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Abdomen > Pancreas > Flashcards

Pancreas Flashcards

0
Q

The head of the panc is ___ to the IVC

A

Anterior

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1
Q

GDA and CBD location to the panc head

A

GDA is ant lat

CBD is post lat

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2
Q

The head of the pan is ____ to the 2nd pt of duodenum

A

Medial

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3
Q

The CBD is ___ to the head of the panc

A

Posterior lateral

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4
Q

The GDA is ___ to the head of the panc

A

Anterior lateral

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5
Q

The SMA and vein are ___ to the neck of the panc

A

Posterior

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6
Q

The uncinate process is ___ to the SMA and vein

A

Posterior

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7
Q

The aorta is __ to the body of the panc

A

Posterior

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8
Q

The celiac axis arises from the aorta ___ to the panc

A

Superior

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9
Q

The GDA and CBD run ____ to the 1st pt of the duodenum

A

Posterior

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10
Q

The splenic vein is ___ to the panc

A

Posterior inferior

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11
Q

The SMA arises from the aorta __ to the pancreas

A

Inferior

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12
Q

The SMA and vein are ___ to the uncinate process

A

Anterior

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13
Q

The SMA and vein are ___ to the third pt of the duodenum

A

Anterior

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14
Q

The SMV is to the ___ of the SMA

A

Right

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15
Q

The PV is the result of the combination of the ___ and the ___

A

SMV and splenic vein

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16
Q

Courvoisier Law

A

Enlg gb with palp mass is suggestive of pancreatic cancer

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17
Q

Islet cell tumor

A

Small, endocrine tumor, usually in tail.
MC benign tumors, some malignant

MC insulinoma: hyperinsulinism & hypoglycemia

2nd MC gastrinoma: assoc with gastric hypersecretions and peptic ulcer disease

Functioning
Nonfunctioning

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18
Q

Panc pseudocyst

A

Collection of panc fluid encapsulated by fibrous tissue,

Caused by acute pancreatitis, chronic pancreatitis, trauma, panc cancer

Mc in panc, intraperitoneal, retroperitoneal, intraparenchymal, thorax

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19
Q

Pancreas

A

Retroperitoneal gland bound ant by the stomach and duodenum, and post by the pre vertebral vessels

Located in the anterior pararenal space

Horseshoe, dumbbell, comma shape.

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20
Q

SMV courses ___ to the uncinate process

A

Anterior

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21
Q

Panc neck is ____ to the portosplenic confluence

A

Anterior

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22
Q

Panc body is ___ to SMA, Aorta, and splenic vein

A

Anterior

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23
Q

Panc body is ____ to stomach

A

Posterior

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24
Q

Panc body is ____ to splenic artery

A

Inferior

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25
Q

Panc tail is ____ to left kidney

A

Anterior

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26
Q

Panc tail is ___ to splenic vein

A

Anterior lateral

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27
Q

Panc tail is ____ to the stomach and splenic artery

A

Posterior

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28
Q

Normal length of pancreas

A

12-18cm L

Head is 2.3-3.5 cm

29
Q

Panc is ___ to PV

A

Inferior

30
Q

Blood supply to pancreas and drainage

A

Splenic artery, pancreaticoduodenal arteries

SMV drains to splenic vein.

31
Q

Panc ducts

A

Main pancreatic duct/duct of Wirsung < 2 mm

Accessory duct/ Duct of Santorini

32
Q

Endocrine function

A

Secretion of insulin, glucagon, and somatostatin

by cells in the islet of Langerhans

33
Q

Exocrine function

A

Secretion of digestive enzymes (amylase, lipase, carboxypeptidase, trypsin, chymotrypsin
by the acini cells

34
Q

Pancreatic enzymes

A

Amylase, lipase, carboxypeptidase, trypsin, chymotrypsin, sodium bicarbonate.

35
Q

Amylase

A

Breaks down carbs

36
Q

Lipase

A

Breaks down fat

37
Q

Carboxypeptidase, chymotrypsin, and trypsin

A

Breaks down protein into amino acids.

38
Q

Sodium bicarbonate

A

Neutralizes stomach acid

39
Q

Nucleasis

A

Breakdown of nucleic acid

40
Q

Panc lab values

A

Amylase, lipase, steatorrhea (fat poo), blood glucose, bilirubin

41
Q

Alpha cells produce
Beta cells produce
Delta cells produce

A

Glucagon
Glucose
Somatostatin

42
Q

Pancreatitis lab

A

Amylase and lipase inc. amylase dec 48-72 hours later while lipase remains elevated for up to 14 days.

43
Q

MC congenital panc anomaly

A

Ectopic tissue

44
Q

Congenital anomalies

A

Ectopic tissue: usually in GI tract

Annular pancreas (panc surrounds duodenum): donut shape. Assoc with duodenal atresia

Pancreas divisium (fusion failure)

Pancreatic cyst (PCD)

Cystic fibrosis (inc exocrine secretion)

45
Q

Cystic Fibrosis

A

Hereditary, die around 40, increased mucous secretion of exocrine gland

Affects pancreas lungs intestines and biliary tract

Echogenic hetero small pancreas.

46
Q

Pancreatitis

A

Inflammation of pancreas. Caused by bile reflux, hypersecretion and obstruction, alcohol, duodenal reflux

47
Q

Acute pancreatitis

A

Cause: biliary tract disease #1, alcohol abuse #2

Pain, fever, n/v, pain after large meal or after alcohol binge.

