pancreas pathology Flashcards
what portion of the pancreas is usually present in partial pancreatic agenesis?
the head and uncinate process
what is pancreatic divisum?
pacreatic divisum is the congenital lack of fusion with the pancreatic ducts
what are the potential complications of pancreatic divisum?
it can cause pancreatitis
were does ectopic pancreatic tissue usually develop?
within the GI tract
is ectopic pancreatic tissue functioning?
yes
what is an annular pancreas?
annular pancreas is where the head of the pancreas surrounds the second portion of the duodenum.
how do congenital cysts usually appear?
cysts result of the abnormal development of the pancreatic ducts
pancreatic congenital cysts can be associated with….
Von Hippel-Lindau syndrome and ADPKD
what is the most common genetic disease in white children?
cystic fibrosis
how does cystic fibrosis affect the pancreas?
cystic fibrosis causes a blockage in the pancreatic ducts, results in the delivery of pancreatic enzymes and poor digestion of food.
what are the clinical symptoms of cystic fibrosis when it starts to affect the pancreas?
- N/V
- poor digestion
- malnutrition
- weight loss
how would the pancreas appear in a cystic fibrosis patient?
hyperechoic, atrophied, calcifications, and small cysts
what are the 5 Bs of acute pancreatitis?
1) Booze
2) blood- trauma
3) Bile- Biliary
4) Bug- infection
5) Birth- congenital
what is the most common cause of acute pancreatitis?
biliary disease
what is the second most common cause of acute pancreatitis?
alcohol abuse
what are the clinical signs of acute pancreatitis?
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
what lab values diagnose acute pancreatitis?
- amylase will increase, will remain for 24 hours
- Lipase will increase, will remain elevated for 5 to 14 days
- leukocytosis
what is the sonographic appearance for acute pancreatitis?
- 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
what are the complications of acute pancreatitis?
- Pseudocyst
- Phlegmon
- Abscess
- Hemorrhage
- Duodenal obstruction
what is the most common cause of children with pancreatitis?
trauma results from child abuse (battered child syndrome)
what is a pseudocyst?
fluid collection that arises from inflammatory process, necrosis, or hemorrhage (tissue destruction)
where is the most common location for a pseudocyst?
Most commonly located in the lesser sac, tail region, anterior pararenal space, more often in the left pararenal space
what is the sonographic appearance of a pseudocyst?
- 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
why is a pseudocyst worrisome?
they can rupture and kill the surrounding tissue
what are the clinical signs of a ruptured pseudocyst?
sudden shock of peritonitis
what is phlegmonous pancreatitis?
severe form of acute pancreatitis caused by extension outside the gland
how will it appear on ultrasound?
- tissue appears hypoechoic with irregular borders
- usually involves the lesser sac, pararenal space, and transverse mesocolon
what is hemorrhagic pancreatitis?
necrosis of blood vessel walls causing hemorrhage. diffuse destruction causing necrosis in and around pancreas
what is the most common cause of hemorrhagic pancreatitis?
alcoholic binges or very large meals
what is the mortality rate of hemorrhagic pancreatitis?
60%
what are the clinical signs of hemorrhagic pancreatitis?
- Severe abdominal pain
- n/v
- abdominal distension due to ileus
- hypotensive
- shock
- increase amylase and lipase
- decreased hematocrit
what is a pancreatic abscess?
collection of pus in or around the gland.
how is a pancreatic abscess developed?
they are developed due to the superinfection of the necrotic pancreas.
what is a pancreatic abscess associated with?
postoperative pancreatitis
how does a pancreatic abscess appear on US?
hypoechoic mass that may have internal echoes
define chronic pancreatitis
recurrent attacks of acute pancreatitis. it results in irreversible damage to the gland due to progressive destruction
what is the most common cause of chronic pancreatitis?
alcoholism and is more common in males
clinical signs of chronic pancreatitis
- Persistent epigastric pain and back pain radiating to the back
- n/v
- weight loss
- diabetes in later stages
- jaundice
lab values of chronic pancreatitis
- Amylase/lipase tests are not good indicators
- Fat in feces
- Abnormal glucose-tolerance test
sonographic appearance of chronic pancreatitis
- 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
complications of chronic pancreatitis
- Pseudocysts
- Thrombosis of the splenic vein and/or portal vein
- Biliary stricture
- Carcinoma
what is the most common pancreatic cancer?
adenocarcinoma
what are the risk factors for adenocarcinoma?
- smoking
- high-fat diet
- chronic pancreatitis
- diabetes
- cirrhosis
what are the clinical signs for adenocarcinoma?
- 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
where does adenocarcinoma usually occur?
in the head of the pancreas
define courvoisier’s sign
indicates jaundice in the gallbladder that is enlarged but not painful
where does metastases usually occur?
liver, portal system, or nodes
what is a cystadenoma
rare, benign tumors in the pancreas
where do cystadenomas usually occur?
more common in the head of the pancreas and can contain calcifications
what is the sonographic appearance of a cystadenoma?
anechoic mass or echogenic mass with hyper and hypoechoic areas
where do cystadenocarcinomas usually appear?
in the tail of the pancreas
how do cyst adenocarcinomas appear on ultrasound?
- large, unilocated complex mass
- cysts may contain calcifications
- 60% occur in the tail of the pancreas
clinical signs of a cystadenocarcinoma
epigastric pain and a palpable mass
what is an islet cell tumor?
an Islet cell tumor is a rare type of hormone-producing tumor that forms in the tissue of the pancreas.
what are the two types of islet cell tumors?
insulinoma and gastrinoma
is insulinoma benign or malignant?
Benign
is gastrinoma benign or malignant?
benign, but 60% become malignant
what is the most common islet cell tumor?
insulinoma (70%)
what type of cells are insulinomas?
B-cell
what type of cell produces insulin?
B-cell or Beta Cell
what are the clinical signs of an insulinoma?
hypoglycemia and elevated insulin levels
what is the second most common islet cell tumor?
gastrinoma (20%)
where are islet cell tumors usually located?
in the body and tail of the pancreas
how do islet cell tumors appear on an ultrasound?
- 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
