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Abdomen > Pancreas > Flashcards

Pancreas Flashcards

0
Q

What are the segments of the pancreas?

A

Head, neck, body, tail, uncinate process

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1
Q

What is the pancreas location?

A

Retroperitoneal, posterior, closer to spine
Lies transverse in the body, extending from
The duodenum to splenic hilum

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2
Q

Location of GDA in relationship to pancreas

A

Anterior, lateral and enters the head of panc antero-superior

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3
Q

Location of CBD in relationship to panc

A

Postero-lateral, entering head of panc postero-superior

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4
Q

Where does the GDA arise from?

A

Common hepatic artery

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5
Q

Location of the neck of panc

A

Anterior to the PC

Anterior to the SMV

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6
Q

Location of the body of panc

A

Anterior to Splenic Vein
Anterior to SMA
Posterior to Stomach
Inferior to Splenic Artery

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7
Q

Location of tail of panc

A

Anterior to splenic vein

Close to spleen

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8
Q

Location of uncinate process of panc

A

Postero-medial portion of the head
Posterior to SMV and SMA
Anterior, medial to IVC

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9
Q

Pancreatic measurements

A

Head AP 2-3 cm
Body AP 1-2 cm
Tail AP 1-3 cm
Total length 17cm

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10
Q

What is the vasculature of the panc?

A

GDA, SMA, and splenic artery

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11
Q

What is the normal size of the duct of wirsung?

A

AP <2 mm

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12
Q

What is the duct of wirsung?

A

Pancreatic duct that leads to the duodenum at the ampulla of vater through the sphincter of oddi

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13
Q

Wirsung duct variant

A

Duct of santorini, accessory duct. Non-functional since bypasses ampulla of vater

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14
Q

As what kind of gland does the pancreas serve?

A

Exocrine- secretes enzymes through ducts

Endocrine- secretes hormones directly into blood stream

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15
Q

What percentage of panc is for digestion and why?

A

80%

Since its digestive enzymes amylase, lipase, and trypsin are released into the c loop of duodenum.

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16
Q

What are the functions of the enzymes produced by the panc?

A

Amylase- sugar/carb breakdown
Lipase- fatty splitting enzyme, most destructive, very toxic
Trypsin- protein breakdown

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17
Q

Endocrine function of panc

A

Hormone producing cells of panc are islets of langerhans or pancreatic islets
They create alpha, beta and delta cells

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18
Q

What do the cells of the endocrine function of panc produce?

A

Alpha cells produce glucagon
Beta cells produce insulin
Delta cells produce somatostatin

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19
Q

What kind of pancreatic congenital anomalies are there?

A

Congenital cysts
Cystic fibrosis
Pancreas divisum
Annular pancreas

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20
Q

Pancreatic neoplasm kinds

A

Adenocarcinoma
Serous cystadenoma
Mucinous cystadenoma and cystadenocarcinoma
Islet cell tumor

21
Q

Multiple cysts in the panc are associated with?

A

Adult polycystic kidney disease and Von Hipple-Lindau Syndrome.

22
Q

What is Cystic Fibrosis?

A

Exocrine gland disorder
Viscous secretions cause pancreatic dysfunction
U/S appearance
Increased echogenicity, glandular atrophy associated with fibrosis and fatty replacement and cysts due to ductal obstruction

23
Q

What is pancreas Divisum?

A

Failure of the dorsal and ventral pancreatic buds to fuse during embrionic development
The smaller santorini’s duct drains the pancreatic body and tail (dorsal panc)
Suggested association with pancreatitis

24
Q

What is annular pancreas?

A

Uncommon congenital anomaly wherein a ring of normal pancreatic tissue encircles the duodenum secondary to abnormal migration of the ventral pancreas
Suggested association with pancreatitis

25
Q

What is Auto-digestion?

A

When the enzymes of the panc are active inside it and begin to eat away at the panc

26
Q

Etiology of acute pancreatitis

A 
Biliary tract diseases
Chronic alcohol abuse
Peptic ulcer
Abdominal trauma
Lupus- autoimmune disorder 
A venomous sting from a scorpion
Infection such as mumps, hep a, b or salmonella
Presence of a tumor (auto-digestion)
27
Q

What are the clinical signs and symptoms of acute pancreatitis?

A

More common in men
Epigastric and back pain, can worsen after meal
Nause
Vomiting
Unexplained weight loss
Fever
Tachycardia
Severe cases can cause hypotension due to dehydration
In extreme cases, bleeding of panc can lead to shock
Pulmonary and renal failure

28
Q

Lab signs of acute pancreatitis

A

Elevated amylase in the 1st 24 hrs, return to normal after 72 hrs
Elevated lipase after 48 hrs and continues to rise for 1-2 weeks
Elevated WBC

29
Q

What are the complications of acute pancreatitis?

