Lesson 3A (Part 2) Flashcards
What does it mean if the body of the pancreas exceeds 3cm AP?
Acute pancreatitis
How much should the pancreatic duct AP measurement be?
3mm or less
What is the most common variant of the pancreas?
Pancreatic divisum
- failure of fusion
What are 3 variants of the pancreas?
- Pancreatic divisum
- Annular pancreas
- Partial agenesis
Annular pancreas
Second part of duodenum is surrounded by a ring of pancreatic tissue that is continuous with the head of the pancreas
- may constrict duodenum
- rare condition
What should be included in the patients history? (3)
- Previous episodes of pancreatitis or hospitalizations
- Gallbladder intact or not
- surgery - Area of pain
- if patient exhibits discomfort while scanning over the pancreas area, this should be relayed to the radiologist
What is an indicator of pancreatitis?
Epigastric pain
When is the role of doppler used with the pancreas? (3)
- If the splenic vein does not appear anechoic and is over distended
- colour and doppler should be used to ascertain patency and hepatopetal flow - Pancreatitis
- Any masses seen
Hepatopetal
Flow towards the liver
What are some indications for a pancreatic scan? (8)
- Severe epigastric pain
- Elevated pancreatic enzymes
- Biliary disease
- Abdominal distension
- Pancreatitis
- Weight loss/anorexia
- Pancreatic neoplasm
- Evaluate mass seen on CT
Acute pancreatitis
An acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems associated with raised pancreatic enzyme levels in blood or urine
What are the top 2 causes/risk factors of acute pancreatitis?
- Gallstones
2. Alcoholism
What are other causes of acute pancreatitis? (9)
- Choledocholithiasis
- Biliary sludge
- Neoplasm
- Infection
- Toxins
- Drugs
- Genetic
- Traumatic
- Iatrogenic factors
- eg. endoscopy or post-operative
What are the steps for diagnosing acute pancreatitis? (2)
- Amylase and lipase are elevated on blood tests
2. Patient is then sent for imaging to help confirm the diagnosis
What are the sonographic findings for acute pancreatitis? (2)
- GB and bile ducts are assessed for stones
2. Enlargement of the pancreas also occurs
CECT
Contrast enhanced CT
What important to check when scanning the pancreas? (3)
- Gallstones
- Choledochalithiasis
- Obstructions
What is US great at seeing?
The biliary system
How can acute pancreatitis appear?
- Hypoechoic
2. Enlarged
Why does acute pancreatitis appear hypoechoic or enlarged?
Due to interstitial edema
- use AP measurements if suspected
Edema
Swelling of the tissue
What is the most common and useful finding to diagnose pancreatitis? (2)
- Hypoechoic or anechoic collections that conform to the retroperitoneal or peritoneal space
- Ascites or complex fluid
What are local complications of pancreatitis associated inflammation?
- Acute fluid collections
- Pseudocysts
- fluid collection persisting over 6 weeks - Abscess
- Necrosis
- Vascular Complications
What are 3 examples of vascular complications?
- Hemorrhage
- Venous thrombosis
- Pseudoaneurysms
What do 40% of patients with acute pancreatitis develop?
Acute fluid collections
What does it mean when acute fluid collections contain debris or necrosis?
It can have an infection
Pseudocyst
Fluid collection that persists more than 6 weeks
- hard to tell the difference between this and a simple cyst (need more testing to confirm)
What is a pseudocyst considered?
Not a true cyst
Why is a pseudocyst not considered a true cyst?
Because it does not have an epithelial lining
Local complications
Complications that are close to the region that was infected
