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SON130 > Chapter 12 > Flashcards

Chapter 12 Flashcards

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1
Q

Where does the pancreas lie?

A

Deep in the epigastrium and left hypochondrium, behind the lesser sac

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2
Q

How is the pancreas divided?

A

Head- Most inferior portion, anterior to IVC, to right of portal-splenic confluence, inferior to MPV and caudate lobe, medial to duodenum

Uncinate process- Small curved tip at the end of the head of the panc.

Neck- Anterior to the confluence or SMV

Body- Largest section, anterior to the SMA, the splenic a. is the superior border of the gland, splenic v. is posteriomedial border

Tail- Anterior to the left kidney, posterior to the left colic flexure and transverse colon (making it difficult to image), splenic v. is posterior border

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3
Q

What is the primary duct?

A

Duct of Wirsung is the primary duct extending the length of the pancreas, enters duodenum with the CBD at the ampulla of Vater (they join)
Duct of Wirsung- easier to visualize, should measure less than 2 mm

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4
Q

What is the secondary duct?

A

Duct of Santorini- secondary duct, drains the upper anterior head, enters the duodenum at the minor papilla 2 cm proximal to the ampulla of Vater

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5
Q

Where does the CBD open into?

A

Opens into the duodenum after forming a common trunk with the pancreatic duct

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6
Q

What is the ms for pancreas? Head, neck, body and tail ms?

A 
Length- 15 cm, range 12-18 cm
Head- thickest part 2-3 cm AP
Neck- 1.5-2.5 cm
Body- 2-2.5 cm
Tail- 1-2 cm
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7
Q

What should sonographers evaluate?

A

Sonographers should evaluate the size, contour, and texture

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8
Q

True or false: The gland appears larger in children than in adults.

A

True

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9
Q

True or False: The gland stays the same even with age.

A

False.

The gland decreases in size with age

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10
Q

What is the vascular supply to the pancreas?

A 
Splenic artery 
Pancreaticoduodenal arteries (many branches)
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11
Q

What is the vascular drainage from the pancreas?

A

Venous drainage is through tributaries of the splenic and superior mesenteric veins

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12
Q

What are the branches of the celiac axis?

A

Celiac axis- superior to pancreas
Left gastric artery
Common hepatic artery
Splenic artery

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13
Q

What is the superior border of the pancreas body and tail?

A

splenic artery

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14
Q

What does the CHA divide into?

A

Common Hepatic Artery- divides into the proper hepatic artery and gastroduodenal artery (GDA)

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15
Q

What is the anterolateral border of the pancreas?

A

GDA

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16
Q

From where does the SMA rise from?

A

SMA- rises from the aorta inferior to the celiac axis, posterior to the lower portion of the pancreatic body

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17
Q

Where is the MPV formed?

A

MPV is formed posterior to the neck by the junction of the SMV and splenic vein.

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18
Q

Where does the CBD join the pancreatic duct?

A

Ampulla of Vater

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19
Q

Define agenesis of the pancreas

A

Agenesis- agenesis of the body and tail, hypertrophy of the pancreatic head. Congenital defect

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20
Q

Define pancreatic divisum

A

Pancreas divisum- Rare, lack of fusion of the dorsal and ventral pancreatic buds, difficult to diagnosis with sonography

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21
Q

Define ectopic pancreatic tissue

A

Ectopic pancreatic tissue- most common pancreatic anomaly, in the form of intramural nodules, frequent sites—stomach, duodenum, small bowel, and large bowel

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22
Q

define annular pancreas

A

Annular pancreas- rare, head of the pancreas surrounds the 2nd portion of the duodenum, more common in males than females

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23
Q

What is the function of the pancreas?

A

Pancreas is a digestive (exocrine) and hormonal (endocrine) gland

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24
Q

What is the function of the exocrine gland?

