Chapter 5: The Pancreas Flashcards
the cells of the pancreas that carry out the exocrine function and, therefore, produce amylase, lipase, sodium bicarbonate, and other digestive enzymes
acinar cells
congenital anomaly of the pancreas that results in the maldevelopment of the pancreas in which the most ventral part of the pancreas encases the duodenum and may consequently lead to duodenal obstruction
annular pancreas
the recurring destruction of the pancreatic tissue that results in atrophy, fibrosis with scarring, and the development of calcification within the gland
chronic pancreatitis
inherited disorder that can affect the lungs, liver, pancreas, and other organs; this disorder changes how the body creates mucus and sweats
cystic fibrosis
coexisting enlargement of the common bile duct and pancreatic duct
double-duct sign
the accessory duct of the pancreas
duct of Santorini
the main pancreatic duct
duct of Wirsung
the first segment of the small intestine
duodenum
endoscopic procedure that utilize flouroscopy (radiographic imaging) to evaluate the biliary tree and pancreas
endoscopic retrograde cholangiopancreatography
form of pancreatitis associated with gallstones and pancreatic duct obstruction
gallstone pancreatitis
an islet cell tumor found within the cells of the pancreas that may produce an abundance of gastrin
gastrinoma
form of pancreatitis associated with bleeding within or around the pancreas
hemorrhagic pancreatitis
elevated amylase
hyperamylasemia
the presence of elevated parathyroid hormone
hyperparathyroidism
bowel obstruction caused by the lack of normal peristalsis
ileus
an islet cell tumor found within the beta cells of the pancreas that may produce an abundance of insulin
insulinoma
most common form of pancreatitis; associated with inflammation of the pancreas and peripancreatic tissue without necrosis
interstitial edematous pancreatitis
tumor found within the islets of Langerhans of the pancreas
islet cell tumors
small islands of tissue found within the pancreas that produce insulin and glucagon
islets of Langerhands
a peritoneal cavity located between the stomach and the pancreas where fluid can accumulate
lesser sac
death of tissue
necrosis
severe form of acute pancreatitis in which there is death of the pancreatic tissue
necrotizing pancreatitis
the most common form of pancreatic malignancy, typically found within the head of the pancreas
pancreatic adenocarcinoma
congenital anomaly of the pancreas that results in a shortened main pancreatic duct that only works to drain the pancreatic head and not the entire pancreas
pancreatic divisum
the surgical procedure in which the head of the pancreas, the gallbladder, some of the bile ducts, and the proximal duodenum are removed because of a malignant pancreatic neoplasm; also referred to as the Whipple procedure
pancreaticduodenectomy
a cyst surrounded by fibrous tissue that consists of pancreatic enzymes that have leaked from the pancrea
pancreatic pseudocyst
fatty infiltration of the pancreas; may be classified as alcoholic or nonalcoholic; may also be referred to as a fatty pancreas
pancreatic steatosis
the peripancreatic fluid collection that results from inflammation of the pancreas
phlegmon
a posteromedial extension of the pancreatic head
uncinate process
a hereditary disease that includes the development of cysts within the pancreas and other organs
von Hippel-Lindau disease
Whipple procedure
pancreaticoduodectonomy
a group of clinical indicators of a functional insulinoma; includes hypoglycemia, low fasting glucose, and relief with intravenous glucose administration
Whipple triad
the syndrome that includes an excessive secretion of acid by the stomach caused by the presence of a functional gastrinoma within the pancreas`
Zollinger-Ellison syndrome
digests carbohydrates and converts starch to sugar
amylase
digests fat and converts fats to fatty acids and glycerol
lipase
neutralizes stomach acid
sodium bicarbonate
breaks down proteins
trypsin, chymotripsin, and caroboxypolypeptides
glucagon- promotes the release of glucose by the liver (increases blood sugar level)
alpha cells
insulin- stimulates the body’s use of glucagon
beta cells
somatostatin- restrains insulin and glucose levels
Delta cells
