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Small Parts > Pancreatic & Adrenal > Flashcards

Pancreatic & Adrenal Flashcards

1
Q

What is a pancreatic acquired cyst? What differentiates it from other cysts?

A
  • arises from within the gland, contains epithelial lining
  • more concerning than cysts in other organs, must be followed up
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2
Q

What is cystic fibrosis?

A
  • congenital disease that affects lungs/digestive system
  • endocrine glands produce excessive thick mucus
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3
Q

How many people are diagnosed with CF yearly in the US?

A

30k, 75% under 2

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4
Q

How does CF affect the pancreas?

A
  • MC involved abd organ
  • can lead to acute pancreatitis
  • undergoes fatty replacement
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5
Q

What is the sono app of the pancreas with CF?

A
  • echogenic
  • calcs in 7% of pts
  • cysts <3 mm diam
  • well-defined serous mass
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6
Q

What causes acute pancreatitis?

A
  • booze: alcoholism MC
  • blood: trauma, surg intervention
  • bile: biliary disease MC, cholelithiasis
  • bug: infectious process
  • birth: congenital
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7
Q

What are additional risk factors for acute pancreatitis?

A
  • CF
  • panc cancer
  • duodenal reflux
  • metabolic disorders
  • drug exposure
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8
Q

What are S&S of acute pancreatitis?

A
  • severe pain radiating to back
  • fever, sweating
  • N/V
  • gaseous distention
  • ileus
  • acute respiratory distress syndrome
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9
Q

What is ileus?

A

Bowel obstruction of ileum segment

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10
Q

What lab values are elevated with acute pancreatitis?

A
  • serum and urine amylase
  • serum lipase
  • WBC
  • bilirubin
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11
Q

What complications result from acute pancreatitis?

A
  • pseudocyst formation
  • phlegmon
  • abscess
  • hemorrhage
  • biliary/duodenal obstruction
  • fluid collections
  • acute peritonitis
  • thrombosis of PS veins
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12
Q

What is the sono app of acute pancreatitis?

A
  • diffuse enlargement with loss of normal echotexture
  • focal enlargement
  • iso to liver
  • poor visualization of splenic vein
  • dilation or compression of panc duct
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13
Q

What is phlegmonous pancreatitis?

A
  • severe complication of acute pancreatitis
  • noninfected solid mass of inflamed pancreatic tissue
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14
Q

What are S&S of phlegmonous pancreatitis?

A
  • same as acute
  • palp epigastric mass
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15
Q

What is the sono app of phlegmonous pancreatitis?

A
  • solid hypo mass
  • mistaken for other panc masses/pseuocyst
  • easily visualized on CT
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16
Q

What is hemorrhagic pancreatitis?

A
  • late stage complication of acute pancreatitis
  • bleeding within or around panc
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17
Q

What are S&S of hemorrhagic pancreatitis?

A
  • severe abdominal pain
  • N/V
  • abd distention
  • ileus
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18
Q

What lab values indicated hemorrhagic pancreatitis?

A
  • elevated serum amylase and serum lipase
  • decreased hematocrit and serum calcium
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19
Q

What is the sono app of hemorrhagic pancreatitis?

A

acute: anechoic
progression: echogenic
well-defined homogenous mass in area of panc

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20
Q

What is chronic pancreatitis?

A

Repeated, persistent or prolonged episodes of acute pancreatitis

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21
Q

What are 3 outcomes of permanent damage from chronic pancreatitis?

A
  1. poor absorption of food leading to weight loss
  2. pain
  3. diabetes from damaged islets of Langerhans
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22
Q

What are risk factors for chronic pancreatitis?

A
  • men more likely, usually 30s-40s
  • cholelithiasis
  • panc malignancy
  • trauma
  • CF, lupus
  • hypercalcemia
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23
Q

What are S&S of chronic pancreatitis?

A
  • chronic epi/RUQ pain radiating to back
  • aggravated by fatty foods and alcohol
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24
Q

What is the sono app of chronic pancreatitis?

