Flashcards in Lesson 3A (Part 3) Deck (28)
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1
What is the sonographic appearance of a pseudocyst?
Almost purely cystic to collections with considerable mural irregularity, septations and internal echogenic debris
2
What can cause the mural irregularity, septations and internal echogenic debris for a pseudocyst? (3)
1. Necrosis
2. Hemorrhage
3. Infection
3
Significant pancreatic necrosis
Parenchyma that is over 3cm AP or involving more then 30% of the pancreas
4
How is significant pancreatic necrosis treated? (2)
1. Antibiotics
2. Close observations
5
What is useful when diagnosing necrosis?
CECT
- US cant be done on its own
6
Why do abscesses occur?
If fluid collection becomes infected
- pus filled collections
7
What can you do with pseudocysts that become infected?
Drained or excised
8
What are considered the 2 most useful modalities when diagnosing acute pancreatitis?
1. CECT
- contrast enhanced CT
2. Abdominal Ultrasound
9
What are useful but usually secondary modalities when diagnosing acute pancreatitis? (2)
1. MRCP
2. MRI
10
What does the choice of modality depend on?
The patients clinical situation
11
When is CECT recommended?
Diagnostic for necrosis
12
When is CT recommended?
For determining delayed complications of acute pancreatitis, guiding aspiration and drainage
13
When is US recommended?
When assessing fluid collections, biliary systems and dilated ducts
14
What modality do you use if this is the patients first episode of acute pancreatitis?
Ultrasound
15
What modality do you use if this is the patients second episode of acute pancreatitis?
CT
16
What is ERCP usually used for?
Therapy
- not diagnosis
17
What can US and CECT be used for in treatment?
1. Guidance aspiration
2. Drain an infected pseudocyst
18
Chronic pancreatitis
Intermittent pancreatic inflammation with progressive irreversible damage to the gland
19
What is the predominant cause of chronic pancreatitis?
Alcoholism
20
What are other causes of chronic pancreatitis? (6)
1. Pancreatic duct obstruction
2. Hypertriglyceremia
3. Hypercalcemia
4. Auto-immune pancreatitis
5. Tropical pancreatitis
6. Genetic mutations
21
What are signs and symptoms of chronic pancreatitis? (3)
1. Pain
2. Malabsorption
3. Diabetes
22
What can chronic pancreatitis lead to? (6)
1. Fibrosis
2. Cellular damage
3. Chronic inflammation
4. Distorted/blocked ducts
5. Permanent structural changes
6. Deficient endocrine and exocrine function
23
What is the sonographic appearance of chronic pancreatitis? (5)
1. Altered parenchymal texture
2. Glandular atrophy
- or gland enlargement
3. Focal masses
4. Dilation and beading of pancreatic duct with calcifications
5. Pseudocysts
24
What is the treatment for uncomplicated chronic pancreatitis? (2)
1. Alleviate pain
2. Control malabsorption and diabetes
25
What is the goal of uncomplicated chronic pancreatitis treament?
Aim to improve quality of life
26
What is the treatment for complicated chronic pancreatitis? (2)
1. Surgery
2. Endoscopy
27
What are possible complications with treatment of complicated chronic pancreatitis? (5)
1. Pseudocysts
- more common in chronic
2. Abscesses
3. Malignancies
4. Thrombosis of portals
5. Pancreatic and bile duct obstruction
- double duct sign
28
