pancreas pathology

Question 1

what portion of the pancreas is usually present in partial pancreatic agenesis?

Answer 1

the head and uncinate process

Question 2

what is pancreatic divisum?

Answer 2

pacreatic divisum is the congenital lack of fusion with the pancreatic ducts

Question 3

what are the potential complications of pancreatic divisum?

Answer 3

it can cause pancreatitis

Question 4

were does ectopic pancreatic tissue usually develop?

Answer 4

within the GI tract

Question 5

is ectopic pancreatic tissue functioning?

Answer 5

yes

Question 6

what is an annular pancreas?

Answer 6

annular pancreas is where the head of the pancreas surrounds the second portion of the duodenum.

Question 7

how do congenital cysts usually appear?

Answer 7

cysts result of the abnormal development of the pancreatic ducts

Question 8

pancreatic congenital cysts can be associated with….

Answer 8

Von Hippel-Lindau syndrome and ADPKD

Question 9

what is the most common genetic disease in white children?

Answer 9

cystic fibrosis

Question 10

how does cystic fibrosis affect the pancreas?

Answer 10

cystic fibrosis causes a blockage in the pancreatic ducts, results in the delivery of pancreatic enzymes and poor digestion of food.

Question 11

what are the clinical symptoms of cystic fibrosis when it starts to affect the pancreas?

Answer 11

• N/V
• poor digestion
• malnutrition
• weight loss

Question 12

how would the pancreas appear in a cystic fibrosis patient?

Answer 12

hyperechoic, atrophied, calcifications, and small cysts

Question 13

what are the 5 Bs of acute pancreatitis?

Answer 13

1) Booze
2) blood- trauma
3) Bile- Biliary
4) Bug- infection
5) Birth- congenital

Question 14

what is the most common cause of acute pancreatitis?

Answer 14

biliary disease

Question 15

what is the second most common cause of acute pancreatitis?

Answer 15

alcohol abuse

Question 16

what are the clinical signs of acute pancreatitis?

Answer 16

severe abd pain in the epigastric region, often radiating to the back. usually occurs after a large meal or alcohol binge, fever, nausea, and less commonly vomiting

Question 17

what lab values diagnose acute pancreatitis?

Answer 17

• amylase will increase, will remain for 24 hours
• Lipase will increase, will remain elevated for 5 to 14 days
• leukocytosis

Question 18

what is the sonographic appearance for acute pancreatitis?

Answer 18

• diffuse enlargement with loss of normal texture (irregular borders)
• less echogenic than liver
• pancreatic duct may be obstructed
• gallstones are present in 60% of patients

Question 19

what are the complications of acute pancreatitis?

Answer 19

• Pseudocyst
• Phlegmon
• Abscess
• Hemorrhage
• Duodenal obstruction

Question 20

what is the most common cause of children with pancreatitis?

Answer 20

trauma results from child abuse (battered child syndrome)

Question 21

what is a pseudocyst?

Answer 21

fluid collection that arises from inflammatory process, necrosis, or hemorrhage (tissue destruction)

Question 22

where is the most common location for a pseudocyst?

Answer 22

Most commonly located in the lesser sac, tail region, anterior pararenal space, more often in the left pararenal space

Question 23

what is the sonographic appearance of a pseudocyst?

Answer 23

• Usually single, but there can be multiple
• Usually oval or round
• Around 2-20cm
• Sonolucent, echo-free mass, increased posterior enhancement
• If fluid-debris is visualized, abscess or hemorrhage should be considered

Question 24

why is a pseudocyst worrisome?

Answer 24

they can rupture and kill the surrounding tissue

Question 25

what are the clinical signs of a ruptured pseudocyst?

Answer 25

sudden shock of peritonitis

Question 26

what is phlegmonous pancreatitis?

Answer 26

severe form of acute pancreatitis caused by extension outside the gland

Question 27

how will it appear on ultrasound?

Answer 27

- tissue appears hypoechoic with irregular borders - usually involves the lesser sac, pararenal space, and transverse mesocolon

Question 28

what is hemorrhagic pancreatitis?

Answer 28

necrosis of blood vessel walls causing hemorrhage. diffuse destruction causing necrosis in and around pancreas

Question 29

what is the most common cause of hemorrhagic pancreatitis?

Answer 29

alcoholic binges or very large meals

Question 30

what is the mortality rate of hemorrhagic pancreatitis?

Answer 30

60%

Question 31

what are the clinical signs of hemorrhagic pancreatitis?

