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*Ultrasound* > Pancreas (normal and abnormal) > Flashcards

Pancreas (normal and abnormal) Flashcards

1
Q

The pancreas is located in this area of the abdomen

A

epigastrium

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2
Q

The pancreas is _____ to the stomach, in the lap of the _____.

A

posterior

duodenum

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3
Q

The pancreas is a _____ _____ structure that lies between the duodenal loop and the splenic _____.

A

non-encapsulated
retroperitoneal
hilum

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4
Q

Pancreas is divided into these 5 parts:

A 
head
uncinate process
neck
body
tail
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5
Q

The pancreas normally measures between _____ and _____ in length (about _____ inches long).

A

12-15 cm

6

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6
Q

This is the most bulbous part of the pancreas, which then narrows at the neck.

A

head

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7
Q

The pancreas head measures less than/equal to _____.

A

3cm

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8
Q

The porto-splenic confluence marks the anatomic position of this part of the pancreas.

A

neck

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9
Q

The lesser sac lies _____ to the body of the pancreas, while the SV runs along the _____ surface.

A

anterior

posterosuperior

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10
Q

The pancreas body measures _____.

A

1.5 cm

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11
Q

This part of the pancreas is related to the spleen, left adrenal glands, and upper pole of the left kidney.

A

tail

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12
Q

The pancreas tails measures _____.

A

2.4 cm

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13
Q

The tail of the pancreas is related to the _____, _____, and _____.

A

spleen
left adrenal glands
upper pole of left kidney

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14
Q

This extends inferior to the main body of the pancreas; thus, it is important to scan the full extent of the pancreas, or carcinoma of the _____ may be missed.

A

uncinate process

uncinate process

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15
Q

The pancreas has 2 functions:

A

1) exocrine

2) endocrine

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16
Q

The exocrine function of the pancreas secretes _____, _____, and _____ through the _____ system and _____ cells.

A 
trypsin
lipase
amylase
ductal
acinar
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17
Q

The exocrine part of the pancreas comprises _____% of the pancreatic tissue.

A

80

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18
Q

The endocrine function of the pancreas secretes _____ via the _____.

A

insulin

islets of Langerhans

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19
Q

The endocrine part of the pancreas forms _____% of the pancreatic tissue.

A

2

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20
Q

The remaining 18% of the pancreatic tissue consists of fibrous _____ that contains _____, _____, and _____.

A

stroma
blood vessels
nerves
lymphatics

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21
Q

Amylase is a digestive enzyme for _____.

A

carbs

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22
Q

Amylase is produced by the pancreas and salivary glands, thus, _____ and salivary gland dysfunction causes increased levels of amylase.

A

pancreatitis

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23
Q

Amylase is also excreted by the _____, so increased levels of amylase are also seen with _____ disease.

A

kidneys

renal

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24
Q

_____ levels parallel the _____ levels.

A

Lipase

amylase

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25
Q

_____ levels rise first and _____ levels rise later, but persist longer.

A

Amylase

lipase

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26
Q

Sometimes the normal pancreas echotexture has a _____ appearance.

A

mottled

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27
Q

The contour of the pancreas is distinct when its echogenicity is _____ (more/less) than the surrounding retroperitoneal fat. It usually appears _____ (roughly/smoothly) contoured.

A

less

smoothly

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28
Q

With aging and obesity, the pancreas becomes more _____ (echogenicity), as a result of the presence of _____, and may be as _____ as the adjacent retroperitoneal fat. This echogenicity is _____ (reversible/irrereversible).

A

echogenic
fatty infiltration
echogenic
reversible

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29
Q

A technique used to better visualize the pancreas involves having the patient drink water to fill the stomach, while in the _____ position. While scanning the pancreas, the patient is then turned to the _____ or _____ position. The water in the stomach and duodenum is used as a(n) _____.

A

LLD
supine
RLD
acoustic window

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30
Q

The posterior wall of the stomach overlies the _____ border of the pancreas body and tail.

A

anterior

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31
Q

The duodenal loop, except for the _____ segment, encircles the pancreas _____.

A

1st

head

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32
Q

The _____, _____ layers (lesser and greater omentum), and the _____ sac come in close contact with the pancreas.

A

colon
peritoneal
lesser

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33
Q

The head of the pancreas is _____ to the IVC.

A

anterior

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34
Q

The head of the pancreas is _____ to the duodenum.

A

medial

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35
Q

The CBD is _____ to the pancreas head.

