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ABD & SMALL PARTS > lipase lasts longer > Flashcards

lipase lasts longer Flashcards

1
Q

serous membrane that lines the abdominopelvic walls

A

peritoneum

contiguous with visceral

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2
Q

where is the lesser sac

A

aka omental bursa

  • potential space for ascites

posterior to stomach
anterior to pancreas
inferior to caudate

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3
Q

omental bursa communicates with the greater sac via the __

A

epiploic foramen

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4
Q

relationship of pancreas to peritoneum

A

retroperitoneal

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5
Q

Panc vasculature supplied by which vessels

A

GDA
SA
SMA

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6
Q

what is the name of the capsule surrounding the pancreas

A

trick question

it does not have a capsule

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7
Q

the uncinate process forms from the __

A

ventral pancreatic bud

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8
Q

what type of gland is the pancreas

A

heterocrine

exocrine -> 80%
endocrine ->20%

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9
Q

exocrine component of pancreas performs functions via __ within ducts

A

acinar cells
‘berry’ cells

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10
Q

what does the exocrine pancreas do for the body

A

digestive enzymes secretes into ducts

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11
Q

what enzymes are associated with pancreas

A

amylase (carbs)
lipase (fats)
trypsin protease (proteins)

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12
Q

which ducts does pancreas dump into

A

main panc duct OF WIRSUNG -> major duodenal papilla -> duo no. 2

accessory panc duct OF SANTORINI -> minor duo papilla -> duo no. 2

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13
Q

what does endocrine panc do

A

secretes into bloodstream

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14
Q

endocrine panc performs functions via __ cells

A

islet cells

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15
Q

islet cells aka

A

islets of langerhans

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16
Q

where do the islet cells live

A

most in tail

  • surround exocrine tissue
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17
Q

types of islet cells

A

alpha cells
beta cells
G cells

also D cells

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18
Q

glucagon aka

A

alpha cells

  • raise blood sugar
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19
Q

insulin aka

A

beta cells

  • lower blood sugar
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20
Q

gastrin aka

A

G cells

  • stimulate gastric acid production
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21
Q

embryology of panc

A

2 duodenal buds

rotate ventral bud alongside duodenum and bile ducts to join dorsal bud

  • dorsal bud is bigger; becomes the superior head, neck, body, tail
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22
Q

annular pancreas aka

A

bifid ventral bud

  • incomplete rotation
  • can cause duo obstruction
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23
Q

failure of fusion of duo buds

A

pancreas divism

leads to minor papilla draining most of pancreas

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24
Q

hypoechoic ventral pancreas due to __

A

uneven lipomatosis (deposition of fat)

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25
Q

sono appearance change with age

A

children -> isoechoic to liver
adult -> iso/echo to liver
senior -> hypoechoic to liver

  • also atrophies over time
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26
Q

why does panc get more hypoechoic with age

A

increased fat in liver making in more echogenic comparatively

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27
Q

structures related to panc tail

A

lesser sac
stomach antrum
LLL
Ao
etc.

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28
Q

max normal diameter f main panc duct

A

<2mm

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29
Q

primary cause of ductal dilatation is __

A

obstruction from tumour

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30
Q

types of acute pancreatitis

A

edematous
hemorrhagic

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31
Q

which type of acute pancreatitis is more concerning

A

hemorrhagic because it is necrotizing

20% of acute cases

** epi pain, nausea, vomiting

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32
Q

edematous pancreatitis tx

A

usually self limiting

resolves spontaneously with or without tx

+/- complications

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33
Q

common causes for acute pancreatitis

A

biliary calculi
* female >50y

alcohol abuse
* male >40y

blunt trauma
* children

drug related
* children (antibiotics/sulfa; diuretic/thiazides)

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34
Q

epigastric pain acute onset and severe (some improvement with bending, radiates to back)

nausea

vomiting

A

acute pancreatitis

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35
Q

lab values tested for acute pancreatitis

A

serum
* elevated

amylase (urinary)
* 3x normal

lipase (serum or stool)
* elevated

+/- WBC
+?- hypocalcemia

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36
Q

which lab value is detected later and lasts a long time; lab value for pancreatitis and panc disease

