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Pancreas Flashcards

(52 cards)

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0
Q

What are the segments of the pancreas?

A

Head, neck, body, tail, uncinate process

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1
Q

What is the pancreas location?

A

Retroperitoneal, posterior, closer to spine
Lies transverse in the body, extending from
The duodenum to splenic hilum

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2
Q

Location of GDA in relationship to pancreas

A

Anterior, lateral and enters the head of panc antero-superior

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3
Q

Location of CBD in relationship to panc

A

Postero-lateral, entering head of panc postero-superior

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4
Q

Where does the GDA arise from?

A

Common hepatic artery

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5
Q

Location of the neck of panc

A

Anterior to the PC

Anterior to the SMV

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6
Q

Location of the body of panc

A

Anterior to Splenic Vein
Anterior to SMA
Posterior to Stomach
Inferior to Splenic Artery

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7
Q

Location of tail of panc

A

Anterior to splenic vein

Close to spleen

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8
Q

Location of uncinate process of panc

A

Postero-medial portion of the head
Posterior to SMV and SMA
Anterior, medial to IVC

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9
Q

Pancreatic measurements

A

Head AP 2-3 cm
Body AP 1-2 cm
Tail AP 1-3 cm
Total length 17cm

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10
Q

What is the vasculature of the panc?

A

GDA, SMA, and splenic artery

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11
Q

What is the normal size of the duct of wirsung?

A

AP <2 mm

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12
Q

What is the duct of wirsung?

A

Pancreatic duct that leads to the duodenum at the ampulla of vater through the sphincter of oddi

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13
Q

Wirsung duct variant

A

Duct of santorini, accessory duct. Non-functional since bypasses ampulla of vater

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14
Q

As what kind of gland does the pancreas serve?

A

Exocrine- secretes enzymes through ducts

Endocrine- secretes hormones directly into blood stream

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15
Q

What percentage of panc is for digestion and why?

A

80%

Since its digestive enzymes amylase, lipase, and trypsin are released into the c loop of duodenum.

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16
Q

What are the functions of the enzymes produced by the panc?

A

Amylase- sugar/carb breakdown
Lipase- fatty splitting enzyme, most destructive, very toxic
Trypsin- protein breakdown

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17
Q

Endocrine function of panc

A

Hormone producing cells of panc are islets of langerhans or pancreatic islets
They create alpha, beta and delta cells

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18
Q

What do the cells of the endocrine function of panc produce?

A

Alpha cells produce glucagon
Beta cells produce insulin
Delta cells produce somatostatin

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19
Q

What kind of pancreatic congenital anomalies are there?

A

Congenital cysts
Cystic fibrosis
Pancreas divisum
Annular pancreas

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20
Q

Pancreatic neoplasm kinds

Study These Flashcards
A

Adenocarcinoma
Serous cystadenoma
Mucinous cystadenoma and cystadenocarcinoma
Islet cell tumor

21
Q

Multiple cysts in the panc are associated with?

Study These Flashcards
A

Adult polycystic kidney disease and Von Hipple-Lindau Syndrome.

22
Q

What is Cystic Fibrosis?

Study These Flashcards
A

Exocrine gland disorder
Viscous secretions cause pancreatic dysfunction
U/S appearance
Increased echogenicity, glandular atrophy associated with fibrosis and fatty replacement and cysts due to ductal obstruction

23
Q

What is pancreas Divisum?

Study These Flashcards
A

Failure of the dorsal and ventral pancreatic buds to fuse during embrionic development
The smaller santorini’s duct drains the pancreatic body and tail (dorsal panc)
Suggested association with pancreatitis

24
What is annular pancreas?
Uncommon congenital anomaly wherein a ring of normal pancreatic tissue encircles the duodenum secondary to abnormal migration of the ventral pancreas Suggested association with pancreatitis
25
What is Auto-digestion?
When the enzymes of the panc are active inside it and begin to eat away at the panc
26
Etiology of acute pancreatitis
``` Biliary tract diseases Chronic alcohol abuse Peptic ulcer Abdominal trauma Lupus- autoimmune disorder A venomous sting from a scorpion Infection such as mumps, hep a, b or salmonella Presence of a tumor (auto-digestion) ```
27
What are the clinical signs and symptoms of acute pancreatitis?
More common in men Epigastric and back pain, can worsen after meal Nause Vomiting Unexplained weight loss Fever Tachycardia Severe cases can cause hypotension due to dehydration In extreme cases, bleeding of panc can lead to shock Pulmonary and renal failure
28
