Term
| The pancreas is a ____________, ___________ sturcture |
|
Definition
| non-encapsulated, retroperitoneal |
|
|
Term
| Between what does the pancreas lie? |
|
Definition
| between the duodenal loop and the splenic hilum |
|
|
Term
| What is the pancreas divided into? |
|
Definition
head
uncinate process
neck
body
tail |
|
|
Term
| What is the normal measurement of panc? |
|
Definition
|
|
Term
| Which is the most bulbous part of the panc which narrows at the neck? |
|
Definition
|
|
Term
| What is the head measurement of the panc? |
|
Definition
|
|
Term
| What anatomic position marks the pancreatic neck? |
|
Definition
| the porto-splenic confluence |
|
|
Term
| what does the panc neck measure? |
|
Definition
|
|
Term
| What lies anterior to the body of panc? |
|
Definition
|
|
Term
| How does the splenic vein run along with the panc? |
|
Definition
| splenic vein runs along its posterosuperior surface |
|
|
Term
| what is the measurement of the panc body? |
|
Definition
|
|
Term
| What is the tail of the panc related to? |
|
Definition
| the tail of the panc is related to the spleen, left adrenal glands, and upper pole of the left kidney |
|
|
Term
| what is the measurement of the panc tail? |
|
Definition
|
|
Term
| What extends inferior to the main body of the panc? |
|
Definition
|
|
Term
| what are the functions of the pancreas? |
|
Definition
|
|
Term
| What does exocrine secret? |
|
Definition
| exocrine secretes trypsin, lipase & amylase |
|
|
Term
Through what does the exocrine secrete trypsin, lipase & amylase?
How much does the exocrine comprise of? |
|
Definition
the ductal system
acinar cells
80% of the panc tissue |
|
|
Term
| What does endocrine secret, through what? |
|
Definition
| secretes insulin via the islets of langerhans |
|
|
Term
| How much does the endocrine form of the panc? |
|
Definition
|
|
Term
| What does the remaining 18% of the panc tissue consist off? |
|
Definition
| consists of fibrous stroma that contains blood vessels, nerves and lymphatics |
|
|
Term
| What are the lab values for panc? |
|
Definition
|
|
Term
| What is the digestive enzyme for carbohydrates? |
|
Definition
|
|
Term
| Which organ produces amylase? |
|
Definition
| pancreas and salivary gland |
|
|
Term
| when does the amylase level increase? |
|
Definition
| if there is a dysfunction of the salivary gland and panc and kidney disease |
|
|
Term
| What is parallel to the amylase level? What happens when amylase level rise? |
|
Definition
Lipase
Amylase level rise first and lipase level rise later but persist longer |
|
|
Term
| What is the panc texture in ultrasound? |
|
Definition
| the normal panc is homogenous with the echogenicity |
|
|
Term
| What is the echotexture of the panc when compared to the liver? |
|
Definition
| is isoechoic or more commonly hyperechoic |
|
|
Term
| what happens to the texture of the panc due to age and obisity? |
|
Definition
it becomes more echogenic as a result of presence of fatty infiltration
this is reversible |
|
|
Term
| What must a tech do to visualize the panc? |
|
Definition
the patient is in LLD and drinks water to fill the stomach
while scanning the patient is then turned to supine or RLD position where water in the stomach and duodenum is used as an acoustic window |
|
|
Term
| What organ lies on the anterior border of the panc body and tail? |
|
Definition
| the posterior wall of the stomach |
|
|
Term
| What is the relation of the duodenal loop with the panc? |
|
Definition
| the duodenal loop, except for the 1st segment, encircles the panc head |
|
|
Term
| Head of the panc is anterior to the? |
|
Definition
|
|
Term
| Head of the panc is medial to the? |
|
Definition
|
|
Term
| CBD is ______ to the panc head |
|
Definition
|
|
Term
| GDA is ________ to the panc head |
|
Definition
|
|
Term
| SMA and SMV are _______ to the panc neck |
|
Definition
|
|
Term
| SMA and SMV are _________ to the uncinate process and 3rd portion of the duodenum |
|
Definition
|
|
Term
| The abd aorta runs ________ to the panc body |
|
Definition
|
|
Term
| The celiac axis arises from the aorta at the _________ border of the panc |
|
Definition
|
|
Term
| The CHA proceeds _________ to the ______, _______ to the panc head |
|
Definition
| anterior, right, cephalad |
|
|
Term
| The ___________ artery follows a tortuous course along the superior border of the panc body and tail |
|
Definition
|
|
Term
| how does the splenic vein course with the panc? |
|
Definition
| splenic vein runs from its origin in the splenic hilum along the posteroinferior aspect of the panc to join the smv |
|
|
Term
The SMV and Splenic vein join _______ to the panc neck to form the ___________.
