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Davies - Abdomen > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Your department protocol requires you to measure the main pancreatic duct whenever it is visible by ultrasound. What is the name of the duct you are measuring?

A

Duct of Wirsung

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2
Q

The accessory pancreatic duct, which is sometimes visible sonographically, is known as?

A

Duct of Santorini

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3
Q

What is the anatomic relationship of the CBD to the pancreas?

A

The CBD is posterior to the head of the pancreas

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4
Q

You are reviewing a CT report on a patient referred for abdominal sonography. The report states that pancreatic divisum is present. What does this mean?

A

The two pancreatic ducts have not fused

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5
Q

What structure can you use to identify the anterior aspect of the head of the pancreas?

A

Gastroduodenal artery

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6
Q

What structure can you use to identify the posterior aspect of the head of the pancreas?

A

CBD

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7
Q

Which structure can be seen coursing transversely at the level of the upper pancreatic head?

A

Gastroduodenal artery

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8
Q

A thin patient has been referred for ultrasound evaluation of the pancreas. Which transducer would be best for this examination?

A) 2.25 MHz phased linear array

B) 3.5 MHz curved linear array

C) 5.0 MHz curved linear array

D) 7.5 MHz small footprint phased array

A

C) 5.0 MHz curved linear array

**the 3.5 MHz curved linear array would be used on a larger patient, but with thin patients it is best to use the higher ferquency to improve spatial resolution. A 7.5 MHz linear array might be another good choice in a thin patient, but not one with a small footprint. In general, transducers with larger footprint have a better spatial resolution as well as the additional benefit of helping to push gas out of the way.**

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9
Q

You are performing an ultrasound exam on a patient with a history of repeated bouts of pancreatitis. What would you most likely use colour Doppler for in this study?

A) evaluate for increased flow in the pancreatic parenchyma

B) improve detectability of possile pseudoaneurysms

C) look for flow direction in the SMA

D) assess the quality of flow in the abdominal aorta

E) rule out thrombus in the IVC

A

B) immprove detectability of possible pseudoaneurysms

** color doppler is used in evaluation of patients with pancreatitis to confirm patency of the splenic, portal, superior mesenteric, and hepatic vessels and to improve detectability of possible peseudoaneuryms. **

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10
Q

During intonation of the pancreas? You notice a prominent vessel just posterior to the pancreatic neck. What vessel are you imaging?

A

Portal-splenic confluence

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11
Q

You are having difficulty imaging the entire pancreas in a patient referred for abdominal ultrasound. Which part of the pancreas is least commonly visualized by ultrasound?

A

Tail

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12
Q

What frequency transducer would most commonly be used for endoscopic ultrasound of the pancreas?

A) 2.25 MHz

B) 3.5 MHz

C) 5.0 MHz

D) 10 MHz

E) 25 MHz

A

10 MHz

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13
Q

You are performing an ultrasound study to rule out re presence of a pancreatic tumour. What is the most commonly occurring malignant tumour of the pancreas?

A

Adenocarcinoma

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14
Q

Which of the following are risks factors for developing a pancreatic cancer?

A)Smoking

B) High-Fat diet

C) Diabetes

D) Chronic Pancreatitis

E) All of the above

A

E) All of the above

** Risk factors for pancreatic adenocarcinoma include all of those listed as well as prior peptic ulcer surgery, cholecystectomy, and occupational exposure to benzidine and gasoline derivatives. **

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15
Q

You are scanning a 52 year old male with a history of alcohol abuse. Ultrasound findings include a hype technic mass in the head of the pancreas, dilatation of the pancreatic and common bile duct, and diffuse calcification within the pancreas. What condition is most likely present?

A) Acute pancreatitis

B) Chronic pancreatitis

C) Adenocarcinoma

D) Cystadenocarcinoma

E) Islet cell tumour

A

B) Chronic pancreatitis

** It can be difficult to differentiate between chronic pancreatitis and adenocarcinoma when chronic pancreatitis presents as a focal mass or a pseudocyst accompanies adenocarcinoma. The presence f calcification within the pancreas implicates chronic pancreatitis. A smooth tapering of a dilated CBD is another clue indicating a benign condition. **

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16
Q

You have a patient who is scheduled for pancreatic surgery following ultrasound and CT evaluation. What is the surgical procedure of choice for pancreatic cancer?

A

Whipple procedure =

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17
Q

You have been asked to aid in staging of pancreatic cancer. Which procedure is most accurate in staging pancreatic adenocarcinoma?