A

Primary exocrine function- produce pancreatic juice, which enters duodenum together with bile—these are essential for normal digestion and absorption of food

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25
What is the function of the endocrine gland?
Endocrine function (located in islets of Langerhans)- controls secretion of glucagon and insulin, failure of the pancreas to produce sufficient insulin leads to diabetes mellitus
26
What are the three lab values associated with pancreas?
Amylase Lipase Glucose
27
Why is the pancreas difficult to visualize?
Pancreas is the most difficult abdominal organ to evaluate because it lies posterior to the stomach and sometimes transverse colon
28
What does the pancreatic tissue texture depend on?
Pancreatic tissue texture depends on the amount of fat between the lobules
29
What are the patient positions for examining the pancreas?
Patient is examined in supine, oblique and sometimes upright positions
30
What is the transducer selection for pancreas?
Curved and 3-5MHz
31
What can provide an acoustic window?
Giving the patient 32 oz. of water through a straw can help with visualization along with having the patient in an upright position
32
Define pancreatitis
Inflammation of the pancreas
33
Why does pancreatitis occur?
Occurs when the pancreas becomes damaged and malfunctions as a result of increased secretion and blockage of ducts Pancreatic tissue may be digested by its own enzymes
34
What is associated with acute pancreatitis that makes it difficult to visualize the pancreas?
In acute pancreatitis it may be difficult to visualize the pancreas because ileus is often associated with this condition
35
What are the categories of pancreatitis?
Acute Hemorrhagic Phlegmonous Chronic
36
What is acute pancreatitis caused by?
Caused by inflamed acini releasing pancreatic enzymes into pancreatic tissue The enzymes usually do not become active until they reach the duodenum to breakdown food
37
What is the most common cause of acute pancreatitis?
Gallstones
38
What is the second most common cause of acute pancreatitis?
Alcohol abuse
39
What are the symptoms of acute pancreatitis?
Severe pain, usually after a large meal or alcohol binge
40
With damage to the tissue and ductal system the pancreatic juices can leak into what?
With damage to the tissue and ductal system the pancreatic juices can leak into the pancreatic tissue as well as peripancreatic tissue
41
With acute pancreatitis, what are the lab values that are elevated?
Amylase increases within 24 hours | Lipase increases within 72-96 hours and stays elevated longer than amylase
42
What are the possible complications of acute pancreatitis?
``` Pseudocyst (10%) Phlegmon (18%) Abscess (1-9%) Hemorrhage (5%) Duodenal obstruction ```
43
What are ultrasound findings of acute pancreatitis?
May appear normal-early Hypoechoic with swelling Enlarged Pancreatic duct may become obstructed
44
What is the most common complication of acute pancreatitis?
fluid collections and pseudocyst
45
When do fluid collections occur?
Fluid collections occur within 4 weeks- may resolve spontaneously
46
When is not considered a pseudocyst?
When well-defined walls are visable
47
What can pseudocyst occur from?
Pseudocyst can occur from trauma or acute/chronic pancreatitis
48
What is the primary and secondary common locations for pseudocysts?
Pseudocyst most common location- lesser sac (anterior to panc. Posterior to stomach) 2nd most common location- pararenal space, most often left
49
What are patient symptoms of spontaneous rupture of a pseudocyst?
Spontaneous rupture occurs in 5% of these patients Symptoms- sudden shock and peritonitis Mortality rate- 50%
50
What are the ultrasound findings of a pseudocyst?
Usually well-defined mass—echo-free Debris may be seen within- infection and hemorrhage Borders are echogenic Calcifications may develop within the wall
51
Define Hemorrhagic Pancreatitis
Rapid progression of acute with rupture of vessels resulting in hemorrhage Diffuse enzyme destruction of pancreas Cause focal areas of fat necrosis In nearly half of these patients this occurs after a large binge or excessively large meal
52
What are the ultrasound findings of hemorrhagic pancreatitis?
