Pancreas Pathology Ch 12 Flashcards
1
Q
digestive enzyme for carbohydrates, produced by the pancreas, parotid glands, gynecologic system and bowel
A
serum amylase
2
Q
serum amylase level of _____ normally usually indicates acute pancreatitis
A
twice
3
Q
may be seen in pancreatitis, is excreted by the kidneys and elevation may be seen in renal disease
A
urine amylase
4
Q
- excreted specifically by the pancreas
- elevated in acute pancreatitis and carcinoma of the pancreas
A
lipase
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
6
Q
may be elevated with obstruction of the pancreatic duct, pancreatic carcinoma, and acute cholceystitis
A
lipase
7
Q
-controls the blood sugar level in the body
A
glucose
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
9
Q
pancreas is both digestive (_______) and hormonal (_______) gland.
A
exocrine, endocrine
10
Q
production and digestion of pancreatic juice; primary function of the pancreas
A
exocrine
11
Q
production of the hormone insulin
A
endocrine
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
13
Q
gallstones are present _____% with acute pancreatitis
A
40-60
14
Q
what is increased in acute pancreatitis
A
serum amylase, lipase, and white blood cells
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
16
Q
sonographic findings of acute pancreatitis
A
- enlarged
- hypoechoic to anechoic due to edema
- borders somewhat indistinct but smooth
17
Q
pancreatic ________ and _______ pancreatic echogenicity are sonographic landmarks for acute pancreatitis
A
enlargement, decreased
18
Q
_______ and ______ are frequent in patients with severe acute pancreatitis
A
fluid collections, edema
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
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
21
Q
space seen with sonography
A
perirenal space
22
Q
space best demonstrated in sagittal view
A
anterior pararenal space
23
Q
are the accumulation of pancreatic fluid and necrotic debris confined by the retroperitoneum.
A
pseudocysts
24
Q
pseudocysts contain high amounts of ….
A
-amylase, lipase, and trysin
25
pseudocysts usually develop over ______ weeks after onset of pancreatitis
4-6 weeks
26
common causes of pseudocysts are....
-chronic pancretitis, acute pancreatitis, pancreatic trauma, pancreatic ductal obstruction and pancreatic neoplasms
27
most common complication of acute pancreatis
pseudocysts
28
_______ is clinically present with history of pancreatitis , persistent pain, and elevated amylase
pseudocysts
29
most common location for pseudocysts
lesser sac - anterior to the pancreas and posterior to the stomach
30
second most common location for pseudocysts
anterior pararenal space (posterior to the lesser sac, bounded by Gerota's fascia)
31
sonographic appearance of pseudocysts
- 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
32
three classification of pseudocysts
- septated-multiple septations
- excessive internal echoes-inflammatory mass, hemorrhage or clot formation
- psudocyst with absence of posterior enhancement caused by the rim of calcification
33
is a rapid progression of acute pancreatitis with rupture of pancreatic vessels and subseaquent hemorrhage
hemorrhagic pancreatitis
34
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
hemorrhagic pancreatitis
35
clinical symptoms of hemorrhagic pancreatitis
- decreased in hematocrit and serum calcium level
| - intense pain, hypotension, shock, and ileus
36
sonographic findings of hemorrhagic pancreatitis
- depends on age of hemorrhage
| - seen as a well-defined homogeneous mass
37
- (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
phlegmon pancreatitis
38
this may lead to necrosis and suppuration and forms as a complication of acute pancreatitis
phlegmon pancreatitis
39
sonographic findings of phlegmon pancreatitis
-hyopechoic with good through transmission
40
infection that usually develops secondary to pancreatitis from post-operative procedures
pancreatic abscess
41
sonographic findings of pancreatic abscess
-variable and depends on the amount of pus and debris
42
- results in pancreatic pseudocyst
| - the by-product of tissue destruction
autodigestion of the pancreas
43
- produces pus or purulent matter
| - sonographically will appear hypoechoic
suppurating pancreas
44
progressive destruction of the pancreatic tissue caused by repeated attacks of acute pancreatitis
chronic pancreatitis
45
chronic pancreatitis is associated with...
- alcoholism (most common)
| - patients with hypercalemia and hyperlipidemia
46
complications of chronic pancreatitis
- pseudocyst
- dilated common bile duct
- thrombosis of the splenic and portal vein
- increased risk of developing pancreatic cancer
47
sonographic findings of chronic pancreatitis
- most common -small and echogenic gland -not imaged well
- bile and pancreatic ductal dilation
- calcification
48
** elevation of serum amylase and lipase are found only during _______ attacks of pancreatitis
acute
49
congenital cyst, most are multiple and are associated with underlying congenital diseases that primary effect other organ systems.