A 
Pancreatic pseudocyst
Peripancreatic fluid collection
Phlegmon or phlegmatous pancreatitis
Hemorrhagic pancreatitis
Abscess 
Pseudoaneurysm
30
Q

What is pancreatic pseudocyst?

A

Results from acute pancreatitis or flare ups of chronic pancreatitis
It is an accumulation of fluid and necrotic debris confined by retroperitoneum. This occurs in an attempt to wall off the panc solutions to prevent further tissue damage
Can form anywhere in the body where fluid traps
Most commonly found in lesser sac (between stomach and panc)

31
Q

What is used to differentiate between cancer and pseudopancreatitis?

A

Normal serum amylase

32
Q

What is chronic pancreatitis?

A

Irreversible destruction by repeated bouts of pancreatic inflammation

33
Q

What causes chronic pancreatitis?

A 
Alcoholism- most common cause
Hereditary recurrent pancreatitis
Cystic fibrosis
High levels of calcium in blood
High blood fat
When digestive enzymes attacking and destroy the panc and nearby tissue. May also be triggered by one acute attack
34
Q

What is the sonographic appearance of chronic pancreatitis?

A 
Small, echogenic
Microcalcifications
Irregular contours 
Dilated duct of wirsung
Bile duct dilation 
Pseudocyst formation
Portal vein thrombosis
35
Q

Lab signs of chronic pancreatitis?

A

Non specific

Later stages- endocrine and exocrine dysfunction

36
Q

What is the treatment for chronic pancreatitis?

A

Whipple procedure

37
Q

What is hemorrhagic pancreatitis?

A

Form of acute pancreatitis with significant fat necrosis leading to rupture of pancreatic vessels and secondary hemorrhage

Incidence: 2-5% of all acute pancreatitis cases

38
Q

What is the clinical presentation of hemorrhagic pancreatitis?

A 
Severe abdominal pain 
Nausea and vomiting
Abdominal distention and varying degree of ileus
Periumbilical ecchymosis (Cullen sign)
Flank ecchymosis (grey-turner sing)
Infrainguinal ecchymosis (fox sign)
39
Q

Lab signs of hemorrhagic pancreatitis

A

Increased serum and urine amylase and serum lipase

Decreased hematocrit and serum calcium

40
Q

What percentage of neoplasm in panc will be in the head?

A

70%

41
Q

What is serous cystadenoma?

A

Aka microcystic cystadenoma
Benign
Associated with Von Hipple-Lindau syndrome
Well defined lobulated mass
Appearance varies from echogenic mass (microcystic) to a multicystic mass (small cysts)

42
Q

Risk factors for pancreatic cancer

A 
More common in men
African American 
>30 years of age
Smoker
Fatty diet
Chronic pancreatitis
Cirrhosis or diabetes
43
Q

Which is the most common pancreatic cancer and where does it arise from?

A

Adenocarcinoma

Acinar cells

44
Q

Associated findings of adenocarcinoma

A 
Bile duct dilation
Courvoisier GB
Dilated panc duct
Pancreatitis
Ascites 
Liver mets
Lymphadenopathy 
Pseudocyst formation
45
Q

What are other names for mucinous cystadenoma?

A

Cystadenocarcinoma, macrocystic cystadenoma

46
Q

Sonographic appearance of mucinous cystadenoma

A 
Well defined, multicystic mass
Solid component (papillary projections)within cystic mass
47
Q

What lab sign will be present with cystadenocarcinoma?

A

Increased CEA (carcino embryogenic antigen)

48
Q

What kind of rumors can arise from islet cells?

A

Alpha cells: glucagononma
Beta cells: insulinoma
Delta cells: gastrinoma

Typically located in the pancreatic tail
Associated with MEN syndrome (multiple endocrine neoplasia)

49
Q

Which is the most common islet cell tumor?

A

Insulinoma
Usually benign
Hyperglycemic symptoms due to hyperinsulinism

50
Q

What is the second most common islet cell tumor?

A

Gastrinoma
Causing gastric and duodenal ulceration
Zollinger-Ellison syndrome is another name for it

51
Q

Sonographic appearance of Zollinger-Ellison Syndrome

A

Round mass with variable echogenicity
Usually 1-2 cm in size
Lymphadenopathy, especially in periportal region

Abdomen (10 decks)

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