Pancreas Patho Flashcards
Inflammatory disease producing temporary pancreatic changes. Dx is usually based on clinical and laboratory findings.
Acute pancreatitis
Most common casues of acute pancreatitis (2).
gallstones (40%)
ETOH (35%)
Sonographic finding in acute pancreatitis?
enlarged pancreas
hypoechoic gland
_______ can take several different directions: resolution, pseudocyst formation, or chronic.
Pancreatitis
Complications from acute pancreatitis (7)
psedocyst formation abscess pancreatic necrosis hemorrhage venous thrombosis pseudoaneurysm formation pancreatic phlegmon (focal pancreatitis)
_______ _________ is an inflammatory mass formed by edema and leakage of pancrearic enzymes. Forms as a complication of acute pancreatitis.
Pancreatic phlegmon (focal pancreatitis)
What is a phlegmon?
A speading inflammatory reaction to an infection which forms a suppurative lesion.
Irreversible destruction due to repeated bouts of pancreatic inflammation.
Chronic pancreatitis
Causes of chornic pancreatitis (7)
ETOH (most common) autoimmune pancreatitis hereditary pancreatitis cystic fibrosis congenital abnormalities (pancreas divisum) abdominal trauma idopathic chronic pancreatitis (20-30%)
What lab values are found with acute attacks of pancreatitis.
Elevated amylase and lipase are elevated only during acute attacks
Sonographic findings with chronic pancreatitis
small/echogenic gland calcifications pncreatic duct dilatation pseudocyst formation bile duct dilatation portal vein thrombosis
True pancrearic cysts are rare and of multiple, then associated with _______ _____ _____ ______ disease and ____ ______-_______ syndrome.
autosomal dominant polycystic kidney disease
von Hippel-Lindau syndrome
Exocrine gland disorder resulting in viscous secretions casuing pancreatic dysfunction.
Cystic fibrosis
Why might a child have a hypoechoic pancreas?
Cystic Fibrosis
Meconium ileus is a common associated condition
Ultrasound findings associated with cystic fibrosis.
increased pancreatic echogenicity
gland atrophy
fibrosis and fatty replacement
cysts due to ductal obstruction
_______ 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.
Pseudocyst
Pseudocysts contain high amounts of ____, _____, _____.
amylase, lipase, trysin
Common casues of pancreatic pseudocysts (5)
acute pancreatitis chronic pancreatitis pancreatic trauma pancreatic ductal obstruction pancreatic neoplasms
The pancreas is located within the ____ ______ space of the retroperitoneum.
anterior pararenal
-when the exudative fluid extravasates from the pancreas it fills this space
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.
anterior pararenal space
lesser peritoenal sac
*pick lesser sac if pararenal space is not an option
Where do pseudocysts more commonly occur?
pancreatic tail
Failure of the dorsal and ventral pancreatic ductal systems to fuse during embryonic development resulting in the smaller Santorini’s duct draining the pancreas.
Pancreas Divisum
Pancreas Divisum may lead to inadequate pancreatic enzyme drainage and _______.
pancreatitis
Congenital anomaly where the ventral pancreas encircles the second portion of the duodenum.
annular pancreas
Annular pancreas may present how sonogrraphically?
Double-bubble sign with dilated stomach and duodenal bulb
90% of patients with pancreatic adenocarcinoma present with ______ and _______ spread of the tumor.
lymphatic and metastatic
Mean patient age for pancreatic adenocarcinoma Dx
55yrs
_____% of pancreatic adenocarcinomas arise from the head.
80%
Pancreatic tumors that produce late symptoms are usually located in the ____ and _____.
body and tail
Symptoms of pancreatic adenocarcinoma
initial symptoms are nonspecific
abd/back pain
painless jaundice
weight loss
Sonographic appearance of pancreatic adenocarcinoma?
solid hypoechoic mass
Assoc findings with pancreatic adenocarcinoma?
Courvoisier's GB bile duct dilatation dilated pancreatic duct liver mets ascites lymphadenopathy pseudocyst formation
elevated chemistries assocaited with pancreatic adenocarcinoma
conjugated bilirubin alkaline phosphatase GGT Amylase Lipase
Describe the Whipple procedure or pancreaticoduodenectomy with cancers of the pancreatic head.
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
T/F - Pancreatic serous cystadenomas are benign and and associated with von Hippel-Lindau disease
T
What were pancreatic serous cystadenomas formerly called?
Microcystic cystadenomas
Sonographic appearance of pancreatic serous cystadenomas?
cluster of grapes-like cysts
external lobulation
-if cysts are small, mass may appear echogenic (many acoustic interfaces) and appear solid with through transmission
Mucinous cystic neoplasms are common or uncommon?
uncommon
Mucinous cystic neoplasms were formerly called what?
macrocystic cystadenoma or cystadenocarcinoma
T/F - Mucinous cystic neoplasms are malignant or potentially malignant.
T
Sonographic findings associated with mucinous cystic neoplasms?
large multicystic mass with numerous septations and debris
-difficult to distinguish between serous cystadenoma and a mucinous cystic neoplasm
Increased levels of what would suggest the Dx of mucinous cystic neoplasm in a patient with a multicystic pancreatic mass.
CEA (Carcinoembryonic antigen)
Islet Cell Tumors are what kind of tumor?
endocrine tumor
Islet cell tumors are (uncommon or common?)
uncommon
-functioning tumors are small and difficult to localize
Islet cell tumors are assocated with (2)
MEN-1 (multiple endocrine neoplasia)
VHL (von Hippel-Lindau disease)
What is the most comon islet cell tumor?
Insulinoma
Insulinomas are usually ______ and related to hyperinsulinemia (hypoglycemia).
benign
Second most common islet cell tumor?
Gastrinoma (Zollinger-Ellison Syndrome)
Gastrinomas are frequently ______.
malignant
Gastrinomas result from gastric acid _______ and gastric and duodenam _______.
gastric acid hypersecretion
gastric and duodenal ulceration
Although not characteristic of insulinomas and gastrinomas, may pancreatic islet cell turmos are commonly located in the _____ and ____.
body and tail
Multiple Endocrine Neoplasia (MEN)
inherited endocrine disorder and categorized into two: Type I (Wermer syndrome) Type II (Sipple's syndrome)
MEN most commonly involves what sites?
parathyroids (hyperparathyroidism) pancreatic islet cells (gastrinomas/insulinomas) pituitary gland (prolactinomas) Adrenal Glands (pheochromocytomas) Thyroid (medullary thyroid ca)
Pancreatitis and salivary gland dysfunction casues increased levels of _____.
amylase
