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Abdomen Pathology > Pancreas Pathology Ch 12 > Flashcards

Pancreas Pathology Ch 12 Flashcards

1
Q

digestive enzyme for carbohydrates, produced by the pancreas, parotid glands, gynecologic system and bowel

A

serum amylase

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2
Q

serum amylase level of _____ normally usually indicates acute pancreatitis

A

twice

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3
Q

may be seen in pancreatitis, is excreted by the kidneys and elevation may be seen in renal disease

A

urine amylase

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4
Q
  • excreted specifically by the pancreas

- elevated in acute pancreatitis and carcinoma of the pancreas

A

lipase

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5
Q

both _______ and ______ rise at the same rate, but the elevation of _____ concentration persists for a longer period of time.

A

amylase and lipase, lipase

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6
Q

may be elevated with obstruction of the pancreatic duct, pancreatic carcinoma, and acute cholceystitis

A

lipase

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7
Q

-controls the blood sugar level in the body

A

glucose

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8
Q
  • increased in diabetics, chronic liver disease and over-activity of several of the endocrine glands
  • decreased levels in islet cell tumor
A

glucose

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9
Q

pancreas is both digestive (_______) and hormonal (_______) gland.

A

exocrine, endocrine

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10
Q

production and digestion of pancreatic juice; primary function of the pancreas

A

exocrine

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11
Q

production of the hormone insulin

A

endocrine

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12
Q

most common causes of acute pancreatitis

A
  • biliary tract disease (most common cause), is commonly due to a stone at the ampulla of vater
  • alcoholism is 2nd most common
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13
Q

gallstones are present _____% with acute pancreatitis

A

40-60

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14
Q

what is increased in acute pancreatitis

A

serum amylase, lipase, and white blood cells

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15
Q

in acute pancreatitis _____ rises first within 24 hours and ______ rises later increasing within 72-94 hours and remains elevated for a period of time

A

amalyse, lipase

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16
Q

sonographic findings of acute pancreatitis

A
  • enlarged
  • hypoechoic to anechoic due to edema
  • borders somewhat indistinct but smooth
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17
Q

pancreatic ________ and _______ pancreatic echogenicity are sonographic landmarks for acute pancreatitis

A

enlargement, decreased

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18
Q

_______ and ______ are frequent in patients with severe acute pancreatitis

A

fluid collections, edema

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19
Q

most common sites for fluid collection are found in the…

A

lesser sac, anterior pararenal spaces, mesocolon, perinenal spaces, and peripancreatic soft tissue spaces

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20
Q

space between stomach and pancreas is easily imaged, the superior recess of this space is seen to surround the caudate lobe

A

lesser sac

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21
Q

space seen with sonography

A

perirenal space

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22
Q

space best demonstrated in sagittal view

A

anterior pararenal space

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23
Q

are the accumulation of pancreatic fluid and necrotic debris confined by the retroperitoneum.

A

pseudocysts

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24
Q

pseudocysts contain high amounts of ….

A

-amylase, lipase, and trysin

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25
Q

pseudocysts usually develop over ______ weeks after onset of pancreatitis

A

4-6 weeks

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26
Q

common causes of pseudocysts are….

A

-chronic pancretitis, acute pancreatitis, pancreatic trauma, pancreatic ductal obstruction and pancreatic neoplasms

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27
Q

most common complication of acute pancreatis

A

pseudocysts

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28
Q

_______ is clinically present with history of pancreatitis , persistent pain, and elevated amylase

A

pseudocysts

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29
Q

most common location for pseudocysts

A

lesser sac - anterior to the pancreas and posterior to the stomach

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30
Q

second most common location for pseudocysts

A

anterior pararenal space (posterior to the lesser sac, bounded by Gerota’s fascia)

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31
Q

sonographic appearance of pseudocysts

A
  • well defined masses sonolucent and echo-free
  • debris within may occur from infection or hemorrhage
  • thick echogenic walls; calcification may develop
  • differential diagnosis is a fluid-filled stomach
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32
Q

three classification of pseudocysts

A
  • septated-multiple septations
  • excessive internal echoes-inflammatory mass, hemorrhage or clot formation
  • psudocyst with absence of posterior enhancement caused by the rim of calcification
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33
Q

is a rapid progression of acute pancreatitis with rupture of pancreatic vessels and subseaquent hemorrhage

