Pancreatic & Adrenal Flashcards
What is a pancreatic acquired cyst? What differentiates it from other cysts?
- arises from within the gland, contains epithelial lining
- more concerning than cysts in other organs, must be followed up
What is cystic fibrosis?
- congenital disease that affects lungs/digestive system
- endocrine glands produce excessive thick mucus
How many people are diagnosed with CF yearly in the US?
30k, 75% under 2
How does CF affect the pancreas?
- MC involved abd organ
- can lead to acute pancreatitis
- undergoes fatty replacement
What is the sono app of the pancreas with CF?
- echogenic
- calcs in 7% of pts
- cysts <3 mm diam
- well-defined serous mass
What causes acute pancreatitis?
- booze: alcoholism MC
- blood: trauma, surg intervention
- bile: biliary disease MC, cholelithiasis
- bug: infectious process
- birth: congenital
What are additional risk factors for acute pancreatitis?
- CF
- panc cancer
- duodenal reflux
- metabolic disorders
- drug exposure
What are S&S of acute pancreatitis?
- severe pain radiating to back
- fever, sweating
- N/V
- gaseous distention
- ileus
- acute respiratory distress syndrome
What is ileus?
Bowel obstruction of ileum segment
What lab values are elevated with acute pancreatitis?
- serum and urine amylase
- serum lipase
- WBC
- bilirubin
What complications result from acute pancreatitis?
- pseudocyst formation
- phlegmon
- abscess
- hemorrhage
- biliary/duodenal obstruction
- fluid collections
- acute peritonitis
- thrombosis of PS veins
What is the sono app of acute pancreatitis?
- diffuse enlargement with loss of normal echotexture
- focal enlargement
- iso to liver
- poor visualization of splenic vein
- dilation or compression of panc duct
What is phlegmonous pancreatitis?
- severe complication of acute pancreatitis
- noninfected solid mass of inflamed pancreatic tissue
What are S&S of phlegmonous pancreatitis?
- same as acute
- palp epigastric mass
What is the sono app of phlegmonous pancreatitis?
- solid hypo mass
- mistaken for other panc masses/pseuocyst
- easily visualized on CT
What is hemorrhagic pancreatitis?
- late stage complication of acute pancreatitis
- bleeding within or around panc
What are S&S of hemorrhagic pancreatitis?
- severe abdominal pain
- N/V
- abd distention
- ileus
What lab values indicated hemorrhagic pancreatitis?
- elevated serum amylase and serum lipase
- decreased hematocrit and serum calcium
What is the sono app of hemorrhagic pancreatitis?
acute: anechoic
progression: echogenic
well-defined homogenous mass in area of panc
What is chronic pancreatitis?
Repeated, persistent or prolonged episodes of acute pancreatitis
What are 3 outcomes of permanent damage from chronic pancreatitis?
- poor absorption of food leading to weight loss
- pain
- diabetes from damaged islets of Langerhans
What are risk factors for chronic pancreatitis?
- men more likely, usually 30s-40s
- cholelithiasis
- panc malignancy
- trauma
- CF, lupus
- hypercalcemia
What are S&S of chronic pancreatitis?
- chronic epi/RUQ pain radiating to back
- aggravated by fatty foods and alcohol
What is the sono app of chronic pancreatitis?
- heterogenous, hyper
- dilated panc duct
- calcs
- extrahepatic biliary dilation
- atrophic
- PS vein thrombus
What is the most life threatening complication of pancreatitis?
abscess
Where do pancreatic abscesses form?
Areas of poor vascularity
What are S&S of pancreatic abscess?
- fever, chills
- leukocytosis
- hypotension
- tender abdomen
What is the sono app of panc abscess?
- hypo mass
- smooth or irregular walls
- echogenic or anechoic depending on age
What is a pseudocyst?
- Fluid collection arising from inflammatory processes, necrosis or hemorrhage
- Complication of pancreatitis or trauma
What are S&S of pseudocyst?
- abd pain
- N/V
- asymptomatic
What is the sono app of pseudocyst?
- usually panc tail
- usually anechoic with enhancement
- complex
- debris within cystic component
- multiloculated
- prone to rupture secondary to abscess or peritonitis
What is cystadenoma?
- solitary or multiple cysts
- rare, benign lesion
What is cystadenoma AKA?
microcystic or serous adenoma
Who gets cystadenoma? S&S?
- Women ~70s
- associated with von Hippel-Lindau
- elevated serum amylase
What is von Hippel-Lindau?
Autosomal dominant condition that can cause asymptomatic pancreatic cysts with possible thick fluid and calcs
What is the sono app of cystadenoma?
- anechoic mass with enhancement
- internal septa
- thick walls
- small size, difficult to visualize
- usually located in body or tail
What is cystadenocarcinoma?
- rare, slow growing tumor arising from panc ducts as cystic neoplasm
- pre-malignant or malignant
Who gets cystadenocarcinoma? S&S?