A

posterior

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36
Q

The GDA is _____ to the pancreas head.

A

anterior

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37
Q

The SMA and SMV are _____ to the pancreas neck.

A

posterior

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38
Q

The SMA and SMV are _____ to the uncinate process and the _____ portion of the duodenum.

A

anterior

3rd

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39
Q

The abdominal AO runs _____ to the pancreas body.

A

posterior

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40
Q

The CA arises from the AO at the _____ border of the pancreas.

A

superior

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41
Q

The CHA proceeds _____ to the right, _____ to the pancreas head.

A

anteriorly

cephalad

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42
Q

The CHA divides into the _____ and the _____.

A

PHA

GDA

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43
Q

The PHA travels _____ towards the liver, along the free edge of the _____ omentum, _____ to the MPV and to the _____ of the CBD.

A

superiorly
lesser
anterior
left

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44
Q

The GDA travels a short distance _____ to the junction of the _____ and the _____ portion of the duodenum, within a groove on the _____ border of the pancreas, _____ to the neck. It passes _____ to the head of the pancreas and divides into _____ and _____ arteries.

A 
posterior
pylorus
1st
superior
lateral
anterior
gastroepiploic
superior pancreaticoduodenal
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45
Q

The SA follows a _____ (adjective) course along the _____ border of the pancreas body and tail.

A

tortuous

superior

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46
Q

The SMA arises from the AO just _____ to the pancreas body, descending _____ to the uncinate process and the _____ portion of the duodenum.

A

posterior
anterior
3rd

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47
Q

The IVC lies _____ to the pancreas head.

A

posterior

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48
Q

The SV runs from its origin in the splenic hilum along the _____ aspect of the pancreas to join the _____.

A

posteroinferior

SMV

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49
Q

The SMV and SV join _____ to the pancreas neck to form the _____, hence the MPV. The MPV ascends toward the porta hepatis _____ to the pancreas head.

A

posterior
portal confluence
cephalad

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50
Q

The CBD travels _____ to the 1st portion of the duodenum and the pancreas head, to lie to the _____ of the main pancreatic duct. It opens into the duodenum at the _____ after forming a common trunk with the _____.

A

posterior
right
Ampulla of Vater
main pancreatic duct

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51
Q

The duodenum is divided into _____ portions.

A

4

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52
Q

The _____ and _____ portion of the duodenum are transverse.

A

1

3

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53
Q

The _____ and _____ portion of the duodenum are long.

A

2

4

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54
Q

Another term for the main pancreatic duct is the

A

Duct of Wirsung

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55
Q

The normal pancreatic duct may be imaged but is considered abnormal if it is more than _____ in size.

A

2 mm

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56
Q

Pancreatic duct dilation is typically due to stones within the _____, from chronic _____ or a stone at the _____.

A

Duct of Wirsung
pancreatitis
Ampulla of Vater

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57
Q

Another term for the Duct of Santorini is

A

Accessory Duct

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58
Q

The Duct of Santorini branches off the _____ in the pancreas head and drains the _____.

A

main pancreatic duct

uncinate process

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59
Q

Agenesis of the pancreas is

A

Absence of the body and tail, with head remaining and showing compensatory hypertrophy.

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60
Q

T or F? Congenital cysts are common.

A

False (they are rare)

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61
Q

This is characterized by viscous secretions and dysfunction of multiple glands, including the pancreas, leading to pancreatic insufficiency.

A

Cystic Fibrosis

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62
Q

The pancreas has _____ (increased/decreased) echogenicity with cystic fibrosis, and is _____ (shrunken/enlarged) with marked _____, fatty replacement, and cysts secondary to the obstruction of the _____.

A

increased
shrunken
fibrosis
small ducts

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63
Q

The failure of the dorsal and ventral pancreatic ducts to fuse during embryonic development is

A

pancreas divisum

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64
Q

The most common congenital variant of pancreatic anatomy is

A

pancreas divisum

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65
Q

Pancreas divisum results in the smaller _____ draining the body and tail, and is associated with _____ (condition).

A

Santorini’s ducts

pancreatitis

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66
Q

Pancreas divisum literally means

A

“divided pancreas”

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67
Q

The small buds that develop into the pancreas during early life arise from the _____.

A

foregut

68
Q

In the _____ week of pregnancy, the 2 buds rotate in a such a way that they are close together and can fuse into the pancreas.

