Pathology of Pancreas test 4

Question 0

What is an annular pancreas?

Answer 0

persistence of the dorsal and ventral pancreas with the head encircling the duodenum

congenital abnormality

may cause obstruction

more common in males

Question 1

What is the most common pancreatic anomaly?

Answer 1

ectopic pancreatic tissue

found in the form of of intramural nodules in various places in the GI tract

acute pancreatitis may develop within this tissue

Question 2

What is the failure of fusion of the panc ducts?

Answer 2

pancreatic divisum

unable to accurately diagnosis with ultrasound

Question 3

The pancreas is an _____________ and ___________ gland

Answer 3

excocrine

endocrine

Question 4

As an exocrine gland what kind of cells does the panc have?

Answer 4

numerous, small, glands (ACINI)

aggregate into lobular acini and are separated by connective tissue

Question 5

what enzymes does the pancreas secrete?

Answer 5

trypsin and chymotrypsin are secreted and are important in protein digesting

the enzymes AMYLASE, LIPASE, phospholipase, and elastases are all elaborated by the panc and activated in the duodenum

Question 6

what is amylase enzyme for?

Answer 6

digestive enzume for carbs.

twice the normal value = pancreatitis

Question 7

what is lipase for?

Answer 7

an enzyme excreted specifically by the pancreas

lipase elevates in pancreatic disease

finish slide 37

Question 8

What are the pancreatic exocrine functions?

Answer 8

enzymes of pancreatic juice digestive action

lipase &raquo_space;»»»»»»»> fats

amylase &raquo_space;»»»»»»»»»»>carbohydrates

Trypsin, chymotrypinogen, carboxypeptidase»»>proteins

nucleases &raquo_space;»»»»»»»»»»»»>nucleic acids

Question 9

How is the endocrine function of the pancreas represented/

Answer 9

by the islets of langerhans

Question 10

what is the most important agent of the pancreas?

Answer 10

secretin

Question 11

What is the main hormone produced by the endocrine portion include?

Answer 11

insulin and glucagon

Question 12

What are the cell types in the endocrine aspect?

Answer 12

beta

alpha delta

Question 13

What are the pancreatic endocrine functions?

Answer 13

Panc hormone cell type action

insulin &raquo_space;»»» Beta &raquo_space;»»»»glucose to glycogen

glucagon &raquo_space;»»»»Alpha &raquo_space;»»»glycogen to glucose

somatostatin &raquo_space;»»»Delta &raquo_space;»»»alpha and beta inhibitor

Question 14

what does glucose do?

Answer 14

Controls the blood - sugar level in the body

Question 15

What are the lab values for pancreatitis?

Answer 15

serum amylase rises

urine amylase rises

serum lipase rises - for a longer time

Question 16

how do we scan the pancreas?

Answer 16

NPO 6-8 hrs

3-5MHz transducer with a mid focal zone

peds use 5-7.5 MHz

Question 17

What are some reasons to scan the pancreas?

Answer 17

severe epigastric pain

abd distention

abnormal lab values

unexplained weight loss

nausea and vomiting

Question 18

What do you identify when you scan?

Answer 18

head, neck, body, tail in sag and trv

evaluate shape, contour, lie and texture

Question 19

What technique might help visualize the pancreas?

Answer 19

WATER TECHNIQUE

water or fluid may be used to fill the stomach for better visualization of the pancreatic area

roll to side and then roll back

Question 20

Echogenicity of the pancreas _________ with age.

Answer 20

increases

Question 21

Where is the pancreatic duct seen more?

Answer 21

in the body than in the tail

Question 22

What is the sonographic blood vessel evaluation of the panc head?

Answer 22

The head is to the RIGHT of the SMV

the IVC is POSTERIOR

the GDA is the ANTERIOR LATERAL border

the CBD is LATERAL to the GDA

the PV is CRANIAL to the head

the Uncinate Process is directly POSTERIOR to the SMV

head measurement < or = 3cm

Question 23

What is the blood vessel sonographic evaluation of the panc neck?

Answer 23

the NECK is directly ANTERIOR to the SMV

the PV is formed behind the neck by the JUNCTION of the SMV and Splenic vein

neck measurement < or = 2.5cm

Question 24

How does the pancreatic duct appear sonographically?

Answer 24

as an echogenic line or lucency bordered by two echogenic lines

Question 25

what is the measurement of the pancreatic duct?

Answer 25

2mm

Question 26

Does the pancreatic duct increase or decrease toward the tail?

Answer 26

decreases

Question 27

what might you confuse the pancreatic duct with?

Answer 27

vascular structures

Question 28

What is panreatitis?

Answer 28

inflammation of the pancreas malfunctions due to increased secretion and blockage of ducts pancreatic tissue may be digested by its own enzyme

Question 29

What are the 5 B's of pancreatitis?

Answer 29

Bile - biliary disease (most common) booze - alcoholism second most common blood - trauma bug - infectious process birth - congenital

Question 30

What is the most common cause of pancreatitis in children?