The MPV ascends towards the pora hepatis __________ to the panc head |
|
Definition
| posterior, portal confluence, cephalad |
|
|
Term
| Where does the CBD travel to the 1st portion of the duodenum and the panc head? |
|
Definition
| CBD travels posterior to the 1st portion of the duodenum and the panc head to lie to the right of the main pancreatic duct and opens into the duodenum at the ampulla of vater after forming a common trunk with the MPD |
|
|
Term
| Duodenum is divided into how many portion? What are they? |
|
Definition
4
1st and 3rd portion are transverse
2nd and 4th portions are longitudinal |
|
|
Term
| The main pancreatic duct is aka |
|
Definition
|
|
Term
| When is the normal pancreatic duct considered abnormal? |
|
Definition
|
|
Term
| When is panc duct dilated? |
|
Definition
due to stone within the duct of wirsung from chronic pancreatitis or
a stone at the ampulla of vater |
|
|
Term
| What is the duct of santorini aka? |
|
Definition
|
|
Term
| What does the accessory duct do? |
|
Definition
| it branches off the MPD in the pancreas head and drains the uncinate process |
|
|
Term
| absence of the body and tail with the remaining pancreatic head showing compensatory hypertrophy is what kind of anomaly? |
|
Definition
| congenital anomalies of panc |
|
|
Term
| What is the disease called when panc has multiple cysts that are associated with adult type polycystic kidney disease |
|
Definition
|
|
Term
| what is the disease that is characterized by viscous secretions and dysfunction of multiple glands, including the panc, leading to pancreatic insufficiency |
|
Definition
|
|
Term
| In which disease does the panc have increased echogenicity and is shrunk with marked fibrosis, fatty replacement and cysts secondary to the obsruction of small ducts? |
|
Definition
|
|
Term
| What is the failure of the dorsal and ventral panc duct to fuse during embryonic development? |
|
Definition
|
|
Term
| what is the most common congenital variant of pancreatic anatomy? |
|
Definition
|
|
Term
| what results due to pancreas divisum? and what is it associated with? |
|
Definition
| the smaller santorini's ducts drain the body and tail and is associated with pancreatitis |
|
|
Term
| what is the uncommon congenital anomaly called where a ring of normal panc tissue encircles the duodenum seconday to the abnormal migration of the ventral panc? |
|
Definition
|
|
Term
| Why is annular pancreas in children frequently diagnosed in infancy? |
|
Definition
| because of associated duodenal obstruction |
|
|
Term
| what is the inflammatory disease producing temorary pancreatic changes? |
|
Definition
|
|
Term
| what is the most common cause of acute pancreatitis? |
|
Definition
biliary tract disease
chronic etoh abuse |
|
|
Term
| what sonographic findings do you see for acute pancreatitis? |
|
Definition
| enlarged hyperechoic gland but may be negative in milder forms of acute pancreatitis |
|
|
Term
| What are the complications of acute pancreatitis? |
|
Definition
pseudocyst formation
abscess
pancreatic necrosis
hemorrhage
splenic vein thrombosis
pseudoaneurysm formation
|
|
|
Term
| What else is visualised during acute pancreatitis? |
|
Definition
| ductal dilation, mass effect from phlegmon or hemorrhage, peripancreatic fluid collections, thickening of adjacent fascial planes and ascites |
|
|
Term
| What is mostly seen in the panc head? |
|
Definition
|
|
Term
| What is difficult to differentiate from a neoplasm? |
|
Definition
|
|
Term
| With normal amylase what is a pancreatic mass likely to represent? |
|
Definition
|
|
Term
| What is likely to be associated with pancreatitis in the pediatric patient? |
|
Definition