- Women ~50s
- diabetes and HTN
- epi pain or palp mass
What is the sono app of cystadenocarcinoma?
- irregular, loculated cystic tumor
- thick walls
- hypo mass
What is adenocarcinoma?
- Most common pancreatic neoplasm
- produces large volume of mucin
- poor prognosis
What is adenocarcinoma AKA?
mucinous or colloid carcinoma
Who is more likely to get adenocarcinoma?
men
What are S&S of adenocarcinoma?
- late onset of symptoms
- weight loss, loss of appetite
- N/V, stool chanes
- radiating back pain
- painless jaundice
- onset of diabetes
- mets
What is the sono app of adenocarcinoma?
- loss of normal parenchyma
- hypo poorly defined mass
- focal mass with irregular borders
- enlarged pancreas
When scanning adenocarcinoma, what should you do if mass is located at panc head?
Look for hydrops, compressed IVC and bilary dilation
Who is eligible for whipple procedure?
patients with adenocarcinoma at panc head with hydrops, compressed IVC, and bilary dilation
What is the difference between functional and nonfunctional Islet Cell Tumors?
functional: produce hormone response to tumor
nonfunctional: do not produce symptoms, typically malignant
How often are Islet Cell Tumors malignant?
90% of the time
What are S&S of insulinoma?
hypoglycemia, MC IST
What are S&S of gastrinoma?
diarrhea and peptic ulcers
What are S&S of glucagonoma?
rash
What is the sono app of Islet Cell Tumor?
- usually in body/tail
- small mass
- contour change
What are the best modalities for pancreatic imaging?
MRI and CT
When do adrenal glands develop?
6 weeks gest
What are the two main components of adrenal anatomy?
cortex (outer) medulla (inner)
What are the three zones of the adrenal cortex?
Outer to inner:
- zona glomerulosa
- zona fasciculata
- zona reticularis
Where are adrenal glands located?
retroperitoneally, immediately superior to kidneys
What is the main variant in adrenal gland anatomy?
Agenesis, uni or bilateral, bilateral = major hormonal problems
When are adrenal glands able to be visualized on US?
- neonatal/pedi stage
- size decreases rapidly in first 10 days of life
What shape are adrenal glands?
V or Y shaped
How do the adrenal medulla and cortex appear on US?
medulla: thin, echogenic stripe
cortex: prominent, hypo outer layer
What are the physiologic functions of adrenal glands?
regulate:
- blood pressure
- blood sugar
- immune response
- stress response
What hormones are secreted by the adrenal cortex?
- steroids
- mineralocorticoids
- glucocorticoids
- gonadal hormones
What hormones are secreted by the adrenal medulla?
- catecholamines: epinephrine, norepinephrine
- endocrine glands
What is aldosterone?
- steroid
- regulates salt and water, blood pressure
What is cortisol?
-steroid that increases neurologic use of glucose
- aids in fight or flight
What is ACTH?
- adrenocorticotropic hormone
- regulates production of cortisol
What are catecholamines?
- produced by stress
- epi, norepi, dopamine
What are metanephrines?
- metabolic by-product of catecholamines
- excreted in urine and blood
What is VMA?
- vanillylmandeic acid
- metabolic by-product of epi/norep
- used to detect neuroblastoma
What causes adrenal hyperfunction?
Cushing’s disease: pituitary tumor causes elevated ACTH, results in excessive cortisol
Conn’s disease: excessive production of aldosterone
What causes adrenal hypofunction?
Addison’s disease: abnormally low production of cortisol and aldosterone
What is adrenal adenoma?
Benign growth of epithelial tissue
What are S&S of adrenal adenoma?
- asymptomatic
- Cushing’s disease
- Conn’s disease
What is the sono app of adrenal adenoma?
- focal mass
- uni or bilateral
- variable size/echogenicity
What is adrenal adenocarcinoma?
malignant growth of epithelial tissue
What are S&S of adrenal adenocarcinoma?
- asymptomatic
- Cushing’s disease
- Conn’s disease
- precocious puberty
What is the sono app of adrenal adenocarcinoma?
- variable size/echogenicity
- complex
- calcs
What is neuroblastoma?
- Pediatric sarcoma arising from medulla
- MC childhood malignancy
What are S&S of neuroblastoma?
- asymptomatic
- palpable mass
- weight loss
- pallor
- fever, tachycardia, sweats
- HTN
What is the sono app of neuroblastoma?
- focal mass
- hetero
- calcs
- renal displacement
How is tuberculosis related to adrenal glands?
Adrenals are most commonly involved organs, results from adrenal insufficiency (Addison’s disease)
What is histoplasmosis?
Inhalation of fungal spores, causes adrenal insufficiency
What is cytomegalovirus?
Life-long virus, adrenals gland are highly sensitive, causes adrenal insufficiency and adrenitis
