Lesson 3A (Part 3)

Question 1

What is the sonographic appearance of a pseudocyst?

Answer 1

Almost purely cystic to collections with considerable mural irregularity, septations and internal echogenic debris

Question 2

What can cause the mural irregularity, septations and internal echogenic debris for a pseudocyst? (3)

Answer 2

1. Necrosis
2. Hemorrhage
3. Infection

Question 3

Significant pancreatic necrosis

Answer 3

Parenchyma that is over 3cm AP or involving more then 30% of the pancreas

Question 4

How is significant pancreatic necrosis treated? (2)

Answer 4

1. Antibiotics

2. Close observations

Question 5

What is useful when diagnosing necrosis?

Answer 5

CECT

- US cant be done on its own

Question 6

Why do abscesses occur?

Answer 6

If fluid collection becomes infected

- pus filled collections

Question 7

What can you do with pseudocysts that become infected?

Answer 7

Drained or excised

Question 8

What are considered the 2 most useful modalities when diagnosing acute pancreatitis?

Answer 8

1. CECT
   - contrast enhanced CT
2. Abdominal Ultrasound

Question 9

What are useful but usually secondary modalities when diagnosing acute pancreatitis? (2)

Answer 9

1. MRCP

2. MRI

Question 10

What does the choice of modality depend on?

Answer 10

The patients clinical situation

Question 11

When is CECT recommended?

Answer 11

Diagnostic for necrosis

Question 12

When is CT recommended?

Answer 12

For determining delayed complications of acute pancreatitis, guiding aspiration and drainage

Question 13

When is US recommended?

Answer 13

When assessing fluid collections, biliary systems and dilated ducts

Question 14

What modality do you use if this is the patients first episode of acute pancreatitis?

Answer 14

Ultrasound

Question 15

What modality do you use if this is the patients second episode of acute pancreatitis?

Answer 15

CT

Question 16

What is ERCP usually used for?

Answer 16

Therapy

- not diagnosis

Question 17

What can US and CECT be used for in treatment?

Answer 17

1. Guidance aspiration

2. Drain an infected pseudocyst

Question 18

Chronic pancreatitis

Answer 18

Intermittent pancreatic inflammation with progressive irreversible damage to the gland

Question 19

What is the predominant cause of chronic pancreatitis?

Answer 19

Alcoholism

Question 20

What are other causes of chronic pancreatitis? (6)

Answer 20

1. Pancreatic duct obstruction
2. Hypertriglyceremia
3. Hypercalcemia
4. Auto-immune pancreatitis
5. Tropical pancreatitis
6. Genetic mutations

Question 21

What are signs and symptoms of chronic pancreatitis? (3)

Answer 21

1. Pain
2. Malabsorption
3. Diabetes

Question 22

What can chronic pancreatitis lead to? (6)

Answer 22

1. Fibrosis
2. Cellular damage
3. Chronic inflammation
4. Distorted/blocked ducts
5. Permanent structural changes
6. Deficient endocrine and exocrine function

Question 23

What is the sonographic appearance of chronic pancreatitis? (5)

Answer 23

1. Altered parenchymal texture
2. Glandular atrophy
   - or gland enlargement
3. Focal masses
4. Dilation and beading of pancreatic duct with calcifications
5. Pseudocysts

Question 24

What is the treatment for uncomplicated chronic pancreatitis? (2)

Answer 24

1. Alleviate pain

2. Control malabsorption and diabetes

Question 25

What is the goal of uncomplicated chronic pancreatitis treament?

Answer 25

Aim to improve quality of life

Question 26

What is the treatment for complicated chronic pancreatitis? (2)

Answer 26

1. Surgery

2. Endoscopy

Question 27

What are possible complications with treatment of complicated chronic pancreatitis? (5)

Answer 27

1. Pseudocysts
   - more common in chronic
2. Abscesses
3. Malignancies
4. Thrombosis of portals
5. Pancreatic and bile duct obstruction
   - double duct sign

Question 28

Which is more likely to cause more damage, acute or chronic pancreatitis?

Answer 28

Chronic pancreatitis