Pancreas Pathology Flashcards
what is acute pancreatitis?
inflammation of the pancreas secondary to the leakage of pancreatic enzymes
is acute pancreatitis reversible?
YES
what are the 2 most common causes of acute pancreatitis?
alcohol abuse
gallstones
the most common location of acute pancreatitis is _____
head of the pancreas
ultrasound appearance of acute pancreatitis (4)
normal to enlarged
ill-defined borders
peripancreatic fluid
40-60% gallstones
signs/symptoms of acute pancreatitis (3)
severe epigastric pain (especially in supine position)
fever
nausea and vomiting
increased lab values of acute pancreatitis (4)
amylase
lipase
ALT
WBC
with acute pancreatitis, the first lab value to increase is ____ within 24hrs
amylase
with acute pancreatitis, _____ increases within 72hrs
lipase
complications of acute pancreatitis (5)
pancreatic pseudocyst
phlegmon pancreatitis
pancreatic abscess
hemorrhagic pancreatitis
duodenal obstruction
the most common cystic pancreatic lesion is ____
pancreatic pseudocysts
pancreatic pseudocysts are encapsulated _____
encapsulated leaked pancreatic enzymes
the most common site of pancreatic pseudocysts is the ____
lesser sac
majority of pancreatic pseudocysts resolve within ____
4 to 12 weeks
ultrasound appearance of pancreatic pseudocysts (3)
anechoic
posterior enhancement
may contain some internal echoes
what is plegmon pancreatitis?
peripancreatic fluid collection that results from pancreatitis
another name for plegmon pancreatitis is _____
focal pancreatitis
plegmon pancreatitis may proceed to ____ if left untreated
necrosis
what is a pancreatic abscess?
area filled with pus within the pancreas
pancreatic abscesses have a high mortality rate of ____
_____ if left untreated
32 to 65%
100% if left untreated
another name for hemorrhagic pancreatitis is _____
necrotizing pancreas
hemorrhagic pancreatitis may occur from (3)
alcoholism
surgical trauma
external trauma
chronic pancreatitis causes (4)
fibrosis
necrosis
scarring
calcification
patients with ___ and ___ are predisposed to chronic pancreatitis
hypercalcemia and hyperlipidemia
ultrasound appearance of chronic pancreatitis (5)
small pancreas
heterogenous
dilated pancreatic duct
calcification
portosplenic vein thrombosis
signs/symptoms of chronic pancreatitis (4)
persistent epigastric pain
anorexia
nausea and vomiting
constipation
what is von hippel-lindau syndrome?
inherited disorder
development of tumors and cysts in various organs
______ can indicate von hippel-lindau syndrome
hemangioblastomas
patients with von hippel-lindau syndrome are at risk of developing ______
pancreatic neuroendocrine tumors
what is cystic fibrosis?
autosomal recessive disorder of exocrine glands
in _______, abnormal viscous mucus blocks ducts in the pancreas and prevents enzymes from reaching the small intestines
cystic fibrosis
ultrasound appearance of cystic fibrosis (4)
hyperechoic pancreas
multiple cysts in pancreas
cirrhosis with possible PHTN
splenomegaly
the most common reason for a hyperechoic pancreas in children
cystic fibrosis
another name for serous cystadenoma
microcystic adenoma
what is serous cystadenoma?
cystic benign tumors < 2cm
serous and mucinous cystadenoma are usually seen in the ____
body and tail of the pancreas
serous cystadenomas are associated with ____
von hippel-lindau syndrome
another name for mucinous adenomas
macrocystic adenomas
what is more common, serous or mucinous cystadenomas?
serous cystadenomas
mucinous cystadenomas arise from ducts as ____
cystic neoplasms
macrocystic adenoma measure ___
> 5cm
macrocystic cystadenomas causes
displacement of CBD and pancreatic duct
what are islet cell tumors?
endocrine tumors within the islets of langerhans
what are the two types of islet cell tumors?
insulinoma and gastrinoma
another name for insulinoma
B-cell tumor
what is the most common islet cell tumor?
