Chapter 5 The Pancreas Flashcards
The sonographic assessment of a pancreatic transplant includes:
•evaluation of vascularity
•pancreatic parenchyma
•search for fluid collections
With ______, the donors duodenum is anastomosed to a loop of the jejunum
Exocrine enteric drainage
With ______, the vasculature of the donor pancreas is anastomosed to the recipients common iliac vessels and the donors duodenum is anastomosed to the bladder
Exocrine bladder drainage
The anteroposterior diameter of the main pancreatic duct should not exceed ______
2mm
______position May help improve visualization of the pancreatic head
LLD
Sonographic findings of chronic pancreatitis
•heterogenous or hyperechoic atrophic gland
•calcifications
•pancreatic pseudocyst
•dilated pancreatic duct
•stones within the pancreatic duct
•portosplenic vein thrombosis
Clinical findings of chronic pancreatitis
- Asymptomatic
- Epigastric pain
- Jaundice
- Back pain
- Elevation in amylase or lipase
- Elevation in ALP
- Anorexia
- Vomiting
- Weight loss
- Constipation
____is the removal of the head of the pancreas, the gallbladder, some of the bile ducts and the proximal duodenum
Whipple procedure
The surgical procedure that is performed on patients with pancreatic adenocarcinoma is called
Whipple procedure
The most common location of pancreatic adenocarcinoma is
pancreatic head
____is the most primary pancreatic malignancy and it is most commonly discovered in men
Pancreatic adenocarcinoma
Mucinous tumor are
•large
•malignant potential
Serous tumors are
•small
•always benign
Mucinous cystadenocarcinoma are found
body and tail of the pancreas
Unencapsulated anechoic fluid collection surrounding all our part of the pancreas is called
Peripancreatic fluid
The body and tail of the pancreas receive their blood supply from the
Splenic artery and SMA
The arterial blood supply to the head of the pancreas is via
Gastroduodenal artery
The two most common congenital anomalies of the pancreas are
• Pancreatic divisum
• Annular pancreas
The pancreatic tail should measure between
1-2cm
The normal measurement of the pancreatic head and body is between
2-3cm
______results from abnormal fusion of the pancreatic duct during embryologic development
Pancreatic divisum
With _______, the most ventral part of the pancreas encases the duodenum and May consequently lead to duodenal obstruction
Annular pancreas
The most common cause of acute pancreatitis are
•alcohol abuse
•biliary tract disease
With diffuse enlargement of the pancreas it will become:
Enlarged and hypoechoic
______will lead to an enlargement of the gland in a particular segment, most often in the head, appearing as a hypoechoic region
Focal pancreatitis
The opening of the sphincter of oddi is triggered by ______released by the duodenum as a result of the presence of chyme
Cholecystokinin
Endocrine tumors Can be found within the
Islets of langerhans
Insulin stimulates the body to use up:
glucagon to produce energy
____is the hormone released by the pancreas that encourages the body’s use of glucagon
Insulin
Which part of the pancreas is located anterior to portal confluence
Pancreatic neck
What vascular structure outlines the pancreatic tail posteriorly
Splenic vein
Which part of the pancreas is located right lateral to superior mesenteric vein, anterior to IVC and inferior to portal vein
Head
The pancreas is a:
Retroperitoneal organ
Courvoisier gallbladder is the
Enlarged GB caused by pancreatic head mass
Coexisting obstruction of the common bile duct and pancreatic duct may be referred to as
Double duct sign
Within which parts of the pancreas are mucinous cystadenocarcinomas most often located
Body and tail
What is the early sonographic appearance of acute pancreatitis
Normal
The arterial blood supply to the head of the pancreas is via the
Gastroduodenal artery
The most common echogencity of a acutely inflamed pancreas is
Hypoechoic
Which cells perform the exocrine function of the pancreas
Acinar cells
The portion of the bowel that encompasses the head of the pancreas is the
Duodenum
What is the name of the main pancreatic duct
Duct of wirsung
The muscle that controls the emptying of bile and pancreatic juices into the duodenum is the
Sphincter of oddi
A gastrinoma of the pancreas can produce
Zollinger-Ellison syndrome
Courvoisier gallbladder is found in the presence of
