Quiz 3 Flashcards
Is the pancreas intraperitoneal or retroperitoneal?
Retroperitoneal
What are the names of the primary and secondary ducts in the pancreas?
- Duct of Wirsung or Pancreatic Duct
- Duct of Santorini or Accessory Duct
What is the most common congenital abnormality of the pancreas?
Ectopic Pancreatic Tissue: found outside the normal location of the pancreas, typically in the gastrointestinal tract.
What are the two functions of the pancreas?
- 90% Exocrine function digestion by Acini Cells
- 10% Endocrine function hormones made by Islets of Langerhans
Where is the endocrine function located?
Islets of Langerhans
What do the endocrine cells produce?
- Insulin (Alpha, Beta, Delta cells)
What are the three types of endocrine cells and what do they make?
- Beta Cells, Insulin hormone, glucose to glycogen
- Alpha Cells, Glucagon hormone, glycogen to glucose
- Delta Cells make Somatostatin which inhibits Beta and Alpha Cells.
What do the enzymes produced by the pancreas do in the body?
- Insulin causes glycogen formation from glucose in the liver
- Enables cells with insulin receptors to take up glucose and decrease blood sugar
- Glucagon raises blood sugar
- Somatostatin inhibits production of both insulin & glucagon
What is the function of the exocrine portion of the pancreas and what does it produce?
Digestive functions. Acini cells produce pancreatic juices
How much pancreatic juice is produced per day?
2L/day
What cells perform the production of pancreatic juices?
Acini cells
What are the enzymes produced by the pancreas?
- Amylase - Carbs to sugar
- Lipase - Fats
- Trypsin, Chymotrypsinogen, Carboxypeptidase - Proteins
- Nucleases - Nucleic acids
- Sodium Bicarbonate - neutralizes acids
What causes glucose to decrease?
Islets of Langerhan Tumors, hyperinsulinemia
What causes glucose to increase?
Diabetes, chronic liver disease, overactive endocrine glands
The sonographic appearance of the pancreas depends on what?
Fat deposits, more fat means more hyperechoic.
What causes pancreatitis?
Most common cause is gallstones, but also trauma, inflammation from peptic ulcer or infection, vascular thrombosis, drugs.
Gallstones are seen in what percent of pancreatitis cases?
40% to 60%
What are the clinical signs of pancreatitis?
- Persistent abdominal pain
- Fever
- Leukocytosis
- Abscess and hemorrhage
- Nausea and vomiting
- Elevated amylase & lipase
- Abdominal distention
What are the lab values that change with pancreatitis?
- Serum amylase rises in acute pancreatitis for the first 3-6 hours
- Urine amylase rises for about 7 hours but is NOT increased in chronic pancreatitis
- Lipase is risen longer in cancer and pancreatitis for 14 days
Normal pancreatic duct measures what?
No greater than 2mm
What are possible complications with pancreatitis?
Pseudocysts
What is the sonographic appearance of acute pancreatitis?
Enlarged, hypoechoic, heterogeneous, severe epigastric pain, caused by gallstones, elevated amylase and lipase
What is the sonographic appearance of chronic pancreatitis?
Shrunken, hyperechoic, calcifications, transient epigastric pain, caused by alcoholism, normal to slightly elevated labs.
What is a pancreatic pseudocyst?
Always acquired; they result from trauma to the gland, acute or chronic pancreatitis, or pancreatic cancer.
What makes a pseudocyst not a cyst?
They generally take on the contour of the available space around them and are therefore not always spherical.
What is the sonographic appearance of a pseudocyst?
Predominantly anechoic that may or may not contain dependent debris.
What is a phlegmon?
An inflammatory process that spreads along fascial pathways, causing localized areas of diffuse inflammatory edema of soft tissue.
Which syndromes are true pancreatic cysts associated with?
- Autosomal Dominant Polycystic Disease
- Von Hippel-Lindau
- Cystic Fibrosis
- Retention Cysts
- Parasitic Cysts
- Neoplastic Cysts
What is the most common primary cancer of the pancreas?
Adenocarcinoma
What are the signs and symptoms of pancreatic cancer?
- Weight loss
- Abdominal pain
- Back pain
- Anorexia
- Nausea and vomiting
- Malaise and weakness
- Jaundice
- Splenomegaly
Where is pancreatic cancer most commonly located?
60-70% in the head
How does pancreatic cancer appear sonographically?
- Hypoechoic (95%)
- Irregular borders
- Pancreatic enlargement
- Dilated pancreatic duct
- Dilated biliary system
What other organ systems should be evaluated with pancreatic cancer?
Adjacent organs such as the stomach, transverse colon, spleen, and adrenal gland.
What procedure can be done to treat pancreatic cancer?
Whipple
What are the two types of cystic neoplasms?
- Microcystic adenoma
- Macrocystic adenoma
What are the other names for microcystic and macrocystic adenomas?
- Microcystic adenoma - serous cystadenoma
- Macrocystic adenoma - Mucinous cystadenoma/cystadenocarcinoma
What is the cancerous name of the macrocystic adenoma?
Cystadenocarcinoma
Are cystic neoplasms common?
