Lesson 3A (Part 3) Flashcards
What is the sonographic appearance of a pseudocyst?
Almost purely cystic to collections with considerable mural irregularity, septations and internal echogenic debris
What can cause the mural irregularity, septations and internal echogenic debris for a pseudocyst? (3)
- Necrosis
- Hemorrhage
- Infection
Significant pancreatic necrosis
Parenchyma that is over 3cm AP or involving more then 30% of the pancreas
How is significant pancreatic necrosis treated? (2)
- Antibiotics
2. Close observations
What is useful when diagnosing necrosis?
CECT
- US cant be done on its own
Why do abscesses occur?
If fluid collection becomes infected
- pus filled collections
What can you do with pseudocysts that become infected?
Drained or excised
What are considered the 2 most useful modalities when diagnosing acute pancreatitis?
- CECT
- contrast enhanced CT - Abdominal Ultrasound
What are useful but usually secondary modalities when diagnosing acute pancreatitis? (2)
- MRCP
2. MRI
What does the choice of modality depend on?
The patients clinical situation
When is CECT recommended?
Diagnostic for necrosis
When is CT recommended?
For determining delayed complications of acute pancreatitis, guiding aspiration and drainage
When is US recommended?
When assessing fluid collections, biliary systems and dilated ducts
What modality do you use if this is the patients first episode of acute pancreatitis?
Ultrasound
What modality do you use if this is the patients second episode of acute pancreatitis?
CT
What is ERCP usually used for?
Therapy
- not diagnosis
What can US and CECT be used for in treatment?
- Guidance aspiration
2. Drain an infected pseudocyst
Chronic pancreatitis
Intermittent pancreatic inflammation with progressive irreversible damage to the gland
What is the predominant cause of chronic pancreatitis?
Alcoholism
What are other causes of chronic pancreatitis? (6)
- Pancreatic duct obstruction
- Hypertriglyceremia
- Hypercalcemia
- Auto-immune pancreatitis
- Tropical pancreatitis
- Genetic mutations
What are signs and symptoms of chronic pancreatitis? (3)
- Pain
- Malabsorption
- Diabetes
What can chronic pancreatitis lead to? (6)
- Fibrosis
- Cellular damage
- Chronic inflammation
- Distorted/blocked ducts
- Permanent structural changes
- Deficient endocrine and exocrine function
What is the sonographic appearance of chronic pancreatitis? (5)
- Altered parenchymal texture
- Glandular atrophy
- or gland enlargement - Focal masses
- Dilation and beading of pancreatic duct with calcifications
- Pseudocysts
What is the treatment for uncomplicated chronic pancreatitis? (2)
- Alleviate pain
2. Control malabsorption and diabetes
What is the goal of uncomplicated chronic pancreatitis treament?
Aim to improve quality of life
What is the treatment for complicated chronic pancreatitis? (2)
- Surgery
2. Endoscopy
What are possible complications with treatment of complicated chronic pancreatitis? (5)
- Pseudocysts
- more common in chronic - Abscesses
- Malignancies
- Thrombosis of portals
- Pancreatic and bile duct obstruction
- double duct sign
Which is more likely to cause more damage, acute or chronic pancreatitis?
Chronic pancreatitis