insulinoma
insulinoma is common in the ____
tail of the pancreas
T/F: insulinoma is most of the time benign
true - 90 to 95% are benign
another name for gastrinoma
G-cell tumor
gastrinoma is usually in the ____
head of the pancreas and duodenum
gastrinoma can produce ____
Zollinger-Ellison syndrome
what is Zollinger-Ellison syndrome?
gastric acid hypersecretion that leads to peptic ulcers
what is glucagonoma?
rare, pancreatic A-cell tumor
glucagonoma is associated with (3)
necrolytic migratory erythema
weight loss
mild DM
pancreatic adenocarcinoma is also known as
pancreatic ductal adenocarcinoma
what is the most common primary pancreatic cancer?
pancreatic adenocarcinoma
pancreatic adenocarcinoma survival time once diagnosed is ___
3 to 6 months
pancreatic adenocarcinoma is usually found in the ____ and leads to ____ and ____
found in the head of the pancreas
leads to CBD obstruction and courvoisier GB
ultrasound appearance of pancreatic adenocarcinoma (3)
hypoechoic mass in the head
double duct sign
hydropic GB
what is the double duct sign?
dilated CBD and pancreatic duct
who are at risk of pancreatic adenocarcinoma? (5)
males
smoking
family history
DM
chronic pancreatitis
what is the Whipple procedure?
removal of the head of the pancreas, GB, some of the bile ducts, and prox duodenum
the Whipple procedure is also called _____
pancreaticoduodenectomy
what is pancreatic cystadenocarcinoma?
malignant form of cystadenoma that arises from the lining of the pancreatic duct
pancreatic cystadenocarcinoma is usually in the ____
body and tail of the pancreas
ultrasound appearance of pancreatic cystadenocarcinoma (3)
multiloculated cystic masses
may contain nodules and calcifications
dilated pancreatic duct
signs/symptoms of pancreatic cystadenoma (5)
asymptomatic initially
epigastric pain
weight loss
palpable mass
jaundice
a pancreas transplant can be done to treat _____
severe type I diabetes
80% of patients who get a pancreas transplant also undergo _____
renal transplant
what are the 2 pancreatic transplant techniques?
exocrine bladder drainage
exocrine enteric drainage
in the exocrine bladder drainage technique, the vascular of the donor pancreas is anastomosed to the recipient’s ____
common iliac vessels
in exocrine bladder drainage, the donor duodenum is anastomosed to the ____
bladder
what are some draw backs of exocrine bladder drainage
dehydration
bladder irritation
in exocrine enteric drainage, the donor’s duodenum is anastomosed to ____
a loop of jejunum
what is a “Y” graft?
used in exocrine enteric drainage
splenic artery and SMA are connected with the donor’s iliac arteries
sonographic assessment of a pancreatic transplant includes (3)
evaluation of vascularity
evaluation of pancreatic parenchyma
search for fluid collections
acute rejection of pancreatic transplant includes (3)
hypoechoic pancreas
heterogenous parenchyma
increase RI
chronic rejection of pancreatic transplant looks like: (3)
hyperechoic pancreas
atrophic pancreas
calcifications
complications of pancreatic transplant (6)
arterial stenosis
arterial thrombosis
graft thrombosis
pseudoaneurysm
splenic vein thrombosis
strictures
patients with chronic pancreatitis usually have ___ levels of pancreatic enzymes
decreased
most common cause of chronic pancreatitis
alcoholic chronic pancreatitis
in children, the most common reason for a pancreatic pseudocyst is
abdominal trauma
mucinous cystadenomas are premalignant or malignant lesions with elevated (2)
CEA
CA 19-9
what is multiple endocrine neoplasia (MEN)?
inherited disorder
multiple tumors in endocrine glands
tumors may be benign or cancerous
MEN syndrome is categorized into
MEN type 1 = Wermer syndrome
MEN type 2 = Sipple’s syndrome
MEN common sites of involvement (5)
parathyroids - hyperparathyroidism
pancreatic islet cells - insulinomas/gastronomas
pituitary glands - prolactinomas
adrenal glands - pheochromocytomas
thyroid - medullary thyroid carcinoma
