pancreas Flashcards
1
Q
describe location of pancreas
A
nonencapsulated organ in retroperitoneum in anterior pararenal space ||horizontal orientation w/ head caudal to tail||head/neck/body/tail/uncinate process
2
Q
pancreas encapsulated or non?
A
nonencapsulated
3
Q
pancreas size
A
12 - 18 L x 1 - 1.5 W x 2.5 AP cm
4
Q
AP head measurement
A
2-3 cm
5
Q
AP neck measurement
A
1-2 cm
6
Q
AP body measurement
A
1-3 cm
7
Q
AP tail measurement
A
2-3 cm
8
Q
AP pancreas should measure < _______
A
3 cm
9
Q
uncinate process|__________ to IVC|____________ to SMV|___________ ___________ to SMA
A
ant|post|right lateral
10
Q
pancreatic head|________ to IVC|__________ to 2nd duodenum and CBD|___________ ____________ to SMV/AO|_________ courses post to pancreatic head|_________ courses ant to pancreatic head
A
ant IVC|medial 2nd duodenum/CBD|R lateral SMV/AO|CBD|GDA
11
Q
pancreatic neck|_________ SMV and uncinate|___________ liver
A
ant|post
12
Q
pancreatic body|___________ SV/SA/SMA/LRV/AO|_________ stomach|__________ __________ liver
A
ant|post|left lateral
13
Q
pancreatic tail|__________ SV/L adrenal/L kidney|_________ to L lateral liver|_________ and __________ to splenic hilum
A
ant|inf|anterior and medial
14
Q
main pancreatic duct AKA
A
duct of wirsung
15
Q
main pancreatic duct joins CBD when exits head to form
A
ampulla of vater
16
Q
the ampulla of vater enters the _________ portion of the duodenum
A
2nd
17
Q
_________________ controls flow of pancreatic enzymes into duodenum thru ampulla of vater
A
sphincter of oddi
18
Q
main pancreatic duct size
A
< 2 mm
19
Q
most common cause of duct dilation?
A
stone formation in main pancreatic duct or ampulla
20
Q
accessory pancreatic duct AKA
A
duct of santorini
21
Q
the duct of santorini drains what part of the pancreas
A
head
22
Q
where does the duct of santorini enter the duodenum
A
2 cm prox to duct of wirsung
23
Q
CA originates from AO _________ to body of pancreas
A
superior
24
Q
3 bracnhes of CA
A
L gastric|splenic|CHA
25
CHA divides into
PHA|GDA
26
describe course of PHA
travels superiorly toward liver ||anterior to PV||Left of bile duct
27
branch of PHA
right gastric
28
describe the course of the GDA
starts at CHA|runs inf posterior to 1st part of duodenum|anterior to pancreatic head
29
branches of GDA
R gastroepiploic|ANT/POST superior pancreaticoduodenal artery
30
superior pancreatoduodenal artery feeds what part of the pancreas
head
31
splenic artery courses __________ and __________ to body and tail of pancreas
superior and posterior
32
splenic artery branches
dorsal pancreatic artery |pancreatic magnum|caudal pancreatic||||- short gastric artery|- left gastroepiploic (gastro-omental) artery
33
splenic artery branches supply what part of the pancreas
body and tail
34
originates from AO just below level of pancreas
SMA
35
SMA is |____________ to the pancreas|____________ to the body of the pancreas |___________ to the uncinate process|___________ to the 3rd portion of the duodenum
inferior|posterior|anterior
36
SMA is located _____________ to the SMV
to the LEFT
37
branch of SMA
inferior pancreatoduodenal
38
SMV is located |__________ of SMA|__________ to the neck |___________ to the uncinate process|___________ to 3rd portion of duodenum
right|posterior|anterior|anterior
39
splenic vein courses ____________ and ___________ to the body and tail of the pancreas
posterior and inferior
40
the splenic vein merges w/ the SMV behind the ____________ of the pancreas
neck
41
CBD travels|____________ to 1st portion of duodenum|____________ to pancreatic head
posterior|posterior
42
bld sugar levels should not exceed
100 mg/dL
43
EXOCRINE
produces substances used in nearby organ and delivered by DUCT
44
____________ cells secrete pancreatic juice
acini
45
pancreatic juice contains
electrolytes|pancreatic digestive enzymes amylase/lipase/trypsin||water|Na|K|Cl|sodium bicarbonate