The pancreatic head is located right lateral to the _______
SMV
The pancreatic head is ____ to the IVC and _____ to the portal vein
anterior
posterior
The unicinate process is ______ to SMV
posterior
The uncinate process is anterior to the _____
aorta
The pancreatic neck is anterior to the ______
portal confluence
The pancreatic tail is marked by the posterior border of the ____
splenic vein`
pancreatitis associated with gallstones and concurrent obstruction of the pancreatic duct
gallstone pancreatitis
pancreatitis associated with bleeding in or around the pancreas; high rate or morbidity and mortality
hemorrhagic pancreas
Form of chronic pancreatitis that results from the body’s immune system attacking the pancreas
autoimmune pancreatitis
Uncommon form of chronic pancreatitis found in the head of the pancreas with associated inflammation of the CBD and second portion of the duodenum`
groove pancreatitis
Form of acute pancreatitis results in the necrosis of the pancreatic parenchyma and the tissue surrounding the pancreas; high rate of morbidity and mortality
Necrotizing pancreatitits
Most common form of acute pancreatitis; associated with inflammation of the pancreatic parenchyma and peripancreatic tissues; necrosis is not present
interstitial edematous pancreatitis
elevated amylase
elevated lipase
leukocytosis
elevated ALT and other liver function labs when biliary obstruction is present
abdominal pain
back pain
fever
nausea and vomiting
acute pancreatitis
pancreas may appear normal
diffusely, enlarged, hypoechoic pancreas (diffuse manifestation)
focal hypoechoic area within the pancreas (total manifestation)
unencapsulated anechoic fluid collection surrounding all or part of the pancreas (peripancreatic fluid)
pancreatic pseudocyst
abscess formation can occur
biliary obstruction may be present
acute pancreatitis
asymptomatic
persistent epigastric pain
jaundice
back pain
possible elevation in amylase or lipase (but they may remain normal)
possible elevation in ALP
anorexia
vomiting
weight loss
constipation
chronic pancreatitis
heterogenous, or hyperechoic, atrophic gland with poor margins
calcifications within the gland
pancreatic pseudocyst
dilated pancreatic duct
stone(s) within the pancreatic duct that may lead to biliary obstruction
possible portosplenic vein thrombosis
chronic pancreatitis
elevated amylase and/or lipase
loss of appetite
weight loss
jaundice
courvoisier gallbladder
epigastric pain
elevated ALP and, possibly, other liver function labs associated with biliary obstruction
History of cigarette smoking, diabetes mellitus, or chronic pancreatitis
Pancreatic Adenocarcinoma
hypoechoic mass in the head of the pancreas
dilated CBD and pancreatic duct (double-duct sign)
liver and other abdominal organs should be evaluated for possible metastasis
enlarged hydropic gallbladder
pancreatic adenocarcinoma
may be asymptomatic initially
epigastic pain
weight loss
palpable mass
jaundice
cystadenomas and cystadenocarcinoma
cystic mass
may actually appear solid and echogenic secondary to the small size of the cysts
serous cystadenoma
multilocular cystic masses that may contain mural nodules and calcifcations
there may be associated dilation of the pancreatic duct
mucinous cystadenoma and cystadenocarcinoma
hypoglycemia, low fasting glucose, and relief with intravenous glucose administration (Whipple triad)
Insulinoma islet cell tumor
Zollinger-Ellison syndrome
Gastrinoma islet cell tumor
hypoechoic mass that may contain calcifications
hypervascularity may be present with color Doppler
visualization is challenging because of their small size
islet cell tumors
possible history of von -Hippel Lindau disease or cystic fibrosis
possible history of ADPKD
true pancreatic cysts
well-defined anechoic mass with posterior enhancement
true pancreatic cyst
hyperechoic echotexture
atrophy
pancreas may contain calcifications
chronic pancreatitis transplant rejection
hypoechoic or heterogenous gland
elevated resistive indices
acute pancreatic transplant rejection
pancreatic transplant fluid collections
abscess
ascites
hematoma
urinoma
pseudocysts
arterial stenosis
arterial thrombosis
graft thrombosis
pseudoaneurysms
splenic vein thrombosis
stricutes
pancreatic transplant vascular complications
Where is the pancreas located?