| choledochal cysts, cystic fibrosis (most common) or hereditary autosomal dominant pancreatitis |
|
|
Term
| when does pancreas become increasingly hypoechogenic relative to normal liver and increases in size? |
|
Definition
|
|
Term
| What is the most common cystic lesion of the pancreas? |
|
Definition
|
|
Term
| What does the cystic lesion of the pancreas contain? |
|
Definition
| accumulation of pancreatic fluid and necrotic debris confined by the retroperitoneum that contains high amounts of amylase, lipase and trypsin |
|
|
Term
| Explain the wall of the pancreatic pseudocyst? |
|
Definition
| Generally spherical and take 4-6 weeks to enclose itself by forming a wall composed of collagen and vascular granulation tissue |
|
|
Term
| What is pancreatic pseudocyst commonly associated with? |
|
Definition
| alcoholic or biliary etiology or after blunt abd trauma in children or secondary to pancreatic malignancy |
|
|
Term
| What symtoms are seen with pancreatic pseudocyst? |
|
Definition
| persistent pain and elevated amylase levels |
|
|
Term
| how does the pancreatic pseudocyst look? |
|
Definition
a well defined, smooth walled anechoic structure with acoustic enhancement
Debris may occur within it due to hemorrhage or infection
|
|
|
Term
| What are the complications from a pseudocyst? |
|
Definition
| may become large and cause obstruction of the stomach, small bowel, colon or bile ducts, progressing to jaundice and obstructive cholangitis |
|
|
Term
| what must be done if a pseudocysts persist beyone 6 weeks or grow larger than 5cm in diameter with evidence of regression? |
|
Definition
| require non-surgical decompression |
|
|
Term
| What is a irreversible destruction to the panc due to repeated bouts of pancreatic inflammation? |
|
Definition
|
|
Term
| What happens to the panc with chronic pancreatitis? |
|
Definition
| the fibrous connective tissue proliferates around the ducts and between the lobules, causing interstitial scarring. This leads to an irregular, nodular appearance of the panc surface |
|
|
Term
| What are the causes of chronic pancreatitis? |
|
Definition
alcoholism
hereditary pancreatitis
cystic fibrosis
congenital abnormalities
blunt abdominal trauma
idiopathic chronic pancreatitis |
|
|
Term
| How does cronic pancreatitis look sonographically? |
|
Definition
small echogenic pancreas
calcifications
pancreatic duct dilatation
pseudocyst formation
bile duct dilatation
portal vein thrombosis |
|
|
Term
| What is a phlegmon pancreatitis? |
|
Definition
| is a non-encapsulated inflammatory process that spreads along peripancreatic tissue, causing localized areas of diffuse inflammatory edima of soft tissue that may proceed to necrosis and suppuration |
|
|
Term
| How does the phlegmon pancreatitis look sonographically? |
|
Definition
| it appears hypoechoic with good through transmission |
|
|
Term
| What is the 10th most common malignancy and the 4th largest cancer killer in adults and has a dismal prognosis for which reaason surgical resection is the only chance for cure in the pancreas? |
|
Definition
| pancreatic neoplasms / cancer |
|
|
Term
| What does patients with pancreatic carinoma (adenocarcinoma) present? |
|
Definition
| lymphatic and metastatic spread of the tumor |
|
|
Term
| What are the symptoms of adenocarcinoma? |
|
Definition
|
|
Term
| what is the sonographic finding of adenocarcinoma of the panc? |
|
Definition
| solid hypoechoic mass, usually in the panc. head that is poorly defined |
|
|
Term
| what are other finding associated with adenocarinoma of the panc? |
|
Definition
bile duct dilatation (courvoisier's GB)
painless jaundice
dilated pancreatic duct
pancreatitis
liver mets