46
amylase fxn
digest carbs
47
lipase fxn
digest fat
48
trypsin fxn
protein to amino acids
49
sodium bicarbonate fxn
neutralizes gastric acid
50
secretion of pancreatic juices controlled by
GI tract hormones
51
__________ stimulates pancreatic juice production
CCK
52
ENDOCRINE
produces substances used in nearby organ and delivered thru BLD VESSELS
53
what cells produce insulin and glucagon
Islet of Langerhaans
54
what cells make up islet of langerhaans
alpha|beta|delta|epsilon|gamma
55
alpha cells make
glucagon
56
beta cells make
insulin
57
delta cells make
somatostatin
58
indications to scan pancreas
epigastric pain|N/V|alcoholism|hypoglycemia - low bld sugar|hyperinsulinism - increased insulin production|hyperglycemia - high bld sugar
59
hyperglycemia aka
diabetes mellitus - increased bld sugar|decreased rate insulin secretion |hereditary or acquired
60
LABS
amylase|lipase|trypsin|WBC|bilirubin|bld glucose
61
digestive enzyme that breaks down carbs
amylase
62
secreted by pancreas and salivary glands and excreted by kidneys
amylase
63
increased levels of amylase ass w/
acute pancreatitis |ductal obstruction|oral contraceptive use
64
decreased levels amylase ass w/
permanent pancreas pancreas damage|hepatitis|cirrhosis
65
digest fats
lipase
66
increased lipase ass w/
acute pancreatitis|ductal obstruction
67
increased levels trypsin ass w/
acute pancreatitis|ductal obstruction
68
increased WBC count
infection
69
increased bilirubin
biliary duct obstruction at pancreas head
70
increased bld glucose ass w/
decreased pancreatic fxn (diabetes)
71
pancreas probe
2.5 - 6.5 MHZ adult|4 - 8 MHZ pediatric||NPO 8-12 hrs|subcostal transverse oblique|LLD for head/uncinate|large footprint for body |RLD coronal w/ spleen window for tail
72
LANDMARKS|post to body|superior to head|travels post and sup to body and tail|seen entering ant head|post to neck/head|inf to body /tail|inf and post to body and tail|joins SV post to head/neck
AO|CA|splenic artery|GDA|IVC/ SMV|LRV branch SMA / SV|SV|SMV
73
name a normal variant of uncinate process
decreased echogenicity due to less fat
74
in children the pancreas is mildly ____________ to ____________ compared to the liver
hypoechoic to isoechoic
75
pancreatic echogenicity increases/decreases with age?
increases
76
in adults the pancreas is _______________ or ______________ to liver tissue
isoechoic or hyperechoic ||renal sinus|pancreas|liver|spleen|renal cortex
77
most common congenital pancreatic anomaly
Pancreatic Divisum - Failure of fusion of fetal pancreatic ducts||results in 2 separate portions of gland w/ separate ductal systems
78
pancreas divisum can lead to
pancreatitis due to abnormal duct system and drainage of enzymes
79
% patients w/ pancreas divisum
10
80
1-2 cm masses of ectopic pancreatic tissue
aberrant tissue
81
aberrant tissue composed of
acinar and ductal cells
82
aberrant tissue can be located
duodenum stomach small bowel
83
head of pancreas surrounds 2nd portion duodenum
annular pancreas||results in complete obstruction of duodenum|rare - surgery requuired
84
autosomal recessive disorder that causes pancreas to secrete thick mucous inhibiting exocrine fxn
cystic fibrosis
85
most common complication of cystic fibrosis
meconium ileus
86
SA cystic fibrosis
gland atrophy|fibrosis and fatty replacement |duct obstruction - cyst formation|increased echogenicity of pancreas
87
polycystic disease
multiple cysts thru gland |various sizes|liver, kidney, spleen invovlment
88
pancreatic duct stones
echogenic foci w/ shadowing|can be ass w/ biliary obstruction ||pancreatic duct stone = no biliary dilation unless stone blocks ampulla of Vater
89
normal pancreatic duct measures
2 mm or less
90
acute onset of pancreatic inflammation
acute pancreatitis
91
reversible|enzymes leak into surrounding tissue|gland edematous
acute pancreaitis
92
