Pancreas - Part 3 Flashcards
What remains increased longer than serum amylase in episodes of acute pancreatitis?
Urine amylase
What is the normal range for serum lipase?
10-140U/L
What does serum lipase increase with? (6)
- Pancreatitis
- Obstruction of the pancreatic duct
- Pancreatic carcinoma
- Acute cholecystitis
- Cirrhosis
- Severe renal disease
What is the normal range of glucose in a fasting patient?
< 100mg/dL
What is the normal range of glucose in a patient 2 hours postprandial?
< 145 mg/dL
What does glucose increase with? (3)
- Severe diabetes mellitus
- Chronic liver disease
- Overactivity of several of the endocrine glands
What does glucose decrease with?
Tumours of the islets of Langerhans in the pancreas
What are causes of acute pancreatitis? (5)
- Biliary disease
- Alcohol abuse
- Trauma
- Peptic ulcer disease
- Idiopathic
What are the clinical findings of acute pancreatitis? (4)
- Abrupt onset of epigastric pain
- Nausea/vomiting
- Elevated lipase and amylase
- Paralytic ileus
What is the US appearance of acute pancreatitis? (4)
- Normal findings
- 30% - Decrease in parenchymal
echogenicity - Smooth borders
- Enlargement
What are 2 differential diagnosis for acute pancreatitis?
- Normal pancreas
2. Neoplasm
Chronic pancreatitis
Repeated, prolonged, or persistent attacks of pancreatitis
What are the causes of chronic pancreatitis? (2)
- Hypocalcemia
2. Hyperlipidemia
What are the clinical findings of chronic pancreatitis? (5)
- Chronic RUQ or epigastric pain
- Nausea/vomiting
- Weight loss
- Abnormal glucose tolerance test
- Normal amylase and lipase values
What is the US appearance of chronic pancreatitis? (6)
- Increase in parenchymal echogenicity
- Irregular borders
- Calcifications
- Pseudocyst formation
- Atrophy
- Prominent pancreatic duct
What are 2 differential diagnosis of chronic pancreatitis?
- Fatty replacement
2. Neoplasm
What are 5 complications of pancreatitis?
- Abscess
- Duodenal obstruction
- Hemorrhage
- Phlegmon
- Pseudocyst
Why does an abscess develop result from?
An infection of the necrotic pancreas
When can an abscess begin to form following an episode of acute pancreatitis?
2-4 weeks
What are the clinical features of an abscess? (4)
- Abdominal pain
- Leukocytosis
- Nausea/vomiting
- Fever
What is the US feature of an abscess? (3)
- Ranges from anechoic to echogenic
- Irregular or smooth borders
- Fluid-debris levels
Duodenal obstruction
High protein concentration in the pancreas enzymes can irritate the duodenum
What are clinical findings of duodenal obstruction? (4)
- Abdominal pain
- Abdominal distention
- Nausea/vomiting
- Constipation
What is the US appearance of duodenal obstruction?
Limited bowel peristalsis
Hemorrhage
Rapid development of inflammation causing necrosis and hemorrhage
What are the clinical findings of hemorrhage? (4)
- Severe abdominal pain
- Nausea/vomiting
- Elevated amylase
- Decrease in hematocrit level
What is the US appearance of hemorrhage? (3)
- Well-defined homogeneous mass
- Cystic mass with debris
- Fluid-debris levels
Phlegmon
Extension of pancreatic inflammation into the peripancreatic tissues
What are clinical findings of phlegmon? (3)
- Severe abdominal pain
- Nausea/vomiting
- Elevated amylase
What is the US appearance of phlegmon? (3)
- Hypo echoic solid mass adjacent to the pancreas
- Posterior acoustic enhancement Irregular borders
- Usually involves the lesser sac, transverse mesocolon, and anterior pararenal space
Pseudocyst
Focal collection of inflammatory necrotic tissue, blood, and pancreas secretions
Where is a pseudocyst most often located?
In the lesser sac followed by the anterior pararenal space
What are the clinical findings of pseudocyst? (3)
- Abdominal pain
- Palpable mass
- Persistent elevated amylase
What is the US appearance of pseudocyst? (3)
- Anechoic or complex mass
- Well-defined borders
- Variable shape