A

hemorrhagic pancreatitis

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34
Q

caused by a sudden escape of active pancreatic enzymes into the glandular parenchyma
-results in focal areas of fat necrosis in and around the pancreas, which leads to rupture of vessels and hemorrhage

A

hemorrhagic pancreatitis

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35
Q

clinical symptoms of hemorrhagic pancreatitis

A
  • decreased in hematocrit and serum calcium level

- intense pain, hypotension, shock, and ileus

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36
Q

sonographic findings of hemorrhagic pancreatitis

A
  • depends on age of hemorrhage

- seen as a well-defined homogeneous mass

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37
Q
  • (focal pancreatitis) is an inflammatory mass formed by edema and leakage of pancreatic enzymes-diffuse infection
  • a spreading inflammatory reaction to an infection which forms a suppurative lesion
A

phlegmon pancreatitis

38
Q

this may lead to necrosis and suppuration and forms as a complication of acute pancreatitis

A

phlegmon pancreatitis

39
Q

sonographic findings of phlegmon pancreatitis

A

-hyopechoic with good through transmission

40
Q

infection that usually develops secondary to pancreatitis from post-operative procedures

A

pancreatic abscess

41
Q

sonographic findings of pancreatic abscess

A

-variable and depends on the amount of pus and debris

42
Q
  • results in pancreatic pseudocyst

- the by-product of tissue destruction

A

autodigestion of the pancreas

43
Q
  • produces pus or purulent matter

- sonographically will appear hypoechoic

A

suppurating pancreas

44
Q

progressive destruction of the pancreatic tissue caused by repeated attacks of acute pancreatitis

A

chronic pancreatitis

45
Q

chronic pancreatitis is associated with…

A
  • alcoholism (most common)

- patients with hypercalemia and hyperlipidemia

46
Q

complications of chronic pancreatitis

A
  • pseudocyst
  • dilated common bile duct
  • thrombosis of the splenic and portal vein
  • increased risk of developing pancreatic cancer
47
Q

sonographic findings of chronic pancreatitis

A
  • most common -small and echogenic gland -not imaged well
  • bile and pancreatic ductal dilation
  • calcification
48
Q

** elevation of serum amylase and lipase are found only during _______ attacks of pancreatitis

A

acute

49
Q

congenital cyst, most are multiple and are associated with underlying congenital diseases that primary effect other organ systems.

A

pancreatic cysts

50
Q

examples of pancreatic cysts

A
  • Von-Hippel-Lindau syndrome

- adult polycystic kidney disease

51
Q

true cysts arise from within the gland and are lined by __________

A

epithelium

52
Q

a hereditary disease that causes excessive production of the thick mucus
-organs such as lungs, pancreas, and intestines become clogged with mucous

A

cystic fibrosis

53
Q

cystic fibrosis is typically diagnosed in….

A

children and young adults

54
Q

sonographic findings of cystic fibrosis

A
  • increased pancreatic echogenicity
  • gland atrophy
  • fibrosis and fatty replacement
  • cysts due to ductal obstruction
55
Q

most common primary malignant pancreatic tumor

-increased risk with smokers

A

adenocarcinoma

56
Q

most common location for adenocarcinoma

A

head

57
Q

clinical symptoms of adenocarcinoma

A
  • pain radiating to back
  • weight loss, jaundice, lack of appetite N&V, stool changes
  • painless jaundice if the tumor is located in the head
  • palpable RUQ mass (Courvoiser’s sign)
58
Q

lap findings for adenocarcinoma

A

-elevated conjugated bilirubin, alkaline phosphatase, amylase, lipase, and GGT

59
Q

surgery to remove pancreatic head, duodenum, portion of bile duct, and the gallbaldder

