Peds- Pancreas

Question 1

what to use as a window for pancreas seen on children and infants?

Answer 1

• larger left lobe liver

Question 2

U/S features pancreas?

Answer 2

• 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

Question 3

Pancreatic duct measurement?

Answer 3

• <1mm

Question 4

congenital anomalies of the pancreas? (2)

Answer 4

1. cyctic fibrosis

2. congenital cysts

Question 5

Cystic Fibrosis

Answer 5

• Autosomal recessive
• High prevalence in Caucasians
• Mostly affects lungs, but also panc., liver, kidneys, intestine

Question 6

cystic fibrosis causes?

Answer 6

• 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

Question 7

cystic fibrosis sono?

Answer 7

• hyperechoic and small panc.
• Small cysts and Ca2+ may be present
• Liver disease and gallstones

Question 8

Pancreatic Neoplasms? (3)

Answer 8

• Rare in children
• Manifestations are similar to those in adults

1. Pancreatic Carcinoma
2. Islet Cell Tumors (Insulinoma)
3. Lymphoma (mets)

Question 9

Pancreatic Carcinoma?

Answer 9

• Non-functioning tumor

- Rare in children

Question 10

Pancreatic Carcinoma clinical presentation?

Answer 10

Non-specific signs and symptoms

Question 11

Pancreatic Carcinoma sono features?

Answer 11

• Large at presentation
• Hypoechoic mass
• Mets to the liver, lymph nodes, and lungs typically has occurred

Question 12

Islet Cell Tumors?

Answer 12

• 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

Question 13

sono features of islet cell tumors?

Answer 13

• Well circumscribed
• Anechoic
• Mets might be present

Question 14

Insulinoma (functioning islet cell tumor) location?

Answer 14

Mostly located in the body or tail of the pancreas

Question 15

Insulinoma (functioning islet cell tumor) Clinical Presentation?

Answer 15

• Hypoglycemia
• Erratic behavior
• Seizures

Question 16

Insulinoma (functioning islet cell tumor) sono features?

Answer 16

• Small, round
• Hypoechoic
• Well-circumscribed mass

Question 17

2 types of Pancreatitis?

Answer 17

• Acute pancreatitis
• Complications
• Chronic pancreatitis

Question 18

acute pancreatitis causes? (5)

Answer 18

1. Blunt abdo trauma
2. Infections, usually viral
3. Drug toxicity
4. Hereditary
5. Idiopathic

Question 19

Acute pancreatitis- pathogenesis?

Answer 19

pancreatic enzymes escape into surrounding tissue

Question 20

acute pancreatitis diagnosis?

Answer 20

• Clinical and Lab data

- Imaging is helpful

Question 21

acute pancreatitits clinical presentation?

Answer 21

• Nausea & Vomiting
• Abdo pain
• Fever, tachycardia, abdo distention

Question 22

actute pancreatitis sono features?

Answer 22

• 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

Question 23

acute pancreatitis complications (4)?

Answer 23

1. Pseudosysts
2. hemorrhage
3. phlegomon
4. abscess

Question 24

pseudocyst locations?

Answer 24

• mostly around pancreas can be anywhere in abdomen and pelvis

Question 25

pseudocyst symptoms?

Answer 25

- abdo pain - bowel/biliary system obstruction - nausea and vomiting

Question 26

pseudocyst lab data?

Answer 26

elevated serum amylase

Question 27

pseodocyst sono apperance?

Answer 27

- anaechois - sharp walls - single or multiple - simple or complex

Question 28

Hemorrhage?

Answer 28

- Disruption of panc vessels - Can be lethal - May produce large panc hematoma

Question 29

hemorrhage sono?

Answer 29

Inhomogenous mass | From anechoic to echogenic

Question 30

Phlegmon?

Answer 30

- Solid inflammatory mass - Consists of necrotic tissue, inflammatory exudate and tissue edema - Can develop into abscess

Question 31

phlegmon sono?

Answer 31

anachoic mass

Question 32

Abscess causes?

Answer 32

- Severe cases of pancreatitis with extensive necrosis | - Infected Phlegmon or Pseudocyst

Question 33

abscess symptoms?

Answer 33

- spiking fevers - chills - abdo pain

Question 34

abscess sono feature?

Answer 34

- Large anechoic mass in panc bed - Debris / purulent material - Thick, irregular, echogenic walls - If air present (gas forming bacteria) – shadowing

Question 35

abscess treatment?

Answer 35

- percutaneous drainage

Question 36

Chronic pancreatitis?

Answer 36

- 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