lipase lasts longer Flashcards
1
Q
serous membrane that lines the abdominopelvic walls
A
peritoneum
contiguous with visceral
2
Q
where is the lesser sac
A
aka omental bursa
- potential space for ascites
posterior to stomach
anterior to pancreas
inferior to caudate
3
Q
omental bursa communicates with the greater sac via the __
A
epiploic foramen
4
Q
relationship of pancreas to peritoneum
A
retroperitoneal
5
Q
Panc vasculature supplied by which vessels
A
GDA
SA
SMA
6
Q
what is the name of the capsule surrounding the pancreas
A
trick question
it does not have a capsule
7
Q
the uncinate process forms from the __
A
ventral pancreatic bud
8
Q
what type of gland is the pancreas
A
heterocrine
exocrine -> 80%
endocrine ->20%
9
Q
exocrine component of pancreas performs functions via __ within ducts
A
acinar cells
‘berry’ cells
10
Q
what does the exocrine pancreas do for the body
A
digestive enzymes secretes into ducts
11
Q
what enzymes are associated with pancreas
A
amylase (carbs)
lipase (fats)
trypsin protease (proteins)
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
13
Q
what does endocrine panc do
A
secretes into bloodstream
14
Q
endocrine panc performs functions via __ cells
A
islet cells
15
Q
islet cells aka
A
islets of langerhans
16
Q
where do the islet cells live
A
most in tail
- surround exocrine tissue
17
Q
types of islet cells
A
alpha cells
beta cells
G cells
also D cells
18
Q
glucagon aka
A
alpha cells
- raise blood sugar
19
Q
insulin aka
A
beta cells
- lower blood sugar
20
Q
gastrin aka
A
G cells
- stimulate gastric acid production
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
22
Q
annular pancreas aka
A
bifid ventral bud
- incomplete rotation
- can cause duo obstruction
23
Q
failure of fusion of duo buds
A
pancreas divism
leads to minor papilla draining most of pancreas
24
Q
hypoechoic ventral pancreas due to __
A
uneven lipomatosis (deposition of fat)
25
sono appearance change with age
children -> isoechoic to liver
adult -> iso/echo to liver
senior -> hypoechoic to liver
* also atrophies over time
26
why does panc get more hypoechoic with age
increased fat in liver making in more echogenic comparatively
27
structures related to panc tail
lesser sac
stomach antrum
LLL
Ao
etc.
28
max normal diameter f main panc duct
<2mm
29
primary cause of ductal dilatation is __
obstruction from tumour
30
types of acute pancreatitis
edematous
hemorrhagic
31
which type of acute pancreatitis is more concerning
hemorrhagic because it is necrotizing
20% of acute cases
** epi pain, nausea, vomiting
32
edematous pancreatitis tx
usually self limiting
resolves spontaneously with or without tx
+/- complications
33
common causes for acute pancreatitis
biliary calculi
* female >50y
alcohol abuse
* male >40y
blunt trauma
* children
drug related
* children (antibiotics/sulfa; diuretic/thiazides)
34
epigastric pain acute onset and severe (some improvement with bending, radiates to back)
nausea
vomiting
acute pancreatitis
35
lab values tested for acute pancreatitis
serum
* elevated
amylase (urinary)
* 3x normal
lipase (serum or stool)
* elevated
+/- WBC
+?- hypocalcemia
36
which lab value is detected later and lasts a long time; lab value for pancreatitis and panc disease
amylase
37
which lab value is more specific
lipase
lasts ~12days
* longer than amylase
38
sono findings of acute pancreatitis
normal most of the time
sometimes diffuse enlargement; may be focal
+/- hypoechoic
+/- peripanc fluid
+/- dilated duct
39
complication from acute pancreatitis
portosplenic vein thrombosis
hemorrhage
duodenal obstruction
pseudocyst
phlegmon
abscess
40
pseudocyst vs. true cyst
no epithelial lining
* walled off fluid collection containing enzymes, fluid and debris
41
pseudocysts take __ to develop
4-6 w
* pancreatitis causes extravasation of panc enxymes
42
sono features of pseudocyst
body, tail, lesser sac, ant pararenal space
unilocular, smoth walled anechoic
enhancement
+/- loculations
+/- complex
+/- solid appearance
avascular
43
typical size and journey of pseudocyst resolution
50% self limiting
usually <5cm
if >5cm, often persisting; can become infected and rupture
44
pseudoaneurysm vs. pseudocyst
break in vessel wall
check with Doppler
pseudoaneurysm shows YINYANG sign
45
acute, inflammatory soft tissue solid mass that is not drainable; may regress with antibiotics or progress to an abscess
phlegmon
* focal hypoechoic mass
+/- enhancement
46
localized infection containing pus
abscess
* complex cystic mass
+/- gas
avascular
47
febrile, chills, elevates WBC, sepsis, pain worsening with time
likely abscess
tx needs drainage
48
repeated bouts of sub clinical pancreatitis
chronic pancreatitis
49
longstanding __ results in progressive destruction of pancreas, fibrosis, decreased panc function
chronic pancreatitis
50
what is the most common cause for chronic pancreatitis
alcohol abuse
51
chronic epi pain, anorexia, weight loss, steatorrhea, +/- DM, lipase and amylase come back normal; ETOH consumption
chronic pancreatitis
52
sono features for chronic pancreatitis
atrophy, increased echogenicity
calcification
* ductal
+/- parenchymal calc
ductal dilatation, tortuosity, irregularity
53
atrophy, increased echogenicity, calc, ductal dilatation, tortuosity
chronic pancreatitis
54
4 patterns of ductal dilatation generally
tumoural obstruction
- smooth
- beaded
chronic pancreatitis
- irregular (angular)
- with calcifications
55
complications with chronic pancreatitis
