Peds- Pancreas Flashcards
what to use as a window for pancreas seen on children and infants?
- larger left lobe liver
U/S features pancreas?
- homogrneous
- hypoechoic
- splenic v. inferior and posterioe to the pan. tail
- SMV- posterior to junction of the head and body
- IVC- posterior and slightly to the right of the head
Pancreatic duct measurement?
- <1mm
congenital anomalies of the pancreas? (2)
- cyctic fibrosis
2. congenital cysts
Cystic Fibrosis
- Autosomal recessive
- High prevalence in Caucasians
- Mostly affects lungs, but also panc., liver, kidneys, intestine
cystic fibrosis causes?
- Exocrine glands produce highly viscous mucus
- Small ductules of panc get obstructed
- Tissue destruction, atrophy, replacement with fibrosis and fat
- Pancreatic insufficiency →improper digestion, steatorrhea
cystic fibrosis sono?
- hyperechoic and small panc.
- Small cysts and Ca2+ may be present
- Liver disease and gallstones
Pancreatic Neoplasms? (3)
- Rare in children
- Manifestations are similar to those in adults
- Pancreatic Carcinoma
- Islet Cell Tumors (Insulinoma)
- Lymphoma (mets)
Pancreatic Carcinoma?
- Non-functioning tumor
- Rare in children
Pancreatic Carcinoma clinical presentation?
Non-specific signs and symptoms
Pancreatic Carcinoma sono features?
- Large at presentation
- Hypoechoic mass
- Mets to the liver, lymph nodes, and lungs typically has occurred
Islet Cell Tumors?
- 2/3 of these produce hormones
- clinical suspicion early in the course of disease
- 1/3 does not
- grow large and obstructs the biliary system or GI tract
- Diagnosed via blood work
- Ultrasound is used in localizing the tumor, especially intraoperative
sono features of islet cell tumors?
- Well circumscribed
- Anechoic
- Mets might be present
Insulinoma (functioning islet cell tumor) location?
Mostly located in the body or tail of the pancreas
Insulinoma (functioning islet cell tumor) Clinical Presentation?
- Hypoglycemia
- Erratic behavior
- Seizures
Insulinoma (functioning islet cell tumor) sono features?
- Small, round
- Hypoechoic
- Well-circumscribed mass
2 types of Pancreatitis?
- Acute pancreatitis
- Complications
- Chronic pancreatitis
acute pancreatitis causes? (5)
- Blunt abdo trauma
- Infections, usually viral
- Drug toxicity
- Hereditary
- Idiopathic
Acute pancreatitis- pathogenesis?
pancreatic enzymes escape into surrounding tissue
acute pancreatitis diagnosis?
- Clinical and Lab data
- Imaging is helpful
acute pancreatitits clinical presentation?
- Nausea & Vomiting
- Abdo pain
- Fever, tachycardia, abdo distention
actute pancreatitis sono features?
- Enlarged pancreas
- Edematous
- Less echogenic than liver
- Normal – similar to more echogenic than liver
- Dilated pancreatic duct
- d = 1.5 mm or more
- normal – less than 1 mm
acute pancreatitis complications (4)?
- Pseudosysts
- hemorrhage
- phlegomon
- abscess
pseudocyst locations?
- mostly around pancreas can be anywhere in abdomen and pelvis
pseudocyst symptoms?
- abdo pain
- bowel/biliary system obstruction
- nausea and vomiting
pseudocyst lab data?
elevated serum amylase
pseodocyst sono apperance?
- anaechois
- sharp walls
- single or multiple
- simple or complex
Hemorrhage?
- Disruption of panc vessels
- Can be lethal
- May produce large panc hematoma
hemorrhage sono?
Inhomogenous mass
From anechoic to echogenic
Phlegmon?
- Solid inflammatory mass
- Consists of necrotic tissue, inflammatory exudate and tissue edema
- Can develop into abscess
phlegmon sono?
anachoic mass
Abscess causes?
- Severe cases of pancreatitis with extensive necrosis
- Infected Phlegmon or Pseudocyst
abscess symptoms?
- spiking fevers
- chills
- abdo pain
abscess sono feature?
- Large anechoic mass in panc bed
- Debris / purulent material
- Thick, irregular, echogenic walls
- If air present (gas forming bacteria) – shadowing
abscess treatment?
- percutaneous drainage
Chronic pancreatitis?
- A clinical condition caused by multiple bouts of acute pancreatitis
- Causes fibrosis and destruction of pancreatic cells
- Pancreatic fibrosis causes areas of strictures and dilation of the main pancreatic duct