pancreatic cysts
50
examples of pancreatic cysts
- Von-Hippel-Lindau syndrome
| - adult polycystic kidney disease
51
true cysts arise from within the gland and are lined by __________
epithelium
52
a hereditary disease that causes excessive production of the thick mucus
-organs such as lungs, pancreas, and intestines become clogged with mucous
cystic fibrosis
53
cystic fibrosis is typically diagnosed in....
children and young adults
54
sonographic findings of cystic fibrosis
- increased pancreatic echogenicity
- gland atrophy
- fibrosis and fatty replacement
- cysts due to ductal obstruction
55
most common primary malignant pancreatic tumor
| -increased risk with smokers
adenocarcinoma
56
most common location for adenocarcinoma
head
57
clinical symptoms of adenocarcinoma
- 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
lap findings for adenocarcinoma
-elevated conjugated bilirubin, alkaline phosphatase, amylase, lipase, and GGT
59
surgery to remove pancreatic head, duodenum, portion of bile duct, and the gallbaldder
Whipple procedure
60
- an uncommon variant of adenocarcinoma
- also known as **colloid carcinoma
- produces a large volume mucin
Mucinous Adenocarcinoma
61
sonographic findings of mucinous adenocarcinoma
- cystic appearance
- tumor calcification
- obstructed bile ducts
62
mucinous adenocarcinoma has a ______ prognosis
poor
63
- rare, benign lesion
- multiple small cysts (tiny cysts appear echogenic)
- cluster of grapes appearance
- frequently found in elderly women
adenomas
64
adenomas are associated with _________ syndrome
von Hippel-Lindau
65
- middle aged females and older females
- malignant or potentially malignant
- consist of large cysts with or without septations
mucinous cystic tumor (macrocystic neoplasms)
66
sonographic appearance of adenomas
- well-defined, multicystic mass (large mass)
- may have an associated solid component
- increased CEA (carinoembryonic antigen)
67
always associate the word mucinous with the potential to be ________
malignant
68
-a form of mucinous cystic neoplam and originates from the main pancreatic duct or its branches
intraductal papillary mucinous tumor
69
- slow growing lesion that affects men and women in the 6th and 7th decades
- may be benign or malignant
- difficult to differentiate from pancreatitis
intraductal papillary mucinous tumor
70
clinical symptoms of intraductal papillary tumor
- abdominal pain
| - elevated serum amylase
71
tumors of the pancreatic islet cells are _______
uncommon
72
types of islet cell tumors...
- functional or non-functional
| - classified as benign or malignant
73
non-functioning islet cell tumors have a slow growth rate and comprise ____ of isle cell tumors. ___% are malignant
1/3, 92
74
most common location for islet cell tumors
body or tail
75
islet cell tumors may be isolated or associated with...
multiple endocrine neoplasia syndrome type 1
76
* * most common functioning islet cell tumor
| - usually benign
insulinoma
77
clinical triad
-fasting hyopglycemia, symptoms of hypoglycemia (due to hyperinsulinemia), and immediate relief of symptoms after administration of IV glucose
insulinoma
78
clinical symptoms of insulinoma
- palpitations, headache, confusion, pallor, sweating, slurred speech, weight loss, and coma
- very tired
79
usually small, well encapsulated and hypervascular
insulinoma
80
second most common functioning islet cell tumor and produces the zollinger-Ellison syndrome
Gastroinoma Zollinger-Ellison Syndrome
81
caused by non-insulin-secreating pancreatic tumors, which secrete excessive amounts of gastrin
Gastroinoma Zollinger-Ellison Syndrome
82
usually effects young adults with peptic ulcer disease
- gastric acid hypersecreation
- gastric and duodenal ulceration
Gastroinoma Zollinger-Ellison Syndrome
83
frequently multiple and malignant, extrahepatic and difficult to locate
most are found in the pancreas with a small amount arising in the duodenum
Gastroinoma Zollinger-Ellison Syndrome
84
parapancreatic neoplasms
- lymphomas-malignant neoplasms that rise from the lymphoid tissues
- lymphangiomas
- paragancliomas
- cystic teratomas
- metastases (uncommon)
85
most frequent parapancreatic neoplasm
lymphomas-malignant neoplasms that rise from the lymphoid tissues
86
most pancreatic pathology is
hyopechoic
87
- enlarged and hyopechoic
- gallstones and alcohol abuse
- gallstones or bile obstruction
**acute pancreatitis
88
- calcification
- n/a
- chronic calcifications caused by alcoholism not gallstones
- pseudocysts (25-40% develop pseudocysts)
**chronic pancreatitis
89
- renal cysts/pancreatic cysts (body)
- n/a
- inherited family risk
**von Hippel Landau
90
- history of pancreatitis
- rarely cystic associated with adenocarcinoma
- increased risk in women
- large majority associated with alcoholic pancreatitis
**pancreatic pseudocyst
91
- n/a
-
- most common are insulinomas (usually benign) and gastrinomas (usually malignant)
**Islet Cell Tumors