sudden onset back pain/abdomen pain |N/V|weight loss|fever
acute pancreatitis
93
acute pancretitis triggered by
a meal or excessive alcohol consumption
94
#1 cause acute pancreatitis|# 2 cause
biliary tract disease|alcohol||also trauma and drugs
95
steatorrhea sign of
inflammatory bowel disease|celiac disease|pancreatitis
96
labs pancreatitis
increased lipase|increased amylase|increased WBC|decreased hematocrit
97
Complications of acute pancreatitis
Pseudocyst - accumulation pancreatic juices walled off and appears to be cyst||Phlegmon - peripancreatic inflammation extends into surrounding tissues|Abscess|Hemorrhage|thrombosis - portal system SV most common|Duodenal obstruction|pseudo/Aneurysm - extrapancreatic juice can erode arterial vessels causing weakness (aneurysm) or leakage (pseudoaneurysm) |ascites|dilated biliary system - extrinsic comp at panc head|inflammation ant pararenal/perirenal spaces and transverse mesocolon
98
focal pancreatitis
phlegmon
99
inflammatory mass formed by edema and leakage of pancreatic juices
focal pancreatitis/phlegmon
100
SA acute pancreatitis
1/3 gland normal |focal involvement - head||diffuseinvolvement - uniformly hypo||enlarged gland |hypo|hetero|increased thru transmission ||fluid accumulation around gland|pseudocyst formation in lesser sac|possible duct stones
101
focal involvement in head of pancreas acute pancreatitis can cause
biliary duct dilation and Courvoisier GB
102
fatty liver disease causes pancreas to appear more hypo
pseudo pancreatitis
103
pancreatitis caused by alcoholism and trauma
hemorrhagic pancreatitis
104
pancreatic enzymes leak into tissue causing areas of fat necrosis and ruptured vessels|inflammation and bleeding
hemorrhagic pancreatitis
105
hemorrhagic discoloration of umbilical area aused by intraperitoneal hemorrhage
cullen sign
106
hemorrhagic discoloration of L flank caused by acute hem panc
grey turner sign
107
labs acute hemorrhagic pancreatitis
decreased hematocrit
108
SA hemorrhagic pancreatitis
diffuse enlargement pancreas|hypoechoic|periglandular fluid|phlegmon
109
irreversible form of pancreatitis
chronic
110
pancreatitis ass w/ fibrosis, stones, and permanent cell damamge
chronic pancreatitis
111
#1 cause chronic pancreatitis
alcohol abuse||more common in males
112
other causes chronic pancreatitis
hereditary pancreatitis|cystic fibrosis|congenital abnormalities|blunt trauma|idiopathic chronic panc
113
complications chronic pancreatitis
jaundice|diabetes||pseudocysts|thrombosis PV/SV|increased risk malignancy
114
labs chronic pancreatitis
amylase and lipase only elevated in acute
115
SA chronic pancreatitis
dilated pancreatic duct|calcifications|stones in duct|gland decreased in size|hyperechoic|hetero|irregular border|SV thrombosis
116
occurs due to neighboring infections|fever/pain|increased WBC count
pancreatic abscess
117
SA pancreatic abscess
complex cystic mass|thick irregular walls|debris|ring down from air made in bacterial infection
118
CYSTS AND NEOPLASMS
cyst- epithelial lining|pseudocyst - no lining
119
simple cysts of pancreas most commonly found in
head and body||uni/multilocular|congenital or acquired
120
pancreatic cysts ass w/
ADPKD|VHL
121
most common lesion seen w/ VHL
simple cysts
122
SA pancreatic cyst
round|anechoic|post enhance|thin walls
123
rare genetic disorder ass w/ visceral cysts, renal and pancreatic cysts, benign masses, and potential malig transformation of cysts in multiple organ systems
Von hippel landau syndrome VHL
124
most common lesion associated w/ VHL
pancreatic cyst
125
multiple pancreatic cysts more common in
VHL than ADPKD
126
attempt of the body to wall off pancreatic juices|- NO epithelial lining, "wall" of the cyst consists of fibrous and granulation tissue|- 9X more common than true cyst
pancreatic pseudocyst
127
A pseudocyst most commonly forms in which retroperitoneal space?