ascites
lymphadenopathy around the aorta
pseudocyst formation |
|
|
Term
| what are the lab finding for adenocarcinoma of the panc? |
|
Definition
elevated bilirubin
elevated Alk. phos
amylase may be elevated |
|
|
Term
| what is typically seen in patients with a pancreatic head tumor? |
|
Definition
| dilatation of the common bile duct and pancreatic duct (double duct sign) |
|
|
Term
| what is the most striking clinical symptom leading to the diagnostic imaging for pancreatic adenocarcinoma? |
|
Definition
| painless obstructive jaundice, which is caused by compression or ingrowth of distal common bile duct |
|
|
Term
| How is pancreatic cancer treated? |
|
Definition
surgery
chemotherapy
radiation therapy
palliative care |
|
|
Term
| What are the surgical procedures offered for pancreatic cancer? |
|
Definition
whipple procedure
distal pancreatectomy and splenectomy |
|
|
Term
| what is the whipple procedure aka? |
|
Definition
|
|
Term
| why is the whipple/pancreaticoduodenectomy performed? |
|
Definition
| due to cancer in the panc head |
|
|
Term
| How is the whipple/pancreaticoduodenectomy procedure performed? |
|
Definition
| the head of the pancreas, a portion of the bile duct, the gb and duodenum are removed. the remaining panc and bile duc are sutured back to the intestines to direct secretions back to the gut |
|
|
Term
| how is the distal pacreatectmy and splenectomy procedure performed? |
|
Definition
| a distal pancreatectomy is the removal of the end of the panc while leaving the pancreatic head attached. It is performed to treat pancreatic cancer localised in the end of the pancreas, but may also be used for chronic pancreatitis, pancreatic pseuodcysts and injury due to trauma. when the disease affects the splenic artery or vein the adjacent spleen is often removed |
|
|
Term
| Which is the benign cystic neoplasm of the pancreas? |
|
Definition
|
|
Term
| how does the serous cystadenoma look sonographically? |
|
Definition
cluster of grapes pattern
when cysts are small, the mass may be echogenic and appear solid with through transmission |
|
|
Term
| which is malignant or potentially malignant cystic neoplasm of the panc? |
|
Definition
|
|
Term
| how does mucinous cyst look like sonographically? |
|
Definition
well-defined multicystic mass (large cysts)
increased CEA lab test |
|
|
Term
| What is an endocrine tumores common in the body and tail which is uncommon? |
|
Definition
|
|
Term
| What is the most common islet cell tumor? what does it cause and is it benign or malignant? |
|
Definition
insulinoma
causes hypoglycemia
usually benign |
|
|
Term
| what is the 2nd most common islet cell tumor? |
|
Definition
|
|
Term
|
Definition
| zollinger-ellison syndrome |
|
|
Term
| what symptoms occur in gastrinoma? are they malignant or benign? |
|
Definition
gastric acid hypersecretion and duodenal ulceration
frequently malignant |
|
|
Term
| What is a group of heritable syndromes characterized by abherant growth of benign or malignant tumors in a subset of endocrine tissues? |
|
Definition
| multiple endocrine neoplasia (MEN) |
|
|
Term
| What does MEN I tumors involve? |
|
Definition
parathyroid glands
endocrine pancreas
the pituitary |
|
|
Term
| what does MEN IIa involve? |
|
Definition
| medullary carcinoma of the thyroid gland, pheochromocytoma and hyperparathyroidism |
|
|
Term
| What does MEN IIB tumor involve? |
|
Definition
| medullary carinoma of the thyroid multiple neuromas, and pheochromocytoma |
|
|
Term
| what is multiple endocrine neoplasia associated with? |
|
Definition
insulinoma
gastrinoma
medullary thryoid carcinoma
pheochromocytoma
parathyroid gland hyperplasia
pituitary tumors |
|
|
