Pancreas Flashcards
What is the most common type of ectopic pancreatic tissue?
Ectopic pancreatic tissue in the GI system
It can develop pancreatitis.
What is an annular pancreas?
A condition where the head encircles the duodenum
More common in males and associated with partial atresia.
What characterizes fibrocystic disease?
Hereditary condition with small cysts
It is also known as cystic fibrosis of the pancreas.
What are congenital cysts?
Usually multiple and result from abnormal development of the pancreatic duct
They are distinct from fibrocystic disease.
What is agenesis in relation to the pancreas?
Absence of the body and tail of the pancreas.
What is the primary function of the endocrine pancreas?
Hormonal regulation
It is performed by the islets of Langerhans.
What do islet cells produce?
Insulin
Islet cells include alpha, beta, and delta cells.
What does alpha cell produce?
Glucagon.
What is the most prevalent endocrine hormone produced by the pancreas?
Insulin.
What is the function of delta cells in the pancreas?
Produce somatostatin; inhibit alpha and beta cells.
What is the primary function of the exocrine pancreas?
Digestive functions.
What do acini cells produce?
Pancreatic juices
Approximately 2 liters per day.
What triggers the secretion of pancreatic juices?
Ingestion of food.
What is the role of lipase in pancreatic juice?
Breaks down fats.
What does amylase do?
Breaks down complex carbohydrates to sugar.
Which enzymes are involved in protein digestion?
Trypsin, chymotrypsinogen, carboxypeptidase.
What is the function of sodium bicarbonate in pancreatic juice?
Neutralizes gastric acid.
List the enzymes found in pancreatic juice.
- Lipase
- Amylase
- Trypsin
- Chymotrypsinogen
- Carboxypeptidase
- Nucleases
What is the primary duct of the pancreas called?
Duct of Wirsung
It enters the medial second part of the duodenum with the CBD at Vater’s ampulla.
What is Santorini’s duct?
A secondary duct that drains the upper anterior head of the pancreas
It enters the duodenum 2 cm proximal to the ampulla of Vater.
What is the typical length of the pancreatic duct?
12 to 18 cm
The head measures 2-3 cm, the body 2-2.5 cm, and the tail 1-2 cm.
What are the main arteries supplying the pancreas?
- SA (Splenic Artery)
- Pancreaticoduodenal arteries (branch of GDA)
- Tributaries of SV (Splenic Vein) and SMV (Superior Mesenteric Vein)
Which enzyme increases in pancreatitis within the first 24 hours?
Amylase
Serum levels rise 3-6 hours after onset and remain elevated in urine for up to 7 days.
What is the role of lipase in relation to the pancreas?
Assesses damage to the pancreas and remains elevated in pancreatitis and cancer
It rises later and can stay elevated for up to 14 days.
What happens to blood glucose levels in tumors of the islets of Langerhans?
Decreases
Increased glucose levels are found in diabetes, chronic liver disease, and overactive endocrine glands.
What is the recommended fasting period before a sonographic evaluation of the pancreas?
NPO for 8-12 hours
What is the usual window for pancreatic imaging?
Left lateral liver (LLL)
The stomach may be filled to provide a window.
What are the common complications of acute pancreatitis?
- Pseudocyst
- Phlegmon
- Abscess
- Hemorrhage
- Duodenal obstruction
- Suppuration (pus formation)
What is a pancreatic pseudocyst?
A collection of fluid that arises from the loculation of inflammatory processes, necrosis, or hemorrhage
Usually associated with pancreatitis and develops 4 to 6 weeks after onset.
What are the sonographic findings of a pancreatic pseudocyst?
Predominantly anechoic that may or may not contain dependent debris
What is the mortality rate of spontaneous rupture of a pancreatic pseudocyst?
50%
Sudden shock and peritonitis may occur in such cases.
What is hemorrhagic pancreatitis?
Rapid progression of acute pancreatitis with diffuse enzymatic destruction of pancreatic substance
What percentage of patients with acute pancreatitis may develop a phlegmon?
18% to 20%
What is the clinical presentation of abscess related to pancreatitis?
- Fever
- Leukocytosis
- Chills
- Hypotension
- Abdominal tenderness
What defines chronic pancreatitis?
Progressive, irreversible destruction due to repeated flare-ups of mild acute pancreatitis
What are the echogenicity findings in chronic pancreatitis?
Increased echogenicity; calcifications; ductal dilation; irregular outline
What is the most common neoplasm of the pancreas?
Adenocarcinoma
It accounts for over 90% of malignant pancreatic tumors and is a leading cause of cancer-related mortality.
What are common symptoms of pancreatic adenocarcinoma?
- Weight loss
- Abdominal pain
- Back pain
- Anorexia
- Nausea and vomiting
What is the average survival rate after diagnosis of pancreatic adenocarcinoma?
