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abdomen > Pathology of Pancreas test 4 > Flashcards

Pathology of Pancreas test 4 Flashcards

0
Q

What is an annular pancreas?

A

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

congenital abnormality

may cause obstruction

more common in males

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1
Q

What is the most common pancreatic anomaly?

A

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

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2
Q

What is the failure of fusion of the panc ducts?

A

pancreatic divisum

unable to accurately diagnosis with ultrasound

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3
Q

The pancreas is an _____________ and ___________ gland

A

excocrine

endocrine

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4
Q

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

A

numerous, small, glands (ACINI)

aggregate into lobular acini and are separated by connective tissue

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5
Q

what enzymes does the pancreas secrete?

A

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

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6
Q

what is amylase enzyme for?

A

digestive enzume for carbs.

twice the normal value = pancreatitis

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7
Q

what is lipase for?

A

an enzyme excreted specifically by the pancreas

lipase elevates in pancreatic disease

finish slide 37

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8
Q

What are the pancreatic exocrine functions?

A

enzymes of pancreatic juice digestive action

lipase &raquo_space;»»»»»»»> fats

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

Trypsin, chymotrypinogen, carboxypeptidase»»>proteins

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

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9
Q

How is the endocrine function of the pancreas represented/

A

by the islets of langerhans

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10
Q

what is the most important agent of the pancreas?

A

secretin

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11
Q

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

A

insulin and glucagon

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12
Q

What are the cell types in the endocrine aspect?

A

beta

alpha delta

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13
Q

What are the pancreatic endocrine functions?

A

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

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14
Q

what does glucose do?

A

Controls the blood - sugar level in the body

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15
Q

What are the lab values for pancreatitis?

A

serum amylase rises

urine amylase rises

serum lipase rises - for a longer time

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16
Q

how do we scan the pancreas?

A

NPO 6-8 hrs

3-5MHz transducer with a mid focal zone

peds use 5-7.5 MHz

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17
Q

What are some reasons to scan the pancreas?

A

severe epigastric pain

abd distention

abnormal lab values

unexplained weight loss

nausea and vomiting

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18
Q

What do you identify when you scan?

A

head, neck, body, tail in sag and trv

evaluate shape, contour, lie and texture

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19
Q

What technique might help visualize the pancreas?

A

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

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20
Q

Echogenicity of the pancreas _________ with age.

A

increases

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21
Q

Where is the pancreatic duct seen more?

A

in the body than in the tail

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22
Q

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

A

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

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23
Q

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

A

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

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24
Q

How does the pancreatic duct appear sonographically?

A

as an echogenic line or lucency bordered by two echogenic lines

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25
Q

what is the measurement of the pancreatic duct?

A

2mm

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26
Q

Does the pancreatic duct increase or decrease toward the tail?

A

decreases

27
Q

what might you confuse the pancreatic duct with?

A

vascular structures

28
Q

What is panreatitis?

A

inflammation of the pancreas

malfunctions due to increased secretion and blockage of ducts

pancreatic tissue may be digested by its own enzyme

29
Q

What are the 5 B’s of pancreatitis?

A

Bile - biliary disease (most common)

booze - alcoholism second most common

blood - trauma

bug - infectious process

birth - congenital

30
Q

What is the most common cause of pancreatitis in children?

A

trauma - child abuse

others:

infectious process

toxic exposure

hereditary

31
Q

What cells get inflamed in pancreatitis?

A

acini cells

32
Q

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

A

pseudocyst

risk for abscess and hemorrhage

most common cause is biliary obstruction

second common cause is alcoholism

33
Q

What increases with acute pancreastitis?

A

pancreatic enzymes

amylase: increases sig within 24 hrs

Lipase: increases within 72-94 hours REMAINS ELEVATED

34
Q

What are the symptoms of acute pancreatitis?

A

slide 9

35
Q

Can pancreatitis resolve itself?

A

mild cases can

the disease can progress to necrosis and hemorrhage

decrease in hematocrit

36
Q

What are the sonographic findings of acute pancreatitis?

A

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

37
Q

Acute pancreatitis may obstruct what?

A

pancreatic duct

38
Q

What is adenopathy?

A

when the lymph nodes are enlarged

39
Q

What is chronic pancreatitis?

A

repeated and persistent

symptoms:

chronic pain

nausea and vomiting

jaundice

weightloss

40
Q

What are the sonographic findings of chronic pancreatitis?

A

increased echogencity

reduced size of the gland

CALCIFICATIONS

41
Q

What are some reasons for chronic pancreatitis?

A

recurrent acute

hypercalcemia

hyperlipidemia

fibrotic scarring

pseudocysts

dilated ducts

thrombosis of the splenic vein

increased risk of cancer

42
Q

What is a progression of pancreatitis?

Finish slide28

A

Hemorrhagic pancreatitis

progression of acute

43
Q

What is Grey Turner’s sign?

A

the hemorrhaging can be seen on the outside

discoloration of flanks

44
Q

What is phlegmonous pancreatitis?

A

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

45
Q

How does phlegmonous pancreatitis appear sonographically?

finish slide 31

A

hypoechoic

ill defined mass

irregular borders

involves lesser sac

46
Q

What are the symptoms of pancreatic abscess?

A

secondary to pancreatitis

may spread

leukocytosis

fever

nausea/vomiting

47
Q

how does a pancreatic abscess appear sonographically?

finish slide 33

A

poorly defined hypoechoic mass

if air is present = shadowing

fluid debis level

48
Q

Are pseudocysts congential or aquired?

A

aquired

not a simple cyst…enzymes are leaking, eventually infection

49
Q

What do pseudocysts arise from?

finish slide 34

A

fluid collections that arise from

50
Q

Where might you find a pseudocyst?

finish slide 35-36

A

form in the potential spaces where enzymes have escaped

develop through the lesser omentum and lesser sac

51
Q

What happens if a pseudocyst ruptures?

A

shock and peritonitis

erosion into other organs

(because it is filled with enzymes)

52
Q

What are congenital cystic lesions?

A

associated with underlying congenital disease that affect other organs

53
Q

What is autosomal dominant polycystic disease?

A

comes from polycystic kidneys and get them in other organs

54
Q

What is Von Hippel-Lindau Disease?

A

autosomal dominant condition

central nervous system and retinal hemangioblastomas

visceral cysts

pheochromocytomas

renal cell carcinoma

pancreatic cysts

55
Q

What is cystic fibrosis?

A

hereditary disease

autosomal recessive

excessive production of mucus

56
Q

What does cystic fibrosis look like sonographically?

A

increase in echogenicity

small cysts

biliary sludge

thick folds in GB

57
Q

What is fibrocystic disease?

finish slide 46

A

is a

58
Q

What is a cystic pancreatic neoplasm?

A

macrocystic adenoma

mucinous:

malignant or benign

middle age females

body and tail

well defined cysts with thick fluid and septations or mural nodules

59
Q

What is microcystic adenoma?

A

slide 48?

60
Q

What is adenocarcinoma?

slide 49

A

most common primary neoplasm

exocrine portion

5% of all cancer deaths

4th cause of cancer mortality

61
Q

What is the most common site of adenocarcinoma?

A

head of the pancreas (60-70%)

body (20-30%)

tail (5-10%)

62
Q

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

A

slide 53

63
Q

How does adenocarcioma appear sonographically?

finish slide 54

A

loss of panc

64
Q

slides 55-66

A

finish

65
Q

Whipple - know what is removed and how it is reattached

A

watch video again from power point

abdomen (11 decks)

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