Depends on the age of the hemorrhage May be homogeneous and echogenic with fresh blood Areas of fat necrosis seen At 1 week may appear cystic
53
Define phlegmonous pancreatitis
Phlegmon is an inflammatory process that spreads along fascial pathways Causes areas of diffuse inflammatory edema of soft tissue May proceed to necrosis Extension outside the gland occurs in 18-20% of patients
54
What are ultrasound findings of phlegmonous pancreatitis?
Phlegmonous tissue appears hypoechoic with good through-transmission Usually involves the lesser sac, left anterior pararenal space, and transverse mesocolon
55
Define pancreatic abcess
Low incidence, but serious complication—related to tissue necrosis Majority of patients develop an abscess secondary to pancreatitis that develops from postoperative procedures High mortality rate if left untreated
56
Ultrasound findings of pancreatic abcess
Poorly defined hypoechoic mass Smooth or irregular walls Few internal echoes seen, may be echo-free Air bubbles may be seen within, with shadowing posterior When it forms secondary to chronic pancreatitis and develops calcification within its walls typically doesn’t resolve on its own
57
Define chronic pancreatitis
Results from recurrent attacks of acute and causes continuing destruction of pancreas
58
What is chronic pancreatitis associated with?
Generally associated with chronic alcoholism or biliary disease
59
What can occur b/c of chronic pancreatitis?
Fibrous connective tissue and scarring occur
60
What can become obstructed b/c of chronic pancreatitis?
Pancreatic duct becomes obstructed because of protein plugs with resultant calcifications
61
What do patients with chronic pancreatitis have a chance of developing?
Patients have an increased risk in developing pancreatic cancer
62
Ultrasound findings of chronic pancreatitis
``` Mixed pattern Increased overall echogenicity with hypoechoic and hyperechoic foci Decreased size Irregular borders Possibly dilated duct ```
63
Name some cystic lesions of the pancreas
Autosomal dominant polycystic disease Congenital cystic lesions of the pancreas Cystic fibrosis Fibrocystic disease of the pancreas Von Hippel-Lindau syndrome Solitary pancreatic cysts
64
What is the most common primary neoplasm of the pancreas?
adenocarcinoma Accounts for greater than 90% of all malignant pancreatic tumors Fourth most common cause of cancer related mortality after lung, breast, and colon cancer
65
What does adenocarcinoma involve?
Involves the exocrine portion of the gland--Fatal tumor
66
What is the survival rate for adenocarcinoma is poorly diagnosed?
Poor prognosis– survival time of 2-3 months and 1 year survival rate of 8%
67
True or false: Majority of patients over 60 years old get adenocarcinoma
true
68
What are the clinical symptoms of adenocarcinoma?
Depends on the location Tumors in the head present symptoms early, causing obstruction of the CBD with jaundice and hydrops of the GB (Courvoisier’s sign) Palpable, nontender GB with jaundice seen in 25% of patients with pancreatic ca Tumors in the body and tail—less specific symptoms Most commonly- weight loss, pain, jaundice, and vomiting (as GI tract has been invaded by tumor) Tumors in the body and tail more frequently larger
69
What is the most common location for pancreatic adenocarcinoma?
head followed by body, then tail
70
Ultrasound findings of adenocarcinoma
Poorly defined mass in the region of the pancreas Hypoechoic or isoechoic Rarely, necrosis will be seen as a cystic area within the mass May have secondary enlargement of the duct from edema or tumor in the panc head If tumor is within the head look for biliary dilation Sonographer should look for mets in the liver, para-aortic nodes, displacement of vessels
71
What are the two types of cystic pancreatic neoplasms?
Microcystic (serous adenoma) | Macrocystic (mucinous adenoma)
72
What accounts for 10-15% of all pancreatic cysts?
Cystic neoplasms of the pancreas account for 10-15% of all pancreatic cyst
73
Define microcystic adenoma
Rare, benign disease is found more often in older women. | Tumor is well circumscribed and usually consists of a large mass with multiple tiny cysts.
74
Define Macrocystic Adenoma
Benign with malignant potential | More often in the tail followed by body then head
75