A

6th

69
Q

If pancreas divisum occurs, this means the _____ bud and the _____ bud did not fuse.

A

dorsal

ventral

70
Q

This is an uncommon congenital anomaly wherein a ring of normal pancreatic tissue encircles the duodenum, secondary to the abnormal migration of the _____ pancreas.

A

annular pancreas

ventral

71
Q

Annular pancreas in children is frequently diagnosed in infancy due to its association with _____ obstruction.

A

duodenal

72
Q

This is an inflammatory disease producing temporary pancreatic changes.

A

acute pancreatitis

73
Q

The 2 most common causes of acute pancreatitis are

A

1) biliary tract disease

2) chronic ETOH abuse

74
Q

It used to be assumed that the cause of acute pancreatitis was

A

that the person didn’t take care of themselves and generally unhealthy habits

75
Q

This is a condition characterized by just one area of inflammation in the pancreas.

A

focal pancreatitis

76
Q

In what region of the pancreas is focal pancreatitis usually found?

A

pancreas head

77
Q

T or F? Focal pancreatitis is difficult to differentiate from a neoplasm.

A

True

78
Q

With normal _____ (enzyme), a pancreatic mass is likely to represent a neoplasm.

A

amylase

79
Q

Pancreatitis in the pediatric patient is most likely associated with _____, _____ (most common), or _____.

A 
choledochal cysts
cystic fibrosis (most common)
hereditary autosomal dominant pancreatitis
80
Q

This condition causes the pancreas to become increasingly hypoechogenic, relative to normal liver, and increases in size.

A

diffuse pancreatitis

81
Q

Also seen with diffuse pancreatitis is (5)

A 
ductal dilation
mass effect from phlegmon or hemorrhage
peripancreatic fluid collections
thickening of adjacent fascial planes
ascites
82
Q

The most common cystic lesion of the pancreas is a

A

pseudocyst

83
Q

What are the 3 enzymes found inside a pseuodcyst?

A

amylase
lipase
trypsin

84
Q

This is an accumulation of pancreatic fluid and necrotic debris, confined by the retroperitoneum, that contains high amounts of amylase, lipase, and trypsin.

A

pseudocyst

85
Q

A pseudocyst is generally spherical and takes _____ - _____ weeks to enclose itself by forming a wall composed of _____ and vascular _____.

A

4-6
collagen
granulation tissue

86
Q

This lesion occurs in 10%-20% of patients who have had acute pancreatitis.

A

pseudocyst

87
Q

You can tell a pseudocyst is newer because it hasn’t started _____ within itself.

A

bleeding

88
Q

What symptoms are some of the main indicators of pseudocysts? (2)

A

persistant pain

elevated amylase levels

89
Q

A well-defined, smooth-walled anechoic structure with acoustic enhancement in the pancreas is probably a

A

pseudocyst

90
Q

Debris may occur within a pseudocyst due to _____ or _____.

A

hemorrhage

infection

91
Q

This condition is most commonly associated with alcoholic or biliary etiology, blunt abdominal trauma in children, or pancreatic malignancy.

A

pseudocyst

92
Q

Pseudocysts that persist beyond _____ weeks or grow larger than _____ in diameter, with evidence of regression, may require non-surgical decompression.

A

6 weeks

5cm

93
Q

This is where percutaneous gastrostomy is combined with cystogastrostomy, under fluoroscopy. And ultrasound guidance is used to drain the pseudocyst.

A

non-surgical decompression

needle draining

94
Q

This is irreversible destruction to the pancreas due to repeated bouts of pancreatic inflammation.

A

chronic pancreatitis

95
Q

With chronic pancreatitis, the fibrous _____ proliferates around the ducts and between the lobules, causing interstitial _____. This leads to an irregular, _____ appearance of the pancreas surface.

A

connective tissue
scarring
nodular

96
Q

What are some complications of a pseudocyst?

A 
May become large and cause obstruction of the
stomach
small bowel
colon
or bile ducts

jaundice

obstructive cholangitis

97
Q

This can ensue with a rupture of a pseudocyst into the peritoneal cavity.