A
  • heterogenous, hyper
  • dilated panc duct
  • calcs
  • extrahepatic biliary dilation
  • atrophic
  • PS vein thrombus
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25
Q

What is the most life threatening complication of pancreatitis?

A

abscess

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26
Q

Where do pancreatic abscesses form?

A

Areas of poor vascularity

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27
Q

What are S&S of pancreatic abscess?

A
  • fever, chills
  • leukocytosis
  • hypotension
  • tender abdomen
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28
Q

What is the sono app of panc abscess?

A
  • hypo mass
  • smooth or irregular walls
  • echogenic or anechoic depending on age
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29
Q

What is a pseudocyst?

A
  • Fluid collection arising from inflammatory processes, necrosis or hemorrhage
  • Complication of pancreatitis or trauma
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30
Q

What are S&S of pseudocyst?

A
  • abd pain
  • N/V
  • asymptomatic
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31
Q

What is the sono app of pseudocyst?

A
  • usually panc tail
  • usually anechoic with enhancement
  • complex
  • debris within cystic component
  • multiloculated
  • prone to rupture secondary to abscess or peritonitis
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32
Q

What is cystadenoma?

A
  • solitary or multiple cysts
  • rare, benign lesion
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33
Q

What is cystadenoma AKA?

A

microcystic or serous adenoma

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34
Q

Who gets cystadenoma? S&S?

A
  • Women ~70s
  • associated with von Hippel-Lindau
  • elevated serum amylase
35
Q

What is von Hippel-Lindau?

A

Autosomal dominant condition that can cause asymptomatic pancreatic cysts with possible thick fluid and calcs

36
Q

What is the sono app of cystadenoma?

A
  • anechoic mass with enhancement
  • internal septa
  • thick walls
  • small size, difficult to visualize
  • usually located in body or tail
37
Q

What is cystadenocarcinoma?

A
  • rare, slow growing tumor arising from panc ducts as cystic neoplasm
  • pre-malignant or malignant
38
Q

Who gets cystadenocarcinoma? S&S?

A
  • Women ~50s
  • diabetes and HTN
  • epi pain or palp mass
39
Q

What is the sono app of cystadenocarcinoma?

A
  • irregular, loculated cystic tumor
  • thick walls
  • hypo mass
40
Q

What is adenocarcinoma?

A
  • Most common pancreatic neoplasm
  • produces large volume of mucin
  • poor prognosis
41
Q

What is adenocarcinoma AKA?

A

mucinous or colloid carcinoma

42
Q

Who is more likely to get adenocarcinoma?

A

men

43
Q

What are S&S of adenocarcinoma?

A
  • late onset of symptoms
  • weight loss, loss of appetite
  • N/V, stool chanes
  • radiating back pain
  • painless jaundice
  • onset of diabetes
  • mets
44
Q

What is the sono app of adenocarcinoma?

A
  • loss of normal parenchyma
  • hypo poorly defined mass
  • focal mass with irregular borders
  • enlarged pancreas
45
Q

When scanning adenocarcinoma, what should you do if mass is located at panc head?

A

Look for hydrops, compressed IVC and bilary dilation

46
Q

Who is eligible for whipple procedure?

A

patients with adenocarcinoma at panc head with hydrops, compressed IVC, and bilary dilation

47
Q

What is the difference between functional and nonfunctional Islet Cell Tumors?

A

functional: produce hormone response to tumor
nonfunctional: do not produce symptoms, typically malignant

48
Q

How often are Islet Cell Tumors malignant?

A

90% of the time

49
Q

What are S&S of insulinoma?

A

hypoglycemia, MC IST

50
Q

What are S&S of gastrinoma?

A

diarrhea and peptic ulcers

51
Q

What are S&S of glucagonoma?

A

rash

52
Q

What is the sono app of Islet Cell Tumor?

A
  • usually in body/tail
  • small mass
  • contour change
53
Q

What are the best modalities for pancreatic imaging?

