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abd > Pancreas Patho > Flashcards

Pancreas Patho Flashcards

1
Q

Inflammatory disease producing temporary pancreatic changes. Dx is usually based on clinical and laboratory findings.

A

Acute pancreatitis

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2
Q

Most common casues of acute pancreatitis (2).

A

gallstones (40%)

ETOH (35%)

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3
Q

Sonographic finding in acute pancreatitis?

A

enlarged pancreas

hypoechoic gland

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4
Q

_______ can take several different directions: resolution, pseudocyst formation, or chronic.

A

Pancreatitis

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5
Q

Complications from acute pancreatitis (7)

A 
psedocyst formation
abscess
pancreatic necrosis
hemorrhage
venous thrombosis
pseudoaneurysm formation
pancreatic phlegmon (focal pancreatitis)
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6
Q

_______ _________ is an inflammatory mass formed by edema and leakage of pancrearic enzymes. Forms as a complication of acute pancreatitis.

A

Pancreatic phlegmon (focal pancreatitis)

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7
Q

What is a phlegmon?

A

A speading inflammatory reaction to an infection which forms a suppurative lesion.

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8
Q

Irreversible destruction due to repeated bouts of pancreatic inflammation.

A

Chronic pancreatitis

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9
Q

Causes of chornic pancreatitis (7)

A 
ETOH (most common)
autoimmune pancreatitis
hereditary pancreatitis
cystic fibrosis
congenital abnormalities (pancreas divisum)
abdominal trauma
idopathic chronic pancreatitis (20-30%)
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10
Q

What lab values are found with acute attacks of pancreatitis.

A

Elevated amylase and lipase are elevated only during acute attacks

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11
Q

Sonographic findings with chronic pancreatitis

A 
small/echogenic gland
calcifications
pncreatic duct dilatation
pseudocyst formation
bile duct dilatation
portal vein thrombosis
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12
Q

True pancrearic cysts are rare and of multiple, then associated with _______ _____ _____ ______ disease and ____ ______-_______ syndrome.

A

autosomal dominant polycystic kidney disease

von Hippel-Lindau syndrome

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13
Q

Exocrine gland disorder resulting in viscous secretions casuing pancreatic dysfunction.

A

Cystic fibrosis

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14
Q

Why might a child have a hypoechoic pancreas?

A

Cystic Fibrosis

Meconium ileus is a common associated condition

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15
Q

Ultrasound findings associated with cystic fibrosis.

A

increased pancreatic echogenicity
gland atrophy
fibrosis and fatty replacement
cysts due to ductal obstruction

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16
Q

_______ are the accumulation of the oancrearyic fluid and necrotic debris confined by the retroperitoneum. Occurs in an attempt to wall off the pnacreatic secretions to prevent further tissue damage.

A

Pseudocyst

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17
Q

Pseudocysts contain high amounts of ____, _____, _____.

A

amylase, lipase, trysin

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18
Q

Common casues of pancreatic pseudocysts (5)

A 
acute pancreatitis
chronic pancreatitis
pancreatic trauma
pancreatic ductal obstruction
pancreatic neoplasms
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19
Q

The pancreas is located within the ____ ______ space of the retroperitoneum.

A

anterior pararenal

-when the exudative fluid extravasates from the pancreas it fills this space

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20
Q

When the exudative fluid extravasates from the pancreas it fills the _____ ______ space. After disruption of the posterior parietal peritoneum, overlying the anterior border of the pancreas, fluid enters the _____ peritoneal sac.

A

anterior pararenal space
lesser peritoenal sac
*pick lesser sac if pararenal space is not an option

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21
Q

Where do pseudocysts more commonly occur?

A

pancreatic tail

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22
Q

Failure of the dorsal and ventral pancreatic ductal systems to fuse during embryonic development resulting in the smaller Santorini’s duct draining the pancreas.

A

Pancreas Divisum

23
Q

Pancreas Divisum may lead to inadequate pancreatic enzyme drainage and _______.

A

pancreatitis

24
Q

Congenital anomaly where the ventral pancreas encircles the second portion of the duodenum.

A

annular pancreas

25
Q

Annular pancreas may present how sonogrraphically?

