Pancreas

Question 1

the head of the pancreas is the most _____ portion

Answer 1

inferior; lies in the C loop of the duodenum

Question 2

the _____ of the pancreas is directly anterior to the portal-splenic confluence or superior mesenteric vein

Answer 2

neck

Question 3

the _____ of the pancreas is the largest section of the gland

Answer 3

body

Question 4

the _____ of the pancreas lies anterior to the left kidney and posterior to the left colic flexure and transverse colon

Answer 4

tail

Question 5

what 2 ducts are seen in the pancreas?

Answer 5

duct of Wirsung and duct of Santorini

Question 6

the duct of _____ is the primary duct extending the length of the pancreas; enters the medial second part of the duodenum with the CDB

Answer 6

Wirsung; should measure less and 2mm and tapers as it reaches the tail

Question 7

the duct of _____ is a secondary duct that drains the upper anterior head; it enters the duodenum at the minor papilla about 2 cm proximal to the ampulla of Vater

Answer 7

Santorini

Question 8

normal pancreas head to tail measure _____, head measures _____, neck _____, body _____, tail _____

Answer 8

15cm; 3cm; 1.5-2.5cm; 2-2.5cm; 1-2cm; decreases in size as you age

Question 9

_____ of the body and tail, with hypertrophy of the pancreas head is a congenital defect

Answer 9

agenesis

Question 10

_____ is a rare condition caused by the lack of fusion of the dorsal and ventral pancreatic buds; drainage of the dorsal and ventral pancreas is through the minor papilla

Answer 10

pancreas divisum

Question 11

_____ is the most common pancreas anomaly, usually in the form of intramural nodules

Answer 11

ectopic pancreas tissue; tissue may be found in various places in the GI tract

Question 12

_____ pancreas is a rare anomaly in which the head of the pancreas surrounds the second portion of the duodenum

Answer 12

annular; more common in males; may be associated with duodenum atresia

Question 13

the pancreas is both a digestive ____ and hormonal _____ gland

Answer 13

exocrine (produce pancreatic juice); endocrine (controls the secretion of glucagons and insulin in the blood)

Question 14

exocrine functions is performed by _____ of the pancreas; can produce up to 2L per day

Answer 14

acini cells; the enzymes of the pancreas juice that aid digestion includes lipase (digest fat), amylase (digest carbs), carbozypeptidase and trypsin (digest proteins)

Question 15

the endocrine function is located in the _____ in the pancreas

Answer 15

islets of Landerhans; cells within the islets are called alpha (produce glucagons), beta (produce insulin), and delta (produce somatostatin) cells

Question 16

a _____ level of twice normal usually indicates acute pancreatitis; as wall as urine amylase

Answer 16

serum amylase; other reasons could be chronic pancreatitis, obstruction of the prancreatic duct, perforated peptic ulcer, acute cholecystitis, and alcohol poisoning

Question 17

the _____ test is performed to assess damage to the pancreas

Answer 17

lipase; rise in acute pancreatitis and carcinoma; lipase elevation persists longer than amylase

Question 18

the _____ tolerance test if performed to discover whether there is a disorder of glucose metabolism

Answer 18

glucose; may be a decrease in blood sugar levels in tumors of the islets of Langerhans

Question 19

_____ occurs when the pancreas becomes damaged and malfunctions as a result of increased secretion and blockage of ducts; when this occurs the pancreas tissue may be digested by its own enzymes

Answer 19

pancreatitis

Question 20

____ pancreatitis is caused by the inflamed acini releasing pancreatic enzymes into the surrounding pancreatic tissue; hypoechoic (edema); borders irregular; head causes depression of IVC; parapancreatic fluid

Answer 20

acute; sudden onset of moderate to severe abdominal pain with radiation to back; nausea and vomiting; history of gallstones or alcoholism; mild fever; abdominal distention

Question 21

the most common cause of pancreatitis in the united states is _____

Answer 21

biliary tract disease; second common is alcohol abuse

Question 22

these extrapancreatic fluid collections occur within _____ from the acute onset of the pancreatitis and may resolve spontaneously

Answer 22

4 weeks

Question 23

_____ are always acquired, they result from trauma to the gland or acute or chronic pancreatitis; defined as a collection of fluid that arises from the loculation of inflammatory processes, necrosis, or hemorrhage

Answer 23

pseudocyst; develops over 4 to 6 weeks after pancreatitis; well-defined mass, usually in area of pancreas, may have debris at bottom; develops when pancreatic enzymes escape from the gland and break down tissue to forma sterile abscess

Question 24

the most common location of a pseudocyst is in the _____ anterior to the pancreas and posterior to the stomach

Answer 24

lesser sac; second most common is the anterior pararenal space

Question 25

_____ pancreatitis is a rapid progression of acute pancreatitis with rupture of pancreatic vessels and subsequent hemorrhage; well defined homogenous mass in mass; foci of extravasated blood and fat necrosis are seen