A) Abdominal ultrasound

B) Endoscopic ultrasound

C) CT

D) MRI

E) Plain film x-ray

A

C) CT

** CT is considered to be superior to transabdominal ultrasound imaging for staging of pancreatic cancers because it can better visualize peripancreatic fat infiltrasiont, vascular encasement, lymph node enlargement, and metastasi. Endoscopic ultrasound is excellent at staging small ampullopancreatic tumors but cannot routinely detect metastasis. **

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18
Q

A patient has been referred to ultrasound to rule out the presence of pancreatic cancer. The cancer is most likely to be located in which part of the pancreas?

A

Head

** adenocarcinoma is the most common form of pancreatic cancer and is most commonly located in the head of the pancreas **

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19
Q

What is the most common ultrasound appearance of pancreatic adenocarcinoma?

A

Hypoechoic mass

** pancreatic adenocarcinoma most commonly presents as a hypoechoic mass in the head of the pancreas. Hyperechoic masses may occur in cases with concomitant chronic pancreatitis. **

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20
Q

Which of the following is an endocrine Tumour of the pancreas?

A) Adenocarcinoma

B) Islet Cell Tumour

C) Cystadenocarcinoma

D) Lymphangioma

E) Pancreaticoblastoma

A

Islet cell tumour

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21
Q

You are requested to perform an abdominal ultrasound on a patient to evaluate for complication of pancreatitis. What should you look for?

A) Pseudoaneurysm

B) Pseudocyst

C) Plegmon

D) Abscess

E) All of the above

A

E) All of the above

** Complications of pancreatitis include pseudoaneurysm, pseudocyst formation, phlegmon, abscess, pancreatic ascites, pancreatic necrosis,biliary obstruction (due to stricture or compression of the duct), vascular thrombosis, gastrointestinal hemorrhage, and hydronephrosis (due to ureteral obstruction by pancreatic effusion). Systemic complications include shock, renal failure, metastatic fat necrosis, respiratory failure, hyperglycemia, and lung failure. Lung failure and sepsis are the leading causes of death associated with pancreatic pseudocyst. **

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22
Q

Which lab values would be of greatest benefit to you in evaluation of a patient with acute pancreatitis?

A) Alphafetoprotein

B) Serum creatinine

C) Serum amylase

D) Serum albumin

E) Alkaline phosphate

A

Serum Amylase

23
Q

You have just discovered a pancreatic mass suspicious for adenocarcinoma in a patient with weight loss and abdominal pain. What associated findings should you look for?

A) Lymphadenopathy

B) Liver metastasis

C) Portal vein aneurysm

D) Aortic aneurysm

E) A and B

A

E) A and B

24
Q

You are scanning a patient with increased pancreatic enzymes and white blood cell count. Which condition is most commonly associated with these lab findings;

A) Acute pancreatitis

B) Chronic pancreatitis

C) Adenocarcinoma of the pancreas

D) Islet cell tumour

E) Metastasis to the pancreas

A

A) Acute pancreatitis

25
Q

You are scanning a patient with a history of alcohol abuse and liver cirrhosis. The pancreatic tissue is heterogeneous. Calcification sand dilatation of the pancreatic duct is present. Which condition is most likely considering this history and findings?

A) acute pancreatitis

B) chronic pancreatitis

C) adenocarcinoma of the pancreas

D) islet cell tumour

E) metastasis to the pancreas

A

B) Chronic pancreatitis

** Chronic pancreatitis is associated with a heterogeneous echo texture and multiple calcifications throughout the gland. Frequently, calcifications may be seen within the duct. Dilatation of the duct is typical. Fibrotic masses that are easily confused with cancer can occur with chronic pancreatitis. **

26
Q

You have been asked to perform an ultrasound study on a patient with pancreatic transplant. What chronic condition does this patient probably have?

A

Chronic pancreatitis Check

27
Q

Where should you look for the pancreas in the patient with a pancreatic transplant?

A

Iliac Fossa

28
Q

Which of the following would be an indicator of pancreatic transplant rejection?

A) high resistance Doppler signals

B) low resistance Doppler signals

C) heterogeneous parenchyma

D) A and C

E) B and C

A

D) A and C

** Rejection of the pancreatic transplant is associated with high-resistance doppler signals and increased heterogeneity of the gland. Complications associated with transplant include vascular thrombosis. pseudoaneurysm, arteriovenous fistula, and pancreatitis. Fluid collections that may be detected include urinoma, hematoma, and inflammatory collections associated with pancreatitis. **

29
Q

A non capsulated collection of necrotic and edematous peripancreatic tissues is termed?

A

Phlegmon

30
Q

What is the most common cause of acute pancreatitis?

A) Obstruction of the pancreatic ducct by biliary calculi

B) Pancreatic divisum

C) Alcohol abuse

D) Trauma

E) Crohn’s disease

A

A) Obstruction of the pancreatic duct by biliary calculi

** The second most common cause of acute pancreatitis is alcohol abuse **

31
Q

Surgery has requested ultrasound guidance to excise an insulinoma. What transducer would be best for this application?