A

Double-bubble sign with dilated stomach and duodenal bulb

26
Q

90% of patients with pancreatic adenocarcinoma present with ______ and _______ spread of the tumor.

A

lymphatic and metastatic

27
Q

Mean patient age for pancreatic adenocarcinoma Dx

A

55yrs

28
Q

_____% of pancreatic adenocarcinomas arise from the head.

A

80%

29
Q

Pancreatic tumors that produce late symptoms are usually located in the ____ and _____.

A

body and tail

30
Q

Symptoms of pancreatic adenocarcinoma

A

initial symptoms are nonspecific
abd/back pain
painless jaundice
weight loss

31
Q

Sonographic appearance of pancreatic adenocarcinoma?

A

solid hypoechoic mass

32
Q

Assoc findings with pancreatic adenocarcinoma?

A 
Courvoisier's GB
bile duct dilatation
dilated pancreatic duct
liver mets
ascites
lymphadenopathy
pseudocyst formation
33
Q

elevated chemistries assocaited with pancreatic adenocarcinoma

A 
conjugated bilirubin
alkaline phosphatase
GGT
Amylase
Lipase
34
Q

Describe the Whipple procedure or pancreaticoduodenectomy with cancers of the pancreatic head.

A

Head of the panc, portion of the CBD, STO, GB, and duodenum are removed.
Remaining pancreas and bile duct are sutured back to the intetsines to direct secretions back to the gut

35
Q

T/F - Pancreatic serous cystadenomas are benign and and associated with von Hippel-Lindau disease

A

T

36
Q

What were pancreatic serous cystadenomas formerly called?

A

Microcystic cystadenomas

37
Q

Sonographic appearance of pancreatic serous cystadenomas?

A

cluster of grapes-like cysts
external lobulation
-if cysts are small, mass may appear echogenic (many acoustic interfaces) and appear solid with through transmission

38
Q

Mucinous cystic neoplasms are common or uncommon?

A

uncommon

39
Q

Mucinous cystic neoplasms were formerly called what?

A

macrocystic cystadenoma or cystadenocarcinoma

40
Q

T/F - Mucinous cystic neoplasms are malignant or potentially malignant.

A

T

41
Q

Sonographic findings associated with mucinous cystic neoplasms?

A

large multicystic mass with numerous septations and debris

-difficult to distinguish between serous cystadenoma and a mucinous cystic neoplasm

42
Q

Increased levels of what would suggest the Dx of mucinous cystic neoplasm in a patient with a multicystic pancreatic mass.

A

CEA (Carcinoembryonic antigen)

43
Q

Islet Cell Tumors are what kind of tumor?

A

endocrine tumor

44
Q

Islet cell tumors are (uncommon or common?)

A

uncommon

-functioning tumors are small and difficult to localize

45
Q

Islet cell tumors are assocated with (2)

A

MEN-1 (multiple endocrine neoplasia)

VHL (von Hippel-Lindau disease)

46
Q

What is the most comon islet cell tumor?

A

Insulinoma

47
Q

Insulinomas are usually ______ and related to hyperinsulinemia (hypoglycemia).

A

benign

48
Q

Second most common islet cell tumor?

A

Gastrinoma (Zollinger-Ellison Syndrome)

49
Q

Gastrinomas are frequently ______.

A

malignant

50
Q

Gastrinomas result from gastric acid _______ and gastric and duodenam _______.

A

gastric acid hypersecretion

gastric and duodenal ulceration

51
Q

Although not characteristic of insulinomas and gastrinomas, may pancreatic islet cell turmos are commonly located in the _____ and ____.

A

body and tail

52
Q

Multiple Endocrine Neoplasia (MEN)

A 
inherited endocrine disorder and categorized into two:
Type I (Wermer syndrome)
Type II (Sipple's syndrome)
53
Q

MEN most commonly involves what sites?

A 
parathyroids (hyperparathyroidism)
pancreatic islet cells (gastrinomas/insulinomas)
pituitary gland (prolactinomas)
Adrenal Glands (pheochromocytomas)
Thyroid (medullary thyroid ca)
54
Q

Pancreatitis and salivary gland dysfunction casues increased levels of _____.

A

amylase

abd (20 decks)

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