had can eventually cause _____ obstruction and _______ gallbladder
CBD, Courvoisier
What is the Whipple procedure
Pancreaticoduodenectomy
During a pancreaticoduodenectomy, what is removed
Pancreas head, GB, prox duodenum, and bile ducts
What are the symptoms of pancreatic adenocarcinoma
Loss of appetite, weight loss, jaundice, epigastric pain
Pts with what type of history have a higher risk of developing pancreatic adenocarcinoma
Hx of smoking, diabetes, and chronic pancreatitis
What lab values may be elevated with pancreatic adenocarcinoma
Amylase and/or lipase, ALP
What does pancreatic adenocarcinoma look like on ultrasound
Hypoechoic mass on the head, double duct sign, Courvoiser gallbladder
What does a Courvoiser gallbladder refer to
Large, palpable gallbladder
A cystadenoma within the pancreas can be called a (microcystic) ______ cystadenoma, or a (macrocystic) ______ cystadenoma
Serous, mucinous
Serous (microcystic) cystadenomas are small and ______
Benign
Macrocystic (mucinous) cystadenomas are big and usually _______
Malignant
When a mucinous tumor is malignant, it’s called
Mucinous cystadenocarcinomas
Mucinous cystadenocarcinomas are often found in what part of the pancreas
Within the body and tail
What are the symptoms of cystadenomas and cystadenocarcinomas
May be asymptomatic at first
Epigastric pain, weight loss palpable mass and jaundice
What does a benign serous cystadenoma look like on ultrasound
Cystic small mass
May appear solid and echogenic due to how small it is
What does a mucinous cystadenoma and cystadenocarcinoma look like
Multilocular cystic mass that may contain mural nodules and calcifications
With mucinous cystadenomas and cystadenocarcinomas, there may be an associated dilation of the _____ duct
Pancreatic
What is the gold standard imaging for the pancreas
Endoscopic retrograde cholangiopancreatography (ERCP)
Islet cell tumors are also called pancreatic ______ tumors
Neuroendocrine
What are islet cell tumors
Tumors found within islets of Langerhans
There are two types of islet cell tumors: insulinoma and ______
Gastrinoma
Insulinomas are more common and usually _____
Solitary
Gastrinomas are usually how many
Múltiples
Functional gastrinomas can cause _______ _______ syndrome
Zollinger Ellison
What is Zollinger Ellison syndrome
Excessive secretion of acid by the stomach that leads to peptic ulcers
Functional insulinomas can cause _____
Hypoglycemia
What is the Whipple triad
A group of clinical indicators of a functional insulinoma
What clinical indicators are included in the Whipple Triad
Hypoglycemia, low fasting glucose, and relieve with IV glucose administration
What are some other symptoms of insulinomas
Palpitations, sweating, tremors, headaches, diabetic coma
What does an islet cell tumor look like on ultrasound
Small hypoechoic mass that may contain calcifications
Hypervascularity may be present in the functioning tumors
Cyst within the pancreas is associated with what three diseases
Von hippel-lindau disease (especially este)
Cystic fibrosis
Autosomal dominant polycystic kidney disease (ADPKD)
When they do a pancreas transplant, ___% of the time they transplant the kidney too
80
Describe exocrine bladder drainage pancreas transplant
Vasculature of donor is attached to pts iliacs
Donors duodenum is attached to bladder (used to expel pancreatic juices)
Describe exocrine enteric drainage (more common)
Donors duodenum is attached to pt jejunum (where it expels pancreas juices)
Vasculature is connected to donors iliacs (Y graft)
What does chronic transplant rejection look like
Hyperechoic, atrophy, calcifications
What does acute transplant rejection looks like
Hypoechoic or heterogenous pancreas, elevated resistive indices
What are some fluid collections that may occur with a transplant
Abscess
Ascites
Hematoma
Urinoma
Pseudocyst
What index usually represents splenic vein thrombosis
> 1.0, with absent splenic inflow
What are some pancreatic transplant vascular complications
Arterial stenosis, arterial thrombosis, graft thrombosis, pseudoaneurysm, splenic vein thrombosis, strictures