within the epigastrium between C-loop of duodenum and splenic hilum
The pancreas consists of 4 main parts
head
neck
body
tail
posteromedial expansion of the pancreatic head
uncinate process
The pancreas is a ____-peritoneal organ
retro
The pancreas functions as an _____ and _____ gland.
endocrine
exocrine
The main exocrine function of the pancreas:
aids in digestion
produce vital digestive enzymes
acinar cells
vital digestive enzymes produced by the acinar cells
amylase
lipase
sodium bicarbonate
trypsin
chymotrypsin
carboxypolypeptidase
main pancreatic duct
duct of Wirsung
accessory duct
duct of Santorini
minor sphincter in accessory duct into duodenum
minor duodenal papilla or accessory papilla
From the main pancreatic duct, enzymes collect in the
ampulla of Vater
The ampulla of Vater is also referred to as the
hepatopancreatic ampulla
pancreatic digestive enzymes mixed with bile from liver are released into the duodenum through the major sphincter:
Sphincter of Oddi
major duodenal papilla
papilla of Vater
Relaxation and opening of Sphincter of Oddi is controlled by:
cholecystokinin
The endocrine function of the pancreas is performed by:
islets of Langerhans
Islets of Langerhans are composed of:
alpha, beta, delta cells
The islets of Langerhans produce _____ and ____ directly into the bloodstreem
insulin
glucagon
promotes release of glucose by the liver which in turn increases blood sugar levels
glucagon
stimulates body to use up glucagon to produce energy
insulin
The head of the pancreas is supplied by the ______ artery.
gastroduodenal
The body and tail of the pancreas are supplied by the _____ and _____ arteries
splenic
superior mesenteric
Venous drainage for the pancreas is performed by _____, ______, and ______ veins.
splenic
superior mesenteric
portal
Normal echogenicity of the pancrease
greater than the liver
diffusely hyperechoic pancreas
pancreatic steatosis
The pediatric patient’s pancreas is more _____ because of lack of fat.
hypoechoic
anechoic tube, consists of two parallel lines, with an anechoic lumen
main pancreatic duct
The main pancreatic duct AP should not exceed ___ mm
2
Normal measurement of the pancreatic head and body
2-3 cm
Normal measurement of the pancreatic tail
1-2 cm
Two most common pancreatic anomalies are
pancreatic divisum
annular pancreas
most common congenital variant of the pancreas
pancreatic divisum
results from abnormal fusion of the pancreatic ducts during embryologic development
pancreatic divisum
results in a shortened main pancreatic duct that only drains the pancreatic head
pancreatic divisum
results from maldevelopment of the two embryologic elements of the pancreas
annular pancreas
the most ventral part of the pancreas encases the duodenum and may consequently lead to duodenal obstruction
annular pancreas
inflammation of the pancreas secondary to the leakage of pancreatic enzymes from the acinar cells into the parenchyma of the organ
acute pancreatitis
Most common causes of acute pancreatitis are
alcohol abuse
biliary tract diseases
Acute pancreatitis is often divided into either _______ pancreatitis or _______ pancreatitis
interstital edematous
necrotizing
peripancreatic fluid collection
phlegmon
lead to enlargment of the head; appear as hypoechoic region; pancreatic margins ill-defined with areas of fluid collections
focal pancreatitis
body will attempt to encapsulate damaging digestive enzymes that leak from the pancreas
pancreatic pseudocyst
The most common location for a pancreatic pseudocyst is:
lesser sac
The lesser sac is located between the _____ and ____
pancreas
stomach
repeated bouts of pancreatic inflammation; often caused by chronic alcohol abuse
chronic pancreatitis
most common primary pancreatic malignancy
pancreatic adenocarcinoma
4th most common cause of cancer-related deaths in men
pancreatic adenocarcinoma
