Lesson 3.1 - Panc Path (part 1)

Question 1

GDA vs CBD location - which is more anterior

Answer 1

GDA more anterior

Question 2

when might serum amylase increase? (4)

Answer 2

• pancreatitis
• obstruction intestinal
• pseudocyst
• peptic ulcer disease

Question 3

when does serum amylase decrease (2)

Answer 3

hepatitis

cirrhosis

Question 4

in episodes of acute pancreatitis, which stays increased longer urine or serum amylase?

Answer 4

urine amylase

Question 5

what stays elevated the longest?

Answer 5

serum lipase

Question 6

elevated serum lipase assoc with (6)

Answer 6

• pancreatitis
• obstruction panc duct
• carcinoma
• cirrhosis
• acute cholecystitis
• severe renal disease

Question 7

what cases indicate elevated glucose

Answer 7

• diabetes mellitus
• chronic liver disease
• over activity of endocrine glands

Question 8

glucose decreases with

Answer 8

tumours of islets of langerhands in the pancreas

Question 9

t/f increased echogenicity in the pac is not always a result of fatty replacement

Answer 9

true

Question 10

panc normal variant size (1)

Answer 10

pseudomass - larger head bulging to right of GDA

Question 11

what area of the pancreas (and size) may indicate acute pancreatitis

Answer 11

if the body exceeds 3 cm AP

Question 12

what size should the panc duct measure

Answer 12

3 mm or less

Question 13

congenital anomalies (3)

Answer 13

• pancreatic divisum
• annular pancreas
• partial agenesis

Question 14

what is the most common pancreas variant

Answer 14

pancreatic divisum

Question 15

describe annular panc

Answer 15

duodenum encircled by a ring of pancreatic tissue - may constrict duo

Question 16

when do we use doppler (3)

Answer 16

• any mass
• suspected pancreatitis
• if splenic vein does not appear anechoic and is over distended

Question 17

are pancreatic enzymes increased or decreased with acute pancreatitis

Answer 17

raised

Question 18

what are the causes/risk factors of acute pancreatitis?

Answer 18

gallstones (40%)

alcoholism (40%)

Question 19

what should you do if you suspect acute pancreatitis? (3)

Answer 19

evaluate the biliary tree for gallstones, choledochlithiasis and obstruction

Question 20

other causes of acute pancreatitis (9)

Answer 20

choledocholithiasis

• biliary sludge
• neoplasm
• infection
• toxins
• drugs
• genetic
• traumatic
• iatrogenic factors

Question 21

steps for diagnosing acute pancreatitis

Answer 21

amylase and lipase elevated on blood test*

pt sent for imaging (US/ CECT)

Question 22

sono findings of pancreatitis

Answer 22

-panc tissue hypoechoic / enlarged
-surrounding/
potential spaces (lesser sac, anterior pararenal spaces, trans mesacolon)
-biliary system (GB stones, choledocalithasis, dilated ducts)

Question 23

the most common and useful finding to diagnose pancreatitis

Answer 23

pac assoc inflammation:
Hypoechoic or anechoic collections that conform to the retroperitoneal space
Ascites

Question 24

*local complications of pancreatitis (4)

Answer 24

fluid collection (40%)
pseudocysts (fluid collection >6 wks)
abscess
necrosis

Question 25

vascular complications associated with pancreatitis (3)

Answer 25

hemorrhage
venous thrombosis
pseudoaneurysms

Question 26

define pseudocyst and why isn’t it a true cyst

Answer 26

fluid collection persists > 6wks

not true cyst /cystic neoplasm because no epithelial lining

Question 27

t/f pseudocyst comprise most of the cystic lesions of the pancreas

Answer 27

true (more common in chronic pancreatitis)

Question 28

How must we confirm its a pseudocyst (2)

Answer 28

clinical history and/or evidence of acute/chronic pancreatitis

Question 29

pseudocyst sono appearance

Answer 29

range in appearance

- purely cystic or mural irregularity, septations , interal echo debris

Question 30

what might a pseudocyst look like

Answer 30

cystic neoplasm

Question 31

significant pancreatic necrosis defined as

Answer 31

parenchyma >3cm AP or

involving more than 30% of the panc

Question 32

how is necrosis treated

Answer 32

antibiotics

Question 33

t/f necrosis can be diagnosed with US

Answer 33

false
CECT (contrast enhanced CT)

Question 34

main modalities in diagnosing acute pancreatitis

Answer 34

CECT

abdo US

Question 35

US ROLE! (3)

Answer 35

• detect gallstones, choledocholithiasis and/or signs of obstruction
• diagnose acute pancreatitis
• treatment: guidance in drainage of infected pseudocyst