Adenocarcinoma in the head of the pancreas
______is the most common islet cell tumor
Insulinoma
One of the most common locations for a pancreatic pseudocyst is within the
Lesser sac
Which type of pancreatic transplantation is more common
Exocrine enteric drainage
Clinical findings of acute pancreatitis
- Elevated labs
- Leukocytosis
- Pain
- Fever
- Nausea
The most common location of focal pancreatitis is within the
Head of the pancreas
_____is a peripancreatic fluid collection that results from the inflammation of the pancreas
Phlegmon
The most common location of adenocarcinoma of the pancreas is within the
Head of the pancreas
_____is the enzyme released by the pancreas that neutralizes stomach acid
Sodium bicarbonate
The whipple procedure is performed on patients who have
Pancreatic carcinoma
The most common form of malignant of the pancreas is
Adenocarcinoma
What is another name for the accessory duct of the pancreas
Duct of santorini
What results in a shortened main pancreatic duct that works to drain only the pancreatic head and not the entire pancreas
Pancreatic divisum
______is located within the epigastrium between the C-loop of the duodenum and the splenic hilum
Pancreas
The pancreas consists of four main parts
•head
•neck
•body
•tail
The pancreas is considered to be a _______organ
Retroperitoneal
In some individuals, there exists a posteromedial extension of the pancreas head, referred to as
Uncinate process
The endocrine function of the pancreas is performed by the
Islets of langerhans
The ______of the pancreas carry out the exocrine function because they produce viral digestive enzymes (amylase, lipase, sodium bicarbonate)
Acinar cells
Primarily, the pancreas is an exocrine gland that aids in _____
Digestion
Sonographic findings of chronic pancreatic transplant rejection
- Hyperechoic echotexture
- Atrophy
- Pancreas may contain calcifications
Sonographic findings of acute pancreatic transplant rejection
- Hypoechoic or heterogenous gland
- Elevated resistive indices
Sonographic findings of true pancreatic cysts
- Well-defined, anechoic mass with posterior enhancement
Clinical findings of true pancreatic cysts
•possible history of von hippel-lindau disease or cystic fibrosis
•possible history of ADPKD
Sonographic findings of islet cell tumors
•hypoechoic mass that may contain calcifications
Clinical findings of islet cell tumors
•insulinoma: low blood sugar symptoms
•gastrinoma: Zollinger-Ellison syndrome
Clinical findings of acute pancreatitis
•elevated amylase (within 24hrs)
•elevated lipase (within 72 hrs)
•elevated ALT and other labs with biliary obstruction
•leukocytosis
•abdominal pain (supine)
•back pain
•fever
•nausea and vomiting
•hemorrhage and low hematocrit
Sonographic findings of acute pancreatitis
•normal pancreas
•diffused pancreas
•focal pancreas
•peripancreatic pseudocyst
•abscess formation (fluid gas bubbles)
•biliary obstruction
•splenic vein thrombosis and psedoaneurysm of the splenic artery
Sonographic findings of serous cystadenoma (2):
- Cystic mass
- Solid and echogenic secondary to the small size of the cysts
Sonographic findings of mucinous cystadenoma and cystadenocarcinoma
- Multilocular cystic masses that may contain mural nodules and calcifications
- Dilation of the pancreatic duct
There are two common types of transplantation techniques
•exocrine bladder drainage
•exocrine enteric drainage
______is described as the excessive section of acid by the stomach that leads to peptic ulcers
Zollinger-Ellison syndrome
_____is a branch of the main pancreatic duct, had a separate minor sphincter into the duodenum
Duct of santorini
At the ______the pancreatic digestive enzymes are mixed with bile from the liver and released into the duodenum through the______
•ampulla of vater
•sphincter of oddi
Clinical findings of pancreatic adenocarcinoma (7):
- Elevated amylase and lipase
- No appetite
- Weight loss
- Jaundice
- Courvoiser gallbladder
- Epigastric pain
- Elevated ALP and other liver function labs associated with biliary obstruction
Sonographic findings of pancreatic adenocarcinoma
- hypoechoic mass
- head of the pancreas
- dilated CBD and pancreatic duct (double duct sign)
- Elevated labs
- enlarged gallbladder (hydropic)
Clinical findings of cystadenoma and cystadenocarcinoma
•May be asymptomatic initially
• epigastric pain
•weight loss
•palpable mass
•jaundice