A

Whipple procedure

60
Q
  • an uncommon variant of adenocarcinoma
  • also known as **colloid carcinoma
  • produces a large volume mucin
A

Mucinous Adenocarcinoma

61
Q

sonographic findings of mucinous adenocarcinoma

A
  • cystic appearance
  • tumor calcification
  • obstructed bile ducts
62
Q

mucinous adenocarcinoma has a ______ prognosis

A

poor

63
Q
  • rare, benign lesion
  • multiple small cysts (tiny cysts appear echogenic)
  • cluster of grapes appearance
  • frequently found in elderly women
A

adenomas

64
Q

adenomas are associated with _________ syndrome

A

von Hippel-Lindau

65
Q
  • middle aged females and older females
  • malignant or potentially malignant
  • consist of large cysts with or without septations
A

mucinous cystic tumor (macrocystic neoplasms)

66
Q

sonographic appearance of adenomas

A
  • well-defined, multicystic mass (large mass)
  • may have an associated solid component
  • increased CEA (carinoembryonic antigen)
67
Q

always associate the word mucinous with the potential to be ________

A

malignant

68
Q

-a form of mucinous cystic neoplam and originates from the main pancreatic duct or its branches

A

intraductal papillary mucinous tumor

69
Q
  • slow growing lesion that affects men and women in the 6th and 7th decades
  • may be benign or malignant
  • difficult to differentiate from pancreatitis
A

intraductal papillary mucinous tumor

70
Q

clinical symptoms of intraductal papillary tumor

A
  • abdominal pain

- elevated serum amylase

71
Q

tumors of the pancreatic islet cells are _______

A

uncommon

72
Q

types of islet cell tumors…

A
  • functional or non-functional

- classified as benign or malignant

73
Q

non-functioning islet cell tumors have a slow growth rate and comprise ____ of isle cell tumors. ___% are malignant

A

1/3, 92

74
Q

most common location for islet cell tumors

A

body or tail

75
Q

islet cell tumors may be isolated or associated with…

A

multiple endocrine neoplasia syndrome type 1

76
Q
    • most common functioning islet cell tumor

- usually benign

A

insulinoma

77
Q

clinical triad
-fasting hyopglycemia, symptoms of hypoglycemia (due to hyperinsulinemia), and immediate relief of symptoms after administration of IV glucose

A

insulinoma

78
Q

clinical symptoms of insulinoma

A
  • palpitations, headache, confusion, pallor, sweating, slurred speech, weight loss, and coma
  • very tired
79
Q

usually small, well encapsulated and hypervascular

A

insulinoma

80
Q

second most common functioning islet cell tumor and produces the zollinger-Ellison syndrome

A

Gastroinoma Zollinger-Ellison Syndrome

81
Q

caused by non-insulin-secreating pancreatic tumors, which secrete excessive amounts of gastrin

A

Gastroinoma Zollinger-Ellison Syndrome

82
Q

usually effects young adults with peptic ulcer disease

  • gastric acid hypersecreation
  • gastric and duodenal ulceration
A

Gastroinoma Zollinger-Ellison Syndrome

83
Q

frequently multiple and malignant, extrahepatic and difficult to locate
most are found in the pancreas with a small amount arising in the duodenum

A

Gastroinoma Zollinger-Ellison Syndrome

84
Q

parapancreatic neoplasms

A
  • lymphomas-malignant neoplasms that rise from the lymphoid tissues
  • lymphangiomas
  • paragancliomas
  • cystic teratomas
  • metastases (uncommon)
85
Q

most frequent parapancreatic neoplasm

A

lymphomas-malignant neoplasms that rise from the lymphoid tissues

86
Q

most pancreatic pathology is

A

hyopechoic

87
Q
  • enlarged and hyopechoic
  • gallstones and alcohol abuse
  • gallstones or bile obstruction
A

**acute pancreatitis

88
Q
  • calcification
  • n/a
  • chronic calcifications caused by alcoholism not gallstones
  • pseudocysts (25-40% develop pseudocysts)
A

**chronic pancreatitis

89
Q
  • renal cysts/pancreatic cysts (body)
  • n/a
  • inherited family risk
A

**von Hippel Landau

90
Q
  • history of pancreatitis
  • rarely cystic associated with adenocarcinoma
  • increased risk in women
  • large majority associated with alcoholic pancreatitis
A

**pancreatic pseudocyst

91
Q
  • n/a
  • most common are insulinomas (usually benign) and gastrinomas (usually malignant)
A

**Islet Cell Tumors

Abdomen Pathology (9 decks)

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