Answer 30

trauma - child abuse others: infectious process toxic exposure hereditary

Question 31

What cells get inflamed in pancreatitis?

Answer 31

acini cells

Question 32

What is the most common complication when the acini cells get inflamed?

Answer 32

pseudocyst risk for abscess and hemorrhage ***most common cause is biliary obstruction*** second common cause is alcoholism

Question 33

What increases with acute pancreastitis?

Answer 33

pancreatic enzymes amylase: increases sig within 24 hrs Lipase: increases within 72-94 hours REMAINS ELEVATED

Question 34

What are the symptoms of acute pancreatitis?

Answer 34

slide 9

Question 35

Can pancreatitis resolve itself?

Answer 35

mild cases can the disease can progress to necrosis and hemorrhage *decrease in hematocrit*

Question 36

What are the sonographic findings of acute pancreatitis?

Answer 36

swelling less echogenic than the liver smooth to indistinct borders anterior compression of the IVC enlargement duct may be obstructed fluid collections may be subtle

Question 37

Acute pancreatitis may obstruct what?

Answer 37

pancreatic duct

Question 38

What is adenopathy?

Answer 38

when the lymph nodes are enlarged

Question 39

What is chronic pancreatitis?

Answer 39

repeated and persistent symptoms: chronic pain nausea and vomiting jaundice weightloss

Question 40

What are the sonographic findings of chronic pancreatitis?

Answer 40

increased echogencity reduced size of the gland **CALCIFICATIONS**

Question 41

What are some reasons for chronic pancreatitis?

Answer 41

recurrent acute hypercalcemia hyperlipidemia fibrotic scarring pseudocysts dilated ducts thrombosis of the splenic vein increased risk of cancer

Question 42

What is a progression of pancreatitis? Finish slide28

Answer 42

Hemorrhagic pancreatitis progression of acute

Question 43

What is Grey Turner's sign?

Answer 43

the hemorrhaging can be seen on the outside discoloration of flanks

Question 44

What is phlegmonous pancreatitis?

Answer 44

areas of edema extension outside the gland in 18-20% extension into the peripancreatic tissue phlegmon -- just oozes into the space...no pseudocyst just a blob of pus

Question 45

How does phlegmonous pancreatitis appear sonographically? finish slide 31

Answer 45

hypoechoic ill defined mass irregular borders involves lesser sac

Question 46

What are the symptoms of pancreatic abscess?

Answer 46

secondary to pancreatitis may spread leukocytosis fever nausea/vomiting

Question 47

how does a pancreatic abscess appear sonographically? finish slide 33

Answer 47

poorly defined hypoechoic mass if air is present = shadowing fluid debis level

Question 48

Are pseudocysts congential or aquired?

Answer 48

aquired not a simple cyst...enzymes are leaking, eventually infection

Question 49

What do pseudocysts arise from? finish slide 34

Answer 49

fluid collections that arise from

Question 50

Where might you find a pseudocyst? finish slide 35-36

Answer 50

form in the potential spaces where enzymes have escaped develop through the lesser omentum and lesser sac

Question 51

What happens if a pseudocyst ruptures?

Answer 51

shock and peritonitis erosion into other organs (because it is filled with enzymes)

Question 52

What are congenital cystic lesions?

Answer 52

associated with underlying congenital disease that affect other organs

Question 53

What is autosomal dominant polycystic disease?

Answer 53

comes from polycystic kidneys and get them in other organs

Question 54

What is Von Hippel-Lindau Disease?

Answer 54

autosomal dominant condition ***central nervous system and retinal hemangioblastomas*** visceral cysts pheochromocytomas renal cell carcinoma pancreatic cysts

Question 55

What is cystic fibrosis?

Answer 55

hereditary disease autosomal recessive excessive production of mucus

Question 56

What does cystic fibrosis look like sonographically?

Answer 56

increase in echogenicity small cysts biliary sludge thick folds in GB

Question 57

What is fibrocystic disease? finish slide 46

Answer 57

is a

Question 58

What is a cystic pancreatic neoplasm?

Answer 58

macrocystic adenoma mucinous: malignant or benign middle age females body and tail well defined cysts with thick fluid and septations or mural nodules

Question 59

What is microcystic adenoma?

Answer 59

slide 48?

Question 60

What is adenocarcinoma? slide 49

Answer 60

most common primary neoplasm exocrine portion 5% of all cancer deaths 4th cause of cancer mortality

Question 61

What is the most common site of adenocarcinoma?

Answer 61

head of the pancreas (60-70%) body (20-30%) tail (5-10%)

Question 62

When there is an adenocarcinoma in the head of the pancreas what does it cause?

Answer 62

slide 53

Question 63

How does adenocarcioma appear sonographically? finish slide 54

Answer 63

loss of panc

Question 64

slides 55-66

Answer 64

finish

Question 65

Whipple - know what is removed and how it is reattached

Answer 65

watch video again from power point