Ultrasound findings of macrocystic adenoma
``` Well-defined Thin or thick walled Usually larger than 2 cm 4 types Hypoechoic Echogenic with debris Cyst with solid mural vegetations Completely filled or solid looking cyst ```
76
Define Intraductal Papillary Mucinous Tumor
Form of mucinous cystic neoplasm Slow growing occurs in patients in their 60’s & 70’s Benign to malignant
77
Where does intraductal papillary mucinous tumor originates from?
Originates from main pancreatic duct or its branches
78
What are the clinical symptoms of intraductal papillary mucinous tumor?
Clinical symptoms- abdomen pain, elevated amylase, so pancreatitis is a differential
79
Define Endocrine Pancreatic Neoplasms
Rise from the islet cells of the pancreas Several types of islet cell tumors; may be functional or nonfunctional Benign or malignant Growth rate is slow Usually do not spread beyond regional lymph nodes and liver
80
What is the most common functioning islet cell tumor or endocrine pancreatic neoplasm? What is the second most common?
Most common functioning islet cell tumor- Insulinoma | 2nd most common functioning islet cell tumor-Gastrinoma
81
Define insulinoma (B-Cell)
Most common functioning islet cell tumor Usually benign Most- small, well encapsulated, and hypervascular
82
What are the clinical symptoms of insulinoma?
Palpitations, headache, confusion, pallor, sweating, slurred speech and coma Clinical triad: Patients in their 40’s-60’s Hypoglycemic symptoms with immediate relief after IV glucose
83
Define gastrinoma (G-Cell)
2nd most common functioning islet cell tumor Produces Zollinger-Ellison syndrome Caused by non-insulin secreting pancreatic tumors that secrete excessive amounts of gastrin Frequently multiple, extrapancreatic, difficult to locate and 60% are malignant
84
What does the gastrinoma stimulate?
Stimulates the stomach to produce great amounts of hydrochloric acid and pepsin
85
What does gastinoma lesion affect?
These lesions usually affect young patients with peptic ulcer disease
86
What does Rare Islet-Cell Tumors include?
Rare functioning islet-cell tumors include: Glucagonoma, lipoma, somatostatinoma and carcinoid and multihormonal tumor Most commonly malignant- glucagonomas and vipomas
87
Define vipomas
Vipomas- associated with GB dilation, fluid-filled distended bowel loops, and excessive secretion of fluid and electrolytes
88
What can be present with rare islet-cell tumors?
Thickening of the gastric wall may be present
89
What are ultrasound findings of nonfunctioning islet-cell tumors?
Typically small Best seen when in the head May be multiple and usually occur in the body and tail—greater concentration of Langerhans islets in that area
90
Define nonfunctioning islet-cell tumor?
33% of all islet-cell neoplasms | Tendency to present as large tumors in the head of the pancreas with a high incidence of malignancy
91
Primary tumors that can metastasize to the pancreas?
``` Primary tumors that can metastasize to the pancreas are: Melanomas Breast Gastrointestinal Lung tumors ```
92
Define lymphoma
Most common parapancreatic neoplasm Arise from lymphoid tissue May be difficult to separate from primary lesion
93
How can intra-abdominal lymphomas appear?
Intra-abdominal lymphoma may appear as a hypoechoic mass or with necrosis, a cystic mass in the pancreas
94
With lymphoma, how can the SMV be displaced?
Superior mesenteric vessels may be displaced anterior instead of posterior, as seen with a primary pancreatic mass
95
Where can multiple nodules be seen with lymphoma?
Multiple nodes are seen along the pancreas, duodenum, porta hepatis, and superior mesenteric vessels.
96
What can Phlegmonous Pancreatitis cause?
Causes areas of diffuse inflammatory edema of soft tissue
97
What can phlegmonous pancreatitis proceed to?
necrosis
98
When does hemorrhagic pancreatitis occur?
In nearly half of these patients this occurs after a large binge or excessively large meal
99
What does hemorrhagic pancreatitis cause?
Cause focal areas of fat necrosis
100
What does majority of patients develop secondary to pancreatitis?
Majority of patients develop an abscess secondary to pancreatitis that develops from postoperative procedures

SON130 (3 decks)

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