Don’t give water to pancreatitis bc causes pain. Sitting up relieves.

Enlarged hypochoic with large pancreatic duct. Hetero panc.

Inc serum amylase

48
Q

Complications of acute pancreatitis

A

Panc abscess
Dehydration (renal failure)

Pulmonary edema (resp distress)

Chronic pancreatitis

Pseudocyst: 20%, contains panc juice, blood, debri. Enzymes escape & digest surrounding tissue and becomes walled off area

Hemorrhage

Phlegmon: inflamed spread diffuse pus

Biliary obstruction

Duodenal obstruction

Pseudoaneurysm

49
Q

Pseudocyst

A

20%, contains panc fluid encapsulated by fibrous tissue

Caused by pancreatitis, trauma, and panc cancer

MC in lesser sac, pancreas, also in peritoneal cavity, within or near panc, liver/spleen/kidney, thorax

Thick borders, fluid filled, debri, septations, ca+

May spontaneous regress, may rupture and 50% die,

50
Q

Hemorrhagic Pancreatitis

A

Panc enzymes suddenly escape into glandular tissue leads to rupture of panc vessels and hemorrhage

Intense pain, pain radiating to back, shock, ileus, dec hematocrit, hypotension, resp distress, metabolic acidosis

Homo mass in panc. Gets cystic with age.

51
Q

Phlegmon

A

Severe form of acute panc, spread of inflammation outside of gland to soft tissue. Edema hypo

Collection of necrotic and adematous peripancreatic tissue

52
Q

Abscess

A

Complication of panc with tissue necrosis.

Fever, chills, wbc inc

Dirty shadow.

53
Q

Chronic pancreatitis

A

Repeated attacks of pancreatitis. Associated with alcohol abuse, usually males, inc risk for pancreatic cancer.

Epigastric pain, back pain, n/v, jaundice, fat poo, flatulence, wt loss, diabetes, obstruction

Amylase and lipase may not be elevated. Will have steatorrhea, abnl glucose, and inc bilirubin with obstruction.

Hyperechoic, small, hetero, panc ductal dilatation, ca+, irregular borders, pseudocyst formation
May be focal hyperechoic

54
Q

Cystic diseases

A

ADPKD
Von Hippel Lindau Syndrome
Fibrocystic disease
True cyst

55
Q

Acinar Cell Adenocarcinoma

A

MC 90% panc cancer. Exocrine part.

Head 60-70%, body 20-30%, tail 5-10%

Diffuse hetero

Back pain, epigastric pain, anorexia, wt loss, jaundice, n/v, stool changes, weak, new onset of diabetes, 80-85% with mets.

Hypo mass, irreg borders, big panc, dilated duct, hetero panc., liver mets, ascites, lymphadenopathy, pseudocyst formation

2-3 month survival

56
Q

Double duct sign in panc cancer

A

Dilated panc duct and CBD

57
Q

Macrocystic Adenoma/ Mucinous Cystadenocarcinoma

A

Rare, significantly malignant potential, slow growing & better prognosis

Tail 60%

Large cyst, 2-20cm, complex, ca+, with or without septations.

58
Q

Microcystic Adenoma / Serous Cystadenoma

A

Rare, benign, assoc with Von Hippel Lindau

MC in panc body and tail

Echogenic mass containing Small cysts.

59
Q

Islet Cell Tumor

A

MC benign tumor of panc but may be malignant. Does not mets. Usually in body & tail. Slow growing.

Functional vs Nonfunctional

MC insulinoma & presents with hypoglycemia. Small hypo. Usually fat people from overeating hypoglycemic episodes.

60
Q

Functional Islet Cell Tumor

A

MC functional, body & tail.

Insulinoma MC 60%, benign
Gastrinoma 18%, usually malignant

61
Q

Non-Functioning Islet Cell Tumor

A

92% malignant, tail

Easier to detect bc slow growing and symptoms don’t start until they’re large.

Homo, hypo, solitary, large are hyper and Ca+, necrotic areas suggest malignancy

62
Q

Panc mets

A

Rare, primary melanoma, GI, breast, lung

63
Q

Panc transplant

A

Used to reverse complications of diabetes

In iliac fossa

Acute rejection: patchy areas of dec echoes, hypo, inc size, ductal dilatation, high RI & hetero panc.

Chronic rejection: inc echoes, dec size, RI > .8

Complications: type 1 diabetes, vascular thrombus, pseudoaneurysm, arterio-venous fistula, abscess, pancreatitis, hematoma, lymphocele, urinoma, pseudocyst, ascites, anastomotic strictures

Norm Doppler RI should be <.7

64
Q

Solid panc mass evaluate

A

Liver for mets, Biliary tree and panc duct for dilatation, regional lymphadenopathy, PV and splenic vein for thrombus

65
Q

Panc head is ___ to portal vein

A

Inferior to

66
Q

Pancreatic divisun

A

2 panc ducts not fused
Panc fail to fuse
MC variant

67
Q

Surgery of choice of panc cancer

A

Whipple procedure. Remove part of panc.

68
Q

MC panc Cancer

A

Adenocarcinoma
Usually in head
Hypo mass

Risks: chronic pancreatitis, smoking, high fatty diet, diabetes

CT image stages Cancer

Look for liver mets and lymphadenopathy

69
Q

Duodenum encircles

A

Head of panc

70
Q

Splenic vein ____ to panc

A

Posterior & inf/caudal to panc.

71
Q

IVC _____ to panc head

A

Posterior

Abdomen (15 decks)

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