They account for less than 10% of all pancreatic cysts and less than 1% of all pancreatic malignancies.
What is the most common benign tumor of the pancreas?
Islet cell tumors - Adenomas (Insulinoma and gastrinoma)
What are the two islet cell tumors?
- Insulinoma
- Gastrinoma
What is the most common islet cell tumor?
70% Insulinoma
What cells is insulinoma made of?
Beta cells
What does insulinoma look like sonographically?
Most are small, well-encapsulated, with good vascular supply, hypoechoic
What percent of insulinomas are benign?
90%
What is different about gastrinomas?
They are mostly malignant and difficult to locate
Where are islet cell tumors often located?
Pancreatic body and tail
What primary tumors can metastasize to the pancreas?
- Melanoma
- Breast
- GI
- Lung
If SMV and SMA are displaced anteriorly, what is the sign?
Sandwich sign
What is MEN syndrome?
Multiple Endocrine Neoplasia Syndrome: rare, inherited disorder where tumors develop in multiple hormone-producing glands of the body.
What pancreatic tumors are associated with MEN Syndrome?
- Pituitary Adenoma (Prolactinomas)
- Parathyroid Adenoma (Hyperparathyroidism)
- Medullary Thyroid Carcinoma
- Pancreatic Islet Cell Tumors (Gastrinoma, Insulinoma)
- Pheochromocytoma (Adrenals)
- Ganglioneuromatosis
What is the most common cause for a hyperechoic pancreas in a child?
Cystic Fibrosis
What types of organs does cystic fibrosis affect?
Lungs and intestines
What do we evaluate for in pancreas transplants?
- Monophasic Venous Flow
- Low-Resistance Arterial Flow
- Pancreatic duct
- Peri-pancreatic fluid collections
What are the three parts of the stomach?
- Fundus
- Body
- Pylorus
What are the names of the two openings in the stomach and what do they connect to?
- Cardiac orifice (connects to the esophagus)
- Pylorus orifice (connects to the duodenum)
What are folds in the stomach called?
Rugae
What should the wall thickness of the stomach be if not distended?
2-6mm thick
What are the segments of the large bowel called?
- Ascending
- Descending
- Transverse
- Sigmoid colon
- Cecum
- Flexures
- Rectum/anus
What is the GEJ, and where is it seen?
GEJ = gastroesophageal junction, seen anterior to aorta, posterior to LLL
What is the most common benign tumor of the small bowel?
Leiomyoma
What is midgut malrotation?
Clinically similar to HPS, small bowel mesentery rotates around the SMA.
What sonographic clue do we have for midgut malrotation?
The SMA and SMV will be reversed in position on ultrasound.
What is blood in the stool called?
Hematochezia
Anemia or low hematocrit is associated with what pathological process?
Chronic Blood Loss
Elevated WBC is generally associated with what pathological process?
Infection
What are the five layers of the bowel from inner to outer?
- Mucosa - echogenic
- Submucosa - hypoechoic
- Muscularis - echogenic
- Serosa - hypoechoic
- Mesothelium - echogenic
Appendix is an extension of what structure?
The apex of the cecum
What does the appendix look like on ultrasound in sagittal and transverse views?
- Sagittal: hypoechoic tube
- Transverse: bullseye or target appearance.
What point can you find the appendix at?
Located on the abdominal wall under McBurney’s point
What are the signs and symptoms of appendicitis?
- Periumbilical pain
- Rebound tenderness over McBurney’s point
- N/V
- Anorexia
- Diarrhea
- Leukocytosis
- Fever
Is appendicitis more common in children or adults?
Children
What is the sonographic appearance of an inflamed appendix?
- Dilated
- Free fluid
- Gas collection
- Appendicolith (stone/blockage)
- Non-compressible
- Cystic with internal echoes
Measurements that indicate appendicitis?
- Wall greater than 2 mm
- AP diameter greater than 6 mm
What is a way to definitively diagnose appendicitis?
CT scan
What is a stone in the appendix called?
Appendicolith
What is the name for the progression from acute appendicitis?
Frank Perforation
What age group does frank perforation most often happen in?
Younger children within 6-12 hours
What group of people is appendicitis often misdiagnosed in?
Women ages 20 to 40
What are some differential diagnoses of appendicitis?
- Acute gastroenteritis
- Mesenteric lymphadenitis in children
- Ruptured ectopic pregnancy
- Mittelschmerz (ovary)
- Inflammation of Meckel’s diverticulum
- Regional enteritis
- Right ovarian torsion
What does HPS stand for?
Hypertrophied Pyloric Stenosis
What does hypertrophy mean?
Over development or increased growth.
What is HPS?
Muscle of pylorus is thickened or hypertrophied, resulting in elongation and constriction of the pylorus.
What are the signs and symptoms of HPS?
- Projectile vomiting
- Dehydration
- Palpable mass (“olive”) in epigastric region
- Doughnut sign
What are the normal measurements for HPS?
- Channel length: Antrum of stomach to distal end of channel > 18 mm
- Muscle thickness > 4 mm
- Pyloric cross-section (A/P) > 15 mm
What is Crohn’s disease?