A

acute peritonitis

98
Q

The 2 main causes of chronic pancreatitis are (6 total)

A

alcoholism **
cystic fibrosis **

(hereditary pancreatitis, congenital abnormalities, blunt abdominal trauma, idiopathic chronic pancreatitis)

99
Q 
These sonographic findings may represent \_\_\_\_\_:
small echogenic pancreas **
calcifications **
pancreatic duct dilation
pseudocyst formation
bile duct dilation
portal vein thrombosis
A

chronic pancreatitis

100
Q

A non-encapsulated inflammatory process =

A

phlegmon

101
Q

This is a non-encapsulated inflammatory process that spreads along peripancreatic tissue, causing localized areas of diffuse inflammatory edema or soft tissue that may proceed to necrosis and suppuration.

A

phlegmon pancreatitis

102
Q

What is the sonographic appearance of phlegmon pancreatitis?

A

hypoechoic

with good through transmission

103
Q

What is the 4th largest cancer killer in adults, with a dismal prognosis, for which surgical resection is the only chance for cure?

A

pancreatic cancer

104
Q

What is the only chance for cure with pancreatic cancer?

A

surgical resection

105
Q

Adenocarcinoma has these main symptoms (2) with these sonographic findings (3)

A

abdominal pain
jaundice

solid, hypoechoic mass
usually in pancreas head
poorly defined

106
Q

90% of patients with pancreatic carcinoma present with _____ and _____ spread of the tumor.

A

lymphatic

metastatic

107
Q

Where does pancreatic carcinoma (adenocarcinoma) usually arise from (80% of the time)?

A

pancreatic head

108
Q

The 5-year survival rate for adenocarcinoma (pancreatic carcinoma) is

A

less than 2%

109
Q

What may be the condition of a patient with these findings:

BD dilation (Courvoisier's GB)
painless jaundice
dilated pancreatic duct
pancreatitis
liver mets
ascites
lyphadenopathy around AO
pseudocyst formation
A

adenocarcinoma (pancreatic carcinoma)

110
Q

Elevated bilirubin and alkaline phosphatase, with possible elevation of amylase, could point to what pancreatic condition?

A

adenocarcinoma (pancreatic carcinoma)

111
Q

T or F? When adenocarcinoma (pancreatic cancer) is in its early stages, the patient does not feel symptoms.

A

True

112
Q

An adenocarcinoma tumor usually appears as a _____ (echogenicity), solid mass.

A

hypoechoic

113
Q

The most striking clinical condition leading to diagnostic imaging for the detection of adenocarcinoma is _____, which is caused by compression or ingrowth of the _____.

A

painless obstructive jaundice

distal CBD

114
Q

_____ is the first imaging test for the evaluation of adenocarcinoma patients.

A

U/S

115
Q

Typically, patients with a pancreatic head tumor show dilation of the _____ and _____, creating a double duct sign.

A

CBD

pancreatic duct

116
Q

This finding is very suggestive for a mass in the pancreatic head, even in the absence of a visible mass.

A

double duct sign (dilation of CBD and MPD)

117
Q

This kind of carcinoma accounts for 85%-90% of all pancreatic tumors.

A

ductal adenocarcinoma

118
Q

What are treatment options for pancreatic cancer? (4)

A

surgery
chemotherapy
radiation therapy
palliative care (hospice)

119
Q

If a adenocarcinoma tumor is deemed resectable, the two surgical procedures offered are

A

Whipple Procedure

Distal Pancreatectomy Splenectomy

120
Q

What is the Whipple Procedure?

A

it removes the head of the pancreas

121
Q

Another term for the removal of the pancreas head is

A

pancreaticoduodenectomy

122
Q

What is removed during a pancreaticoduodenectomy (4)?

A

pancreas head
portion of bile duct
GB
duodenum

123
Q

After a pancreaticoduodenectomy, what is done with the remaining pancreas and bile duct?

A

They are sutured back to the intestines to direct secretions back to the gut

124
Q

The type of procedure suggested for an adenocarcinoma tumor depends on

A

the location of the tumor

125
Q

This procedure is the end of the pancreas is removed, the pancreas head is left attached.

A

distal pancreatectomy and splenectomy

126
Q

What is a distal pancreatectomy and splenectomy meant to treat (main)?

A

pancreatic cancer localized in the end of the pancreas

127
Q

Distal pancreatectomy and splenectomy may also be used for these 3 reasons

A

chronic pancreatitis
pancreatic pseudocysts
injury due to trauma

128
Q

When pancreas cancer affects the SA or _____, the adjacent _____ is often removed. (referring to distal pancreatectomy/splenectomy topic)

A

SV

spleen

129
Q

What are the 2 main cystic neoplasms of the pancreas?