lesser sac (omental bursa) |anterior pararenal space
128
SA pseudocyst
smooth walls|enhanced through transmission|thick walls|internal debris|calcifications in the walls||dilated pancreatic duct
129
labs pseudocyst
increased amylase, lipase, trypsin
130
pseudocyst associated w/ what vascular problems
SA aneurysm - enzymes erode wall - weaken |SV thrombosis
131
causes pancreatic pseudocyst
acute pancreatitis|chronic pancreatitis|pancreas trauma|pancreas duct obstruction|pancreatic neoplasms
132
most common benign tumor of pancreas (can become malig)
islet cell tumors||- islet of langerhaans endocrine cells alpha beta delta and gamma make insulin and glucagon
133
islet cell tumor aka
pancreatic endocrine tumor (PET)
134
hyperfunctioning tumor diagnosed at small size due to clinical symptoms related to hyperfxn
PET
135
labs islet cell tumor
increased amylase
136
islet cell tumor composed of _________ cells and most commonly found in pancreas ___________ and ___________
abnormal beta cells|body and tail
137
most common type islet cell tumor
Insulinoma (usually benign)||hyperinsulinism = hypoglycemia||ass w/ VHL
138
2nd most common type islet cell tumor
gastrinoma (usually malignant)||hyper gastric acid secretion = cause gastric and duodenal ulceration ||ass w/ MEN syndrome
139
SA islet cell tumor (PET)
solid hypo mass|well circumscribed|cystic areas|< 3 cm
140
formation of one or more gastrinomas of pancreas or duodenum
Zollinger-Ellison Syndrome||- secrete lots of gastrin and cause peptic ulcers
141
composed of beta cells and may develop in duct causing obstruction
adenoma
142
SA adenoma
solid mass|posterior enhancement|varying echogenicity
143
serous cystic neoplasm
serous cystadenoma||ass VHL
144
serous cystadenomas usually affect the pancreatic _________ and __________
body and tail
145
serous cystadenoma used to be called
microcystic cystadenomas||cysts <2 cm |always benign
146
macrocystic serous cystadenoma
> 2 cm|malig potential for cystandenocarcinoma
147
labs serous cystadenoma
increased amylase
148
SA serous cystadenoma
cluster of grapes |external lobulation||thick walls
149
most frequent cystic tumor of the pancreas
mucinous cystadenoma
150
mucinous cystadenoma
benign tumor that contain mucinous material
151
larger than serous cystadenoma and more potential to become malignant
mucinous cystadenoma
152
SA mucinous cystadenoma
loculated cystic masses w/ debris and internal calcifications||large multicystic mass w/ septations and debris
153
4th leading cause of death from cancer
pancreatic cancer
154
70% of pancreatic malignant neoplasms occur in the
head
155
most common primary malignancy of pancreas
adenocarcinoma||HOWEVER - mets is much more common
156
90% of adenocarcinomas originate from
ductal system
157
mean patient age adenocarcinoma
55 yrs
158
adenocarcinoma symtpoms
painless jaundice|weight loss|abdominal / back pain |N/V
159
most lethal malignancy of all types of cancer
adenocarcinoma
160
SA adenocarcinoma
solid hypoechoic lobulated mass |pancreatic head ||irregular borders
161
other findings w/ adenocarcinoma
courvoisier GB|dilated biliary tree/ pancreatic duct|liver mets|ascites|lymphadenopathy|pseudocyst
162
labs adenocarcinoma
elevated direct bilirubin |elevated ALP |elevated amylase|elevated lipase|elevated GGT||normal pancreatic enzyme levels common
163
whipple procedure
pancreaticoduodenectomy||used to treat cancerous tumors at head of pancreas or duodenum||includes removal head of pancreas, portion of bile duct, GB, 1st +2nd part of duodenum,||Pancreas and hepatic duct are reattached to jejunum.
164
rare slow growing malignancy
mucinous cystadenocarcinoma
165
SA mucinous cystadenocarcinoma
cystic mass w/ septations|thick irregular walls||more common in body and tail
166
4 x more common than primary pancreatic cancer
pancreatic mets
167
most common primaries for pancreatic mets
RCC|lung|breast|melanoma|colon|stomach||occurs late in the primary cancer
168
SA pancreatic mets
hypervascular
169
most common reason for pancreas transplant
insulin dependent diabetic w/ renal failure
170
location of renal/pancreatic transplant
R iliac fossa for pancreas|kidney on L
171
pancreas transplant rejection
high resistance|heterogenous gland
172
complications of transplant rejection
pancreatitis||fluid collections - urinoma/hematoma/inflammatory collections ass w pancreatitis||thrombosis