A

amylase

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37
Q

which lab value is more specific

A

lipase

lasts ~12days
* longer than amylase

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38
Q

sono findings of acute pancreatitis

A

normal most of the time

sometimes diffuse enlargement; may be focal

+/- hypoechoic
+/- peripanc fluid
+/- dilated duct

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39
Q

complication from acute pancreatitis

A

portosplenic vein thrombosis

hemorrhage

duodenal obstruction

pseudocyst

phlegmon

abscess

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40
Q

pseudocyst vs. true cyst

A

no epithelial lining

  • walled off fluid collection containing enzymes, fluid and debris
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41
Q

pseudocysts take __ to develop

A

4-6 w

  • pancreatitis causes extravasation of panc enxymes
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42
Q

sono features of pseudocyst

A

body, tail, lesser sac, ant pararenal space

unilocular, smoth walled anechoic

enhancement

+/- loculations
+/- complex
+/- solid appearance

avascular

43
Q

typical size and journey of pseudocyst resolution

A

50% self limiting

usually <5cm

if >5cm, often persisting; can become infected and rupture

44
Q

pseudoaneurysm vs. pseudocyst

A

break in vessel wall

check with Doppler

pseudoaneurysm shows YINYANG sign

45
Q

acute, inflammatory soft tissue solid mass that is not drainable; may regress with antibiotics or progress to an abscess

A

phlegmon

  • focal hypoechoic mass
    +/- enhancement
46
Q

localized infection containing pus

A

abscess

  • complex cystic mass
    +/- gas

avascular

47
Q

febrile, chills, elevates WBC, sepsis, pain worsening with time

A

likely abscess

tx needs drainage

48
Q

repeated bouts of sub clinical pancreatitis

A

chronic pancreatitis

49
Q

longstanding __ results in progressive destruction of pancreas, fibrosis, decreased panc function

A

chronic pancreatitis

50
Q

what is the most common cause for chronic pancreatitis

A

alcohol abuse

51
Q

chronic epi pain, anorexia, weight loss, steatorrhea, +/- DM, lipase and amylase come back normal; ETOH consumption

A

chronic pancreatitis

52
Q

sono features for chronic pancreatitis

A

atrophy, increased echogenicity

calcification
* ductal
+/- parenchymal calc

ductal dilatation, tortuosity, irregularity

53
Q

atrophy, increased echogenicity, calc, ductal dilatation, tortuosity

A

chronic pancreatitis

54
Q

4 patterns of ductal dilatation generally

A

tumoural obstruction
- smooth
- beaded

chronic pancreatitis
- irregular (angular)
- with calcifications

55
Q

complications with chronic pancreatitis

A

pseudocysts

obstruction of biliary tree

duodenal obstruction

portosplenic vein thrombosis

splenic artery aneurysm/ pseudoaneurysm

56
Q

lethal, genetic disease usually dx in early childhood characterized by increased secretions of mucous by exocrine glands

A

cystic fibrosis

  • lung, pancreas, biliary tree
57
Q

frequent infection, panc insufficiency, biliary cirrhosis associated with __

A

cystic fibrosis

58
Q

sono appearance of cystic fibrosis

A

often poor acoustic windows

echogenic panc, atrophies

heterogeneous echo texture
+/- small cysts

+/- dilated panc duct and CBD

59
Q

most pancreatic tumours are __

A

solid and malignant

60
Q

subsets of solid panc tumours

A

adenocarcinoma

islet cell tumour
* functioning
* non functioning

metastases

61
Q

subtypes of cystic panc tumours

A

serous cystic

mucinous cystic
* IPMN
* SPEN

62
Q

cancer of the exocrine panc originating in the glandular epithelium

A

adenocarcinoma

*90% of panc tumours

63
Q

male >45y, smoking, chronic pancreatitis, ETOH, family hx, DM

A

increased risks for adenocarcinoma

64
Q

adenocarcinoma usually in __ of panc

A

head
ampulla of vater (hepatopanc)

  • cause for biliary obstruction and jaundice
65
Q

weight loss, +/- pain, +/- jaundice, palpable RUQ mass, nontender gb, +/- DVT

A

adenocarcinoma symptoms

66
Q

lab findings with adenocarcinoma

A

often normal, amylase/lipase may be elevated

LFTs may be elevated with metastatic disease

tumour marker CA19-9

67
Q

sono features of adenocarcinoma

A

poorly defined, hypoechoic focal mass

diffuse hypoechoic panc involvement

+/- compression of adj structures

+/- dilated COURVOISIER GB (with jaundice)