Recurrent granulomatous inflammatory disease of colon
What is Meckel’s diverticulum?
Congenital sac or blind pouch found in the lower ileum.
Where is Meckel’s diverticulum found?
Lower ileum
What is diverticulosis?
Development of small outpouchings in the digestive tract, most often in the sigmoid colon.
What is diverticulitis?
Condition where small pouches in the large intestine become inflamed or infected.
Where is the most common location for diverticulitis?
Sigmoid Colon
What are the presenting symptoms of diverticulitis?
- N/V
- LLQ pain
- Fever
- Leukocytosis
What pain location is associated with diverticulitis?
LLQ pain
What is the sonographic appearance of diverticulitis?
- Thickened bowel
- Abscess formation in LLQ
- Target/pseudokidney sign
- Hypoechoic external rim representing thickened intestinal wall and an echogenic center
What sonographic sign could be associated with diverticulitis?
Target/pseudokidney sign
What is gastritis/colitis?
- Inflammatory disease
- Enlarged rugal folds
- Generalized thickening of the mucosal layer
- Can develop polyps and ulcerations
What wall measurements are normal in the colon wall?
- Colon wall 4-9 mm thick if not distended
- 2-4 mm thick when distended ≥ 5 cm
What is intussusception?
Telescoping of bowel: segment of bowel prolapses into a more distal segment.
Who is intussusception most common in?
Children
What are the clinical findings of intussusception?
- Crampy intermittent abdominal pain
- Vomiting
- Passage of blood through rectum
What stool appearance is associated with intussusception?
Hematochezia
What are the sonographic findings/signs of intussusception?
- Oval, pseudokidney mass with central echoes in sagittal imaging
- Sonolucent doughnut or target configuration in transverse
- “Cinnamon bun” sign
What is the most common tumor of the GI tract in children under 10 years old?
Lymphoma
What are common symptoms of gastrointestinal issues?
Abdominal pain, vomiting, passage of blood through rectum
Hematochezia is the term for blood in stool.
What stool appearance is associated with intussusception?
Hematochezia
Refers to the passage of fresh blood through the rectum.
What are the sonographic findings for intussusception?
- Oval, pseudokidney mass with central echoes in sagittal imaging
- Sonolucent doughnut or target configuration in transverse imaging
- Cinnamon bun sign
What are the different types of bezoars?
- Trichobezoar (hairball)
- Phytobezoar (nondigestible plant or vegetable materials)
- Lactobezoar (milk materials, seen in infants)
- Concretions (inorganic substances, medications, gum)
What is another term for trichobezoar?
Rapunzel Syndrome
What are the sonographic signs related to gastrointestinal conditions?
- Cinnamon bun sign – intussusception
- Pseudokidney sign – Acute Diverticulitis
- Donut sign – hypertrophied pyloric stenosis
- Olive sign – hypertrophied pyloric stenosis
What are the normal measurements for the kidneys?
- 9-12 cm in length
- 5 cm in width
- 2.5 cm cortex to wall
What structures are located posterior to the kidneys?
- Diaphragm
- Quadratus lumborum muscle
- Psoas muscle
Where might a kidney be located if it isn’t in a normal position?
The pelvis
What is the normal echotexture of the kidneys?
Hypoechoic or Isoechoic
What happens to the kidneys when a patient takes a deep breath while scanning?
The kidneys will move up, allowing for a better view
What is the functional unit of the kidney?
Nephron
What is another name for Gerota’s fascia?
Perinephric fascia
What does Gerota’s fascia surround?
Surrounds the true capsule, perinephric fat, adrenals
What are the three functions of the kidneys?
- Excretion of waste
- Regulation of composition of blood
What is a Dromedary hump?
Localized bulge on lateral border of kidney, common variant of cortical thickening
What is a Hypertrophied column of Bertin?
Hypertrophy of renal cortical tissue located between 2 pyramids
What is a Double collecting system?
Renal sinus is divided and each sinus has a renal pelvis
What is a Horseshoe kidney?
Kidneys are connected usually at the lower poles, connection is termed an isthmus
What is Renal ectopia?
One or both kidneys are in an abnormal place, usually in the pelvis
What is the term for when a kidney ascends to the contralateral side?
Crossed renal ectopia
What occurs in crossed fused renal ectopia?
Developing kidneys fuse in the pelvis; one kidney ascends to its normal position
What is an Extrarenal pelvis?
When renal pelvis protrudes outside renal hilum
What is a Junctional parenchymal defect?
Triangular echogenic area in the anterior aspect of the right upper pole
Which condition appears as an echogenic triangle in the anterior right upper pole?
Junctional parenchymal defect
Which conditions can appear as a pseudo tumor?
- Dromedary hump
- Hypertrophied column of Bertin
- Fetal lobulation
What looks like an extension of the cortex into the kidney?
Hypertrophied column of Bertin
What is the term for fusion of the lower poles of the kidneys?
Horseshoe kidney
What lab values are associated with renal failure?
Elevated serum BUN and Creatinine
What is the normal echotexture of the kidney?
Heterogeneous