A

serious cystadenoma

mucinous cystic

130
Q

Which of the 2 main cystic neoplasms is typically benign and which is malignant (or potentially malignant)?

A

serous cystadenoma is benign

mucinous cystic is malignant (or possibly malignant)

131
Q

What was serous cystadenoma formerly called?

A

microcystic cystadenomas

132
Q

What condition does a “cluster of grapes” refer to with pancreatic disease?

A

serous cystadenoma

133
Q

This is the micro form of cystic neoplasm.

A

serous cystadenoma

134
Q

When serous cystadenomas are small, the mass may be _____ (echogenicity) and appear _____ (structure/texture) with through transmission.

A

echogenic

solid

135
Q

What were mucinous cystic neoplasms formally called?

A

macrocystic neoplasms

136
Q

The sonographic appearance of a mucinous cyst is a

A

well-defined multicystic mass (large cysts)

137
Q

With mucinous cysts, what lab test level is increased?

A

CEA (Carcinoembryonic antigen)

138
Q

What is the macro form of cystic neoplasms of the pancreas?

A

mucinous cystic neoplasm (formerly called macrocystic neoplasms

139
Q

The suggestion for treatment of mucinous cystic neoplasms is _____, due to the possibility of _____.

A

resection

malignant transformation

140
Q

Mucinous cystic neoplasms, 90% of the time, develop in the pancreas _____ (region).

A

tail

141
Q

Compared to serous cystic neoplasms of the pancreas, mucinous cystic neoplasms are _____ (larger/smaller) and _____ (more/less) numerous.

A

larger

less

142
Q

What is the most common islet cell tumor?

A

insulinoma

143
Q

Is insulinoma benign or malignant?

A

usually benign (90%)

144
Q

Insulinoma is a tumor of the pancreas that produces excessive amounts of _____.

A

insulin

145
Q

Insulinomas are more common in _____ (men/women).

A

women

146
Q

Insulinomas tumors are usually small, about less than _____.

A

2cm

147
Q

These are hormonally active tumors arising from islet cells that produce insulin.

A

insulinoma

148
Q

Islet cell tumors are _____ (shape) or _____ (shape) and are a well-_____, _____ (echogenicity) mass.

A

round
oval
circumscribed
hypoechoic

149
Q

This is the 2nd most common islet cell tumor.

A

gastrinoma

150
Q

Are gastrinomas malignant or benign?

A

often malignant (60%)

151
Q

Gastrinoma is also known as

A

Zollinger-Ellison syndrome

152
Q

People with _____ are commonly people that get gastrinomas.

A

peptic ulcers

153
Q

This is a tumor in the pancreas that secretes excess gastrin, leading to ulceration the duodenum, stomach and the small intestine.

A

gastrinoma

154
Q

Gastrinoma is most commonly found in the _____ (50%-70%) and less commonly in the _____ (20%-40%). Those occurring in the _____ have a greater potential for malignancy.

A

duodenum
pancreas
pancreas

155
Q

What does MEN stand for?

A

multiple endocrine neoplasia

156
Q

This is a group of heritable syndromes, characterized by abherant growth of benign or malignant tumors in a subset of endocrine tissues.

A

MEN

157
Q

What are the 3 types of MEN?

A

MEN I
MEN IIA
MEN IIB

158
Q

These are tumors involving the parathyroid glands:

endocrine pancreas and the pituitary

A

MEN I

159
Q

This is medullary carcinoma of the thyroid gland:

pheochromocytoma and hyperparathyroidism

A

MEN IIA

160
Q

This is medullary carcinoma of the thyroid:

multiple neuromas and pheochromocytoma

A

MEN IIB

161
Q

MEN is associated with (6)

A 
insulinoma
gastrinoma
medullary thyroid carcinoma
pheochromacytoma
parathyroid gland hyperplasia
pituitary tumors
162
Q

This deals with masses and tumors that can form with all the endocrine glands in the body.

A

MEN

163
Q

3 possible reasons for increased amylase production are

A 
Pancreatitis 
Salivary gland dysfunction 
Renal dysfunction
(Pancreas, salivary glands, kidneys produce amylase)
164
Q

Which persists longer? Amylase or lipase?

A

Lipase

165
Q

What is the usual size of the pancreas neck?

A

10 mm

166
Q

With this, MULTIPLE CYSTS ARE ASSOCIATED WITH ADULT TYPE POLYCYSTIC KIDNEY DISEASE

A

Congenital cysts

*Ultrasound* (14 decks)

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