+/- biliary dilatation

+/- panc duct dilatation
*DOUBLE DUCT SIGN

+/- lymphadenopathy, mets

68
Q

courvoisier gb associated with __

A

adenocarcinoma

  • thin walls, NONTENDER
  • due to malignant obstruction of distal CBD
  • +/- sluge
  • results in distension, jaundice and enlarged gb
69
Q

cancer of the endocrine panc

A

islet cell tumours

**TAIL b/c islet cells

70
Q

most islet cell tumours are __

A

functioning

71
Q

types of functioning islet cell tumours

A

insulinoma
* B cell
* most common

gastrinoma
* G cell

less common:
glucagonoma
* alpha cell

somastatinoma
* D cell

72
Q

which panc tumour is of the B cell

A

insulinoma

functioning islet cell tumour

73
Q

which panc tumour increases insulin causing hypoglycemia, heart palpitations and sweating

A

insulinoma

74
Q

sono feature of insulinoma

A

usually small

echo poor

typically benign and in tail

75
Q

which panc tumour is of the G cells

A

gastrinoma

76
Q

which panc tumour increases gastrin causing diarrhea, too much gastric acid and peptic ulcers

A

gastrinoma

  • functioning islet cell tumour
77
Q

what is Zollinger-Ellison syndrome and what is it associated with

A

increased gastric acid build up

associated with gastrinoma

78
Q

which functioning islet cell tumour is usually malignant

A

gastrinoma

glucagonoma

79
Q

which panc tumour decreases insulin; encouraging DM and inhibition of endocrine function

A

somastatinoma

  • D cell functioning islet cell tumour
80
Q

which panc tumour increases glucagon, causing hyperglycemia and DM

A

glucagonoma

  • alpha cell functioning islet cell tumour
81
Q

which type of islet cell tumours are larger but harder to dx

A

non functioning

  • high incidence of malignancy
82
Q

which panc tumour is most common malignant tumour

A

adenocarcinoma

83
Q

sono features of non functioning islet cell tumours

A

in the head of the panc

double duct sign

intrahepatic biliary dilatation

courvoisier gb

84
Q

MEN syndrome aka

A

multiple endocrine neoplasia

neoplastic / hyperplastic involvement in several endocrine glands

genetic autosomal dominant

85
Q

MEN syndrome is genetic, autosomal __

A

dominant

86
Q

type I MEN syndrome

A

pituitary

parathyroid

pancreas

87
Q

type II MEN syndrome

A

thyroid

parathyroid

adrenal

88
Q

mets to the panc are very __ ; and are associated with which primaries

A

uncommon

lung, breast, thyroid, melanoma

OR direct extension form kidney, stomach, lymph nodes

89
Q

only consider a met in pancrease if pt has what hx

A

hx of a known primary

90
Q

serous vs. mucinous cystic neoplasms of the panc

A

serous = microscopic, benign, old people

mucinouse = big, complex, malignant, women

91
Q

cystic neoplasm of panc with well defined cystic or solid appearance, very small, and has central scar in some instances

A

serous cystic neoplasm

92
Q

thin walled cystic neoplasm ddx pseudocyst

A

mucinous cystic neoplasm

93
Q

what are the 2 main types of mucinous cystic neoplasms seen in the panc

A

IPMN

SPEN

94
Q

IPMN aka

A

intraductal papillary mucinous neoplasm

  • old ladies
  • some malignant
  • complex, biliary and ductal dilatation
95
Q

SPEN aka

A

solid pseudopapillary epithelial neoplasm

  • young women
  • slow rate of growth
  • variety of appearances
96
Q

which types of panc neoplasm is mostly found in young women

A

SPEN

97
Q

which panc neoplasm with hx of abd pain, nausea, vomiting, weight loss, acute pancreatitis, and an old woman

A

IPMN

98
Q

cystic lesions of the panc associated with __

A

ADPKD

Von Hippel-Lindau disease

99
Q

genetic tumour-producing disease (autosomal dominant) the predisposes patient to develop benign and malignant tumours

A

Von Hippel-Lindau disease

associated lesions
- CNS
- retinal hemangioblastoma
- clear cell renal carcinoma
- pheochromocytoma
- panc cysts

100
Q

where will you find a pancreatic transplant

A

iliac crest (lower quadrant)

101
Q

what is the most common procedure performed for pancreatic conditions

A

Wipple procedure

102
Q

when performing endoscopic evaluation of the pancreas, the frequency should be around __ MHz

A

10MHz

103
Q

what structure is seen coursing transversely through the anterior head of the pancreas

A

gastroduodenal artery

104
Q

what would be the use of employing colour Doppler to a pt ?pancreatitis

A

r/o pseudoaneurysm

ABD & SMALL PARTS (16 decks)

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