A) 2.25 MHz curved array

B) 3.5 MHz curved array

C) 5.0 MHz curved array

D) 7.0 MHz curved array

E) 10 MHz linear array

A

E) 10 MHz linear array

32
Q

You have documented the presence of a pseudocyst adjacent to the pancreatic head in a 56 year old male. Pseudocysts may be associated with which of the following?

A) acute pancreatitis

B) chronic pancreatitis

C) pancreatic cancer

D) A and B

E) all of the above

A

E) All of the above

33
Q

What is the relationship of the superior mesenteric artery to the pancreas?

A

Posterior to the neck of the pancreas

34
Q

You have been asked to rule out pseudocyst formation in a patient with acute pancreatitis. What is the ultrasound appearance of a pancreatic pseudocyst?

A

Cyst without internal echoes,

cyst with low-level echoes,

cyst with internal septations,

well defined wall

35
Q

You are performing an ultrasound on an obese patient and notice a small hypoechoic tumour located in the tail of the pancreas. This most likely represent?

A) adeonocarcinoma

B) Cystadenocarcinoma

C) Insulinoma

D) Klatskin tumour

E) Pancreaticoblastoma

A

Insulinoma

** the most common type of islet cell tumor is insulinoma. Others include gastinomas, glucagonoma, vipoma and somatostatinoma. Insulinomas are usually benign and present in the 4th through 6th decades of life. The presenting symptom is usually hypoglycemia. They most commonly occur as olitary tumour in the body and tail of the pancreas, although multiple tumors occur in about 10% of cases. Sonographically, they appear as well-defined hypoechoic lesions. They are usually small and may be difficult to detect sonographically because they are small and the patient typically is obese (due to overeating from hypoglycemic episodes) **

36
Q

Which part of the pancreas does the duodenum encircle?

A

Head

37
Q

What is the relationship of the splenic vein to the pancreas?

A

Posterior and caudal

38
Q

Which vessel is located at the superior border of the pancreas?

A

Celiac trunk

39
Q

When imaging the he pancreas, which vessel do you routinely visualize at the posterior border of the pancreatic head?

A

IVC

40
Q

During insonation of the pancreas, you routinely image a vessel coursing anterior to the uncinate process. What is this vessel?

A

Superior mesenteric vein

41
Q

You have obtained a sagittal image of the pancreatic head and detect a small tubular structure coursing cephalocaudad anterior to the pancreas. What is this structure?

A

Gastroduodenal artery

42
Q

Which part of the pancreas generally has the largest dimensions?

A

Head

** The head of the pancreas generally has the largest dimensions and the neck the smallest. The size of the pancreas tends to decrease with age **

43
Q

Which letter represents the pancreatic body?

A

D

44
Q

Part of your routine protocol for pancreatic imaging is to comment on the echogenicity of the organ. What is the normal echogenicity of the normal pancreas?

A) Either isoechoic or hyperechoic compared to the liver

B) Always hypoechoic compared to the liver

C) Always hyperechoic compared to the liver

D) Always isoechoic compared to the liver

E) The pancreatic echogenicity should never be compared to the liver

A

A) Either isoechoic or hyperechoic compared to the liver

45
Q

The tail of the pancreas is in contact with which of the following structures?

A) left kidney

B) splenic flexure of the colon

C) A and C

D) all of the above

A

D) All of the above

46
Q

Which letter represents the uncinate process?

A

A

47
Q

Which letter represents the pancreatic tail?

A

E

48
Q

Which letter represents the pancreatic body?

A

D

49
Q

You are attempting to image the head of hte pancreas in a patient referred for abdominal sonography. How should you align the probe on the body to obtain a long-axis view fo the head and body of the pancreas?

A

Obtain a midline transverse scan plane with the left side of the probe slightly caudad compared to the right side of the probe.

**Since hte head of the pancreas lies slightly caudal to the body and tail, the probe must be angled with the left side lower thant the right**

50
Q

In the ultrasound image above, what structure is labeled E?

A) SMA

B) Gastroduodenal artery

C) Common bile duct

D) Common hepatic duct

E) Left gastrict artery

A

SMA

51
Q

What part of the pancreas is anterior to the vessel labeled E?

A) Head

B) Uncinate process

C) Neck

D) Body

E) Tail

A

Body

52
Q

What vessel is seen posterior to the vessel labeled D?

A

Abdominal Aorta

53
Q

What part of the pancreas is NOT demonstrated in this image?

A

Tail

Davies - Abdomen (2 decks)

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