A

MRI and CT

54
Q

When do adrenal glands develop?

A

6 weeks gest

55
Q

What are the two main components of adrenal anatomy?

A

cortex (outer) medulla (inner)

56
Q

What are the three zones of the adrenal cortex?

A

Outer to inner:
- zona glomerulosa
- zona fasciculata
- zona reticularis

57
Q

Where are adrenal glands located?

A

retroperitoneally, immediately superior to kidneys

58
Q

What is the main variant in adrenal gland anatomy?

A

Agenesis, uni or bilateral, bilateral = major hormonal problems

59
Q

When are adrenal glands able to be visualized on US?

A
  • neonatal/pedi stage
  • size decreases rapidly in first 10 days of life
60
Q

What shape are adrenal glands?

A

V or Y shaped

61
Q

How do the adrenal medulla and cortex appear on US?

A

medulla: thin, echogenic stripe
cortex: prominent, hypo outer layer

62
Q

What are the physiologic functions of adrenal glands?

A

regulate:
- blood pressure
- blood sugar
- immune response
- stress response

63
Q

What hormones are secreted by the adrenal cortex?

A
  • steroids
  • mineralocorticoids
  • glucocorticoids
  • gonadal hormones
64
Q

What hormones are secreted by the adrenal medulla?

A
  • catecholamines: epinephrine, norepinephrine
  • endocrine glands
65
Q

What is aldosterone?

A
  • steroid
  • regulates salt and water, blood pressure
66
Q

What is cortisol?

A

-steroid that increases neurologic use of glucose
- aids in fight or flight

67
Q

What is ACTH?

A
  • adrenocorticotropic hormone
  • regulates production of cortisol
68
Q

What are catecholamines?

A
  • produced by stress
  • epi, norepi, dopamine
69
Q

What are metanephrines?

A
  • metabolic by-product of catecholamines
  • excreted in urine and blood
70
Q

What is VMA?

A
  • vanillylmandeic acid
  • metabolic by-product of epi/norep
  • used to detect neuroblastoma
71
Q

What causes adrenal hyperfunction?

A

Cushing’s disease: pituitary tumor causes elevated ACTH, results in excessive cortisol
Conn’s disease: excessive production of aldosterone

72
Q

What causes adrenal hypofunction?

A

Addison’s disease: abnormally low production of cortisol and aldosterone

73
Q

What is adrenal adenoma?

A

Benign growth of epithelial tissue

74
Q

What are S&S of adrenal adenoma?

A
  • asymptomatic
  • Cushing’s disease
  • Conn’s disease
75
Q

What is the sono app of adrenal adenoma?

A
  • focal mass
  • uni or bilateral
  • variable size/echogenicity
76
Q

What is adrenal adenocarcinoma?

A

malignant growth of epithelial tissue

77
Q

What are S&S of adrenal adenocarcinoma?

A
  • asymptomatic
  • Cushing’s disease
  • Conn’s disease
  • precocious puberty
78
Q

What is the sono app of adrenal adenocarcinoma?

A
  • variable size/echogenicity
  • complex
  • calcs
79
Q

What is neuroblastoma?

A
  • Pediatric sarcoma arising from medulla
  • MC childhood malignancy
80
Q

What are S&S of neuroblastoma?

A
  • asymptomatic
  • palpable mass
  • weight loss
  • pallor
  • fever, tachycardia, sweats
  • HTN
81
Q

What is the sono app of neuroblastoma?

A
  • focal mass
  • hetero
  • calcs
  • renal displacement
82
Q

How is tuberculosis related to adrenal glands?

A

Adrenals are most commonly involved organs, results from adrenal insufficiency (Addison’s disease)

83
Q

What is histoplasmosis?

A

Inhalation of fungal spores, causes adrenal insufficiency

84
Q

What is cytomegalovirus?

A

Life-long virus, adrenals gland are highly sensitive, causes adrenal insufficiency and adrenitis

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