Most common location of pancreatic adenocarcinoma is
pancreatic head
hypoechoic mass in the head of the pancreas; double-duct sign
pancreatic adenocarcinoma
obstruction of both CBD and pancreatic duct
double-duct sign
stage 1 pancreatic adenocarcinoma
mass confined to pancreas
Stage 2 pancreatic adenocarcinoma
involves local lymph node involvement
Stage 3 pancreatic adenocarcinoma
evidence of distant metastasis
surgical procedure performed on patients with pancreatic adenocarcinoma
whipple procedure
pancreaticoduodenectomy
Whipple procedure
Removal of head of pancreas, the gallbladder, some of the bile ducts, and proximal duodenum
Whipple procedure
small almost always benign cystadenomas
serous cystadenoma
larger; malignant potential; most often found within the body and tail of pancreas
mucinous cystadenomas
Symptoms of cystadenomas
epigastric pain, weight loss, palpable mass, jaundice
may actually appear solid and echogenic secondary to small size of cysts
serous cystadenomas
most often appears as a multilocular cystic mass that may contain mural nodules and calcifications
mucinous cystadenomas
house endocrine tissue of the pancreas
Islets of Langerhans
endocrine tumors of the pancreas
Islet cell tumors or pancreatic neuroendocrine tumors
Two most common types of islet cell tumors
insulinomas
gastrinomas
signs of insulinomas
Whipple triad (hypoglycemia, low fasting glucose, relief with intravenous glucose administation)
Whipple triad
hypoglycemia, low fasting glucose, relief with intravenous glucose administation
Islet cell tumor associated with Zollinger-Ellison Syndrome
Gastrinoma
excessive secretion of acid by stomach that leads to peptic ulcers
Zollinger-Ellison syndrome
small, hypoechoic mass that may contain calcifications
islet cell tumors
True pancreatic cysts may be associated with:
von Hippel-Lindau disease
cystic fibrosis
autosomal polycystic kidney disease
Most common reason for pancreatic transplant
severe type I diabetes
2 common techniques of pancreatic transplant
exocrine bladder drainage
exocrine enteric drainage
Acute rejection of pancreas sonographic appearance
heterogenous, hypoechoic
Chronic rejection of pancreas sonographic appearance
hyperechoic, atrophic, contains calcifications
Most common complication of pancreatic transplant
thrombosis of graft
An _____ gland uses ducts to transport digestive juices.
exocrine
An ______ gland releases hormones directly into the bloodstream.
endocrine
The ______ artery, which takes a similar path within the abdomen, may be confused for a dilated pancreatic duct, and thus, Color Doppler should be utilized to differentiate the two structures.
splenic
_______, which is the most common congenital variant of the pancreas, can lead to both acute and chronic pancreatitis
pancreatic divisum
Acute pancreatitis will cause a rise in amylase first and then a rise in lipase, with ______ being the most helpful lab finding for diagnosis of the disease
lipase
_________ will result in a diffusely, enlarged, hypoechoic pancreas.
diffuse acute pancreatitis
_______ can result in an atrophic, hyperechoic pancreas with calcifications and a prominent pancreatic duct.
Chronic pancreatitis
Pancreatic adenocarcinoma is most commonly found in the ____ of the pancreas.
head
_______ occurs when the gallbladder is palpable because it is enlarged. This is due to the presence of a (potentially malignant) pancreatic head mass that leads to biliary obstruction and the backup of a large amount of bile in the gallbladder.
Courvoisier gallbladder
Pancreatic cystadenocarcinoma is most commonly found in the ____ or ____ of the pancreas.
body
tail
Functional gastrinomas can produce _______ syndrome, which is described as the excessive secretion of acid by the stomach that leads to peptic ulcers.
Zollinger-Ellison
_______ disease is associated with cysts in the pancreas.
von Hippel Lindau