2 to 3 months
What are the characteristics of mucinous adenocarcinoma?
Cystic in nature
What are true cysts associated with?
- Congenital conditions
- Acquired conditions
What conditions are associated with multiple pancreatic cysts?
- Autosomal dominant polycystic kidney disease
- Von Hippel-Lindau syndrome
What are the tumors associated with Von Hippel- Lindau syndrome?
Renal cell carcinoma
Hemangioma
Pheochromocytoma (adrenal tumor)
Pancreatic cystadenoma/cystadenocarcinoma
Adenoma
Islet cell tumor
Cysts associated with a variety of organs
*Combination of cystic and solid tumors
What are some adenocarcinoma clinical symptoms?
Obstruction of the common bile duct with subsequent jaundice and hydrops of the gallbladder.
Weight loss
Pain
jaundice
Vomiting as the gastrointestinal tract becomes invaded by tumor.
What are two types of pancreatic cystic neoplams?
Microcystic adenoma (serous cystadenoma)
Macrocystic adenoma (mucinous cystadenoma/cystadenocarcinoma)
What are cystadenomas?
Rare fluid collections that arise from the epithelium of the pancreatic duct
They are primarily cystic with septations and thick walls and can be easily confused with pseudocysts.
What is the association of cystadenomas with amylase levels?
Associated with increased levels of amylase
What is the significance of CEA levels in pancreatic tumors?
↑CEA; Association with von-Hippel Lindau
What characterizes microcystic adenomas?
Benign rare disease, older females, well circumscribed, large mass with multiple tiny cysts (grape-like)
What defines macrocystic adenomas?
May be mucinous cystadenoma or cystadenocarcinoma, middle-aged females, may be malignant or benign with malignant potential
Where do macrocystic adenomas arise?
Arises from duct in body or tail
What are common symptoms of macrocystic adenomas?
Epigastric pain and mass, irregular, lobulated
What are islet cell tumors?
Can be functional or nonfunctional; benign or malignant, small, usually in body or tail
What is the most common benign tumor of the pancreas?
Islet cell tumors
What percentage of nonfunctioning islet cell tumors are malignant?
92% are malignant
What are the two types of functioning islet cell tumors?
Insulinoma (70%), gastrinoma (20%)
What are gastrinomas associated with?
Gastric hypersecreations and peptic ulcer disease (Zollinger-Ellison syndrome)
What is the most common islet cell tumor?
Insulinomas
What characteristics do insulinomas typically have?
Most are small, well-encapsulated, with good vascular supply. Most are benign (90%).
What is the typical echogenicity of insulinomas?
Hypoechoic
What are Multiple Endocrine Neoplasia (MEN) syndromes?
Familial, autosomal dominant, adenomatous hyperplasia affecting endocrine system
Name one tumor associated with MEN syndromes.
Pituitary adenoma (prolactinomas), Parathyroid adenoma (hyperparathyroidism), Medullary thyroid carcinoma, Pancreatic islet cell tumors (gastrinoma, insulinoma), Pheochromocytoma (adrenals), ganglioneuromatosis
What is the most common lethal genetic defect in Caucasians?
Cystic fibrosis
Cystic fibrosis is a genetic disorder that affects various organs, particularly the lungs and pancreas.
What is a major cause of pancreatic exocrine failure in children?
Cystic fibrosis
Pancreatic insufficiency can lead to malabsorption and nutritional deficiencies.
What recurrent conditions may occur many times prior to the diagnosis of cystic fibrosis?
Recurrent acute and chronic pancreatitis
These conditions can complicate the clinical picture and delay diagnosis.
How does the pancreas typically appear in patients with cystic fibrosis?
Hyperechoic and small
Imaging studies often reveal these characteristics in the pancreas of affected individuals.
What additional complications may be present in cystic fibrosis patients?
Gallstones and liver disease
These complications can arise due to the effects of cystic fibrosis on various organ systems.
What is the most common cause of a hyperchoic pancreas in a child?
Cystic fibrosis
Hyperchoic pancreas is a significant imaging finding associated with this condition.
To which vessel is a pancreas transplant connected?
PV (Portal Vein)
Proper connection to the portal vein is crucial for transplant success.
What two types of flow should be evaluated in pancreas transplants?
Monophasic venous flow and low-resistant arterial flow
These flow characteristics are indicators of transplant viability.
What structure should be visualized during a pancreas transplant evaluation?
Pancreatic duct
Visualization of the duct is important for assessing the transplant’s anatomical configuration.
What should be evaluated for in relation to the pancreas during transplant assessment?
Peri-pancreatic fluid collections
Fluid collections can indicate complications such as leaks or infections.