Answer 25

hemorrhagic; decreased hematocrit and serum calcium levels; intense, severe pain radiating to back, with subsequence shock and ileus; hypotension

Question 26

a _____ is an inflammation process that spreads along fascial pathways, causing localized ares of diffuse inflammatory edema of soft tissue that may proceed to necrosis and suppuration

Answer 26

phlegmon; appears hypoechoic with good through-transmission

Question 27

the majority of patients develop _____ secondary to pancreatitis that develops from postoperative procedures; unilocular or multilocular and can spread superiorly into the mediastinum

Answer 27

abscess; hypotension; tender abdomen; hypoechogenic mass with smooth borders; thick walls; echo-free to echogenic

Question 28

______ pancreatitis results from recurrent attacks of acute pancreatitis and causes continuing destruction of the pancreatic parenchyma; malabsorption; fatty stools; signs of diabetes; weight loss; jaundice

Answer 28

chronic; the ducts become obstructed with a build-up of protein plugs with resultant calcifications along the duct; small and fibrotic gland; irregular borders; mixed echogenicity; dilated pancreatic duct

Question 29

_____ disease has cysts that vary from microscopic to several centimeters in diameter and have an epithelial lining; often found in patients with polycystic renal disease

Answer 29

autosomal dominate polycystic; well-defined mass with serous fluid

Question 30

_____ is an autosomal dominant condition characterized by central nervous system and retinal hemangioblastomas, visceral cysts, pheochromocytomas, and renal cell carcinoma

Answer 30

Von Hippel-Liudau Disease; well-defined mass with thick fluid; calcifications; single or multiple; size varies from microscopic to several cm

Question 31

_____ cysts of the pancreas result from the anomalous development of the pancreatic duct

Answer 31

congenital; usually multiple and range from small to 3 to 5 cm in size

Question 32

______ is a hereditary disease that causes excessive production of thick mucus by the endocrine gland; most common pancreatic abnormality found is fatty replacement of pancreas

Answer 32

cystic fibrosis; well-defined mass with serous fluid; size varies; fibrous replacement will occur throughout the parenchyma

Question 33

_____ cysts are microscopic sacs that may be congenital or acquired; often found in infants

Answer 33

true; well-defined mass with serous fluid; unilocular or multilocular

Question 34

the most common primary neoplasm of the pancreas is _____; loss of normal pancreatic parenchyma; hypoechoic poorly defined mass; focal mass with irregular borders; enlargement of pancreas; if located in the head look for hydrops

Answer 34

adenocarcinoma; involves the exocrine portion of the gland; wight loss; nausea vomiting, stool changes, pain radiating to back, painless jaundice; matastasizes to lymph nodes, liver, lung, bone, duodenum, peritoneum, and adrenal gland

Question 35

enlargement of the _____ in the pancreatic area may lead to encasement of the celiac axis or SMV artery

Answer 35

lymph node

Question 36

dilation of the pancreatic and common duct is common with the _____ tumor

Answer 36

ampullary

Question 37

what are the 2 types of cystic pancreatic neoplasms?

Answer 37

microcyctic (serous) adenoma and macrocystic (mucinous) adenoma

Question 38

the _____ adenoma is one of the pancreatic lesions found in von Hippel-Lindau disease; vary from 1 to 20 mm

Answer 38

microcystic; well-defined tumors with external lobulation; cyst walls thicker than the membranes between miltilocular cysts; hypervascular

Question 39

______ adenocarinoma is an uncommon, slow-growing tumor that rises from the duct as a cystic neoplasm; large cyst; significant malignant potential

Answer 39

macrocystic; more common in the tail and body; foci and calcification may be seen; smooth surfaced; irregular lobulated cystic tumor; hypoechoic mass; thick walls

Question 40

_____ is the most common functioning islet cell tumor

Answer 40

insulinoma (B-cell tumor); hypoglycemic symptoms; palpitations; headaches; confusion; pallor; sweating; coma; small, well encapsulated, and hypervascular

Question 41

______ is the second most common functioning islet cell tumor and produces the Zollinger-Ellison syndrome; caused by non-insulin secreting pancreatic tumors but secretes excessive amounts of gastrin

Answer 41

Gastrinoma (G-cell tumor); diarrhea; multiple; extrapancreatic; malignant

Question 42

______ tumors have a tendency to present as large tumors in the head of the pancreas with high incidence of malignancy

Answer 42

nonfunctioning islet-cell tumors

Question 43

______ is uncommon but primary tumors that can include melanomas, breast, gastrointestinal, and lung

Answer 43

metastasis

Question 44

_____ are malignant neoplasms that rise from the lymphoid tissue; most frequent parapancreatic neoplasm

Answer 44

lymphomas; hypoechoic mass or with necrosis a cystic mass in the pancreas; multiple nodes are seen