Answer 31

- Severe abdominal pain - n/v - abdominal distension due to ileus - hypotensive - shock - increase amylase and lipase - decreased hematocrit

Question 32

what is a pancreatic abscess?

Answer 32

collection of pus in or around the gland.

Question 33

how is a pancreatic abscess developed?

Answer 33

they are developed due to the superinfection of the necrotic pancreas.

Question 34

what is a pancreatic abscess associated with?

Answer 34

postoperative pancreatitis

Question 35

how does a pancreatic abscess appear on US?

Answer 35

hypoechoic mass that may have internal echoes

Question 36

define chronic pancreatitis

Answer 36

recurrent attacks of acute pancreatitis. it results in irreversible damage to the gland due to progressive destruction

Question 37

what is the most common cause of chronic pancreatitis?

Answer 37

alcoholism and is more common in males

Question 38

clinical signs of chronic pancreatitis

Answer 38

- Persistent epigastric pain and back pain radiating to the back - n/v - weight loss - diabetes in later stages - jaundice

Question 39

lab values of chronic pancreatitis

Answer 39

- Amylase/lipase tests are not good indicators - Fat in feces - Abnormal glucose-tolerance test

Question 40

sonographic appearance of chronic pancreatitis

Answer 40

- Heterogenous with increased echogenicity due to fibrotic changes, fatty changes, and calcification - Ductal dilation - Irregular outline to the gland - Varied: small and atrophied - Calculi within ducts and cyst formations

Question 41

complications of chronic pancreatitis

Answer 41

- Pseudocysts - Thrombosis of the splenic vein and/or portal vein - Biliary stricture - Carcinoma

Question 42

what is the most common pancreatic cancer?

Answer 42

adenocarcinoma

Question 43

what are the risk factors for adenocarcinoma?

Answer 43

- smoking - high-fat diet - chronic pancreatitis - diabetes - cirrhosis

Question 44

what are the clinical signs for adenocarcinoma?

Answer 44

- More common in males older than 60 - Symptoms occur late, 90% will have mets before the cancer is diagnosed - Pain radiating to the back - Steady aching epigastric pain - Weight loss - Painless jaundice, usually presence first - n/v - new onset of diabetes

Question 45

where does adenocarcinoma usually occur?

Answer 45

in the head of the pancreas

Question 46

define courvoisier's sign

Answer 46

indicates jaundice in the gallbladder that is enlarged but not painful

Question 47

where does metastases usually occur?

Answer 47

liver, portal system, or nodes

Question 48

what is a cystadenoma

Answer 48

rare, benign tumors in the pancreas

Question 49

where do cystadenomas usually occur?

Answer 49

more common in the head of the pancreas and can contain calcifications

Question 50

what is the sonographic appearance of a cystadenoma?

Answer 50

anechoic mass or echogenic mass with hyper and hypoechoic areas

Question 51

where do cystadenocarcinomas usually appear?

Answer 51

in the tail of the pancreas

Question 52

how do cyst adenocarcinomas appear on ultrasound?

Answer 52

- large, unilocated complex mass - cysts may contain calcifications - 60% occur in the tail of the pancreas

Question 53

clinical signs of a cystadenocarcinoma

Answer 53

epigastric pain and a palpable mass

Question 54

what is an islet cell tumor?

Answer 54

an Islet cell tumor is a rare type of hormone-producing tumor that forms in the tissue of the pancreas.

Question 55

what are the two types of islet cell tumors?

Answer 55

insulinoma and gastrinoma

Question 56

is insulinoma benign or malignant?

Answer 56

Benign

Question 57

is gastrinoma benign or malignant?

Answer 57

benign, but 60% become malignant

Question 58

what is the most common islet cell tumor?

Answer 58

insulinoma (70%)

Question 59

what type of cells are insulinomas?

Answer 59

B-cell

Question 60

what type of cell produces insulin?

Answer 60

B-cell or Beta Cell

Question 61

what are the clinical signs of an insulinoma?

Answer 61

hypoglycemia and elevated insulin levels

Question 62

what is the second most common islet cell tumor?

Answer 62

gastrinoma (20%)

Question 63

where are islet cell tumors usually located?

Answer 63

in the body and tail of the pancreas

Question 64

how do islet cell tumors appear on an ultrasound?

Answer 64

- difficult to image due to their small size - 1-2cm - located in the body or tail of the pancreas - small, well-defined, homogenous, solid, hypoechoic mass - well-encapsulated with good vascular supply