pseudocysts
obstruction of biliary tree
duodenal obstruction
portosplenic vein thrombosis
splenic artery aneurysm/ pseudoaneurysm
56
lethal, genetic disease usually dx in early childhood characterized by increased secretions of mucous by exocrine glands
cystic fibrosis
* lung, pancreas, biliary tree
57
frequent infection, panc insufficiency, biliary cirrhosis associated with __
cystic fibrosis
58
sono appearance of cystic fibrosis
often poor acoustic windows
echogenic panc, atrophies
heterogeneous echo texture
+/- small cysts
+/- dilated panc duct and CBD
59
most pancreatic tumours are __
solid and malignant
60
subsets of solid panc tumours
adenocarcinoma
islet cell tumour
* functioning
* non functioning
metastases
61
subtypes of cystic panc tumours
serous cystic
mucinous cystic
* IPMN
* SPEN
62
cancer of the exocrine panc originating in the glandular epithelium
adenocarcinoma
*90% of panc tumours
63
male >45y, smoking, chronic pancreatitis, ETOH, family hx, DM
increased risks for adenocarcinoma
64
adenocarcinoma usually in __ of panc
head
ampulla of vater (hepatopanc)
* cause for biliary obstruction and jaundice
65
weight loss, +/- pain, +/- jaundice, palpable RUQ mass, nontender gb, +/- DVT
adenocarcinoma symptoms
66
lab findings with adenocarcinoma
often normal, amylase/lipase may be elevated
LFTs may be elevated with metastatic disease
tumour marker CA19-9
67
sono features of adenocarcinoma
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
courvoisier gb associated with __
adenocarcinoma
* thin walls, NONTENDER
* due to malignant obstruction of distal CBD
* +/- sluge
* results in distension, jaundice and enlarged gb
69
cancer of the endocrine panc
islet cell tumours
**TAIL b/c islet cells
70
most islet cell tumours are __
functioning
71
types of functioning islet cell tumours
insulinoma
* B cell
* most common
gastrinoma
* G cell
less common:
glucagonoma
* alpha cell
somastatinoma
* D cell
72
which panc tumour is of the B cell
insulinoma
functioning islet cell tumour
73
which panc tumour increases insulin causing hypoglycemia, heart palpitations and sweating
insulinoma
74
sono feature of insulinoma
usually small
echo poor
typically benign and in tail
75
which panc tumour is of the G cells
gastrinoma
76
which panc tumour increases gastrin causing diarrhea, too much gastric acid and peptic ulcers
gastrinoma
* functioning islet cell tumour
77
what is Zollinger-Ellison syndrome and what is it associated with
increased gastric acid build up
associated with gastrinoma
78
which functioning islet cell tumour is usually malignant
gastrinoma
glucagonoma
79
which panc tumour decreases insulin; encouraging DM and inhibition of endocrine function
somastatinoma
* D cell functioning islet cell tumour
80
which panc tumour increases glucagon, causing hyperglycemia and DM
glucagonoma
* alpha cell functioning islet cell tumour
81
which type of islet cell tumours are larger but harder to dx
non functioning
* high incidence of malignancy
82
which panc tumour is most common malignant tumour
adenocarcinoma
83
sono features of non functioning islet cell tumours
in the head of the panc
double duct sign
intrahepatic biliary dilatation
courvoisier gb
84
MEN syndrome aka
multiple endocrine neoplasia
neoplastic / hyperplastic involvement in several endocrine glands
genetic autosomal dominant
85
MEN syndrome is genetic, autosomal __
dominant
86
type I MEN syndrome
pituitary
parathyroid
pancreas
87
type II MEN syndrome
thyroid
parathyroid
adrenal
88
mets to the panc are very __ ; and are associated with which primaries
uncommon
lung, breast, thyroid, melanoma
OR direct extension form kidney, stomach, lymph nodes
89
only consider a met in pancrease if pt has what hx
hx of a known primary
90
serous vs. mucinous cystic neoplasms of the panc
serous = microscopic, benign, old people
mucinouse = big, complex, malignant, women
91
cystic neoplasm of panc with well defined cystic or solid appearance, very small, and has central scar in some instances
serous cystic neoplasm
92
thin walled cystic neoplasm ddx pseudocyst
mucinous cystic neoplasm
93
what are the 2 main types of mucinous cystic neoplasms seen in the panc
IPMN
SPEN
94
IPMN aka
intraductal papillary mucinous neoplasm
* old ladies
* some malignant
* complex, biliary and ductal dilatation
95
SPEN aka
solid pseudopapillary epithelial neoplasm
* young women
* slow rate of growth
* variety of appearances
96
which types of panc neoplasm is mostly found in young women
SPEN
97
which panc neoplasm with hx of abd pain, nausea, vomiting, weight loss, acute pancreatitis, and an old woman
IPMN
98
cystic lesions of the panc associated with __
ADPKD
Von Hippel-Lindau disease
99
genetic tumour-producing disease (autosomal dominant) the predisposes patient to develop benign and malignant tumours
Von Hippel-Lindau disease
associated lesions
- CNS
- retinal hemangioblastoma
- clear cell renal carcinoma
- pheochromocytoma
- panc cysts
100
where will you find a pancreatic transplant
iliac crest (lower quadrant)
101
what is the most common procedure performed for pancreatic conditions
Wipple procedure
102
when performing endoscopic evaluation of the pancreas, the frequency should be around __ MHz
10MHz
103
what structure is seen coursing transversely through the anterior head of the pancreas
gastroduodenal artery
104
what would be the use of employing colour Doppler to a pt ?pancreatitis
r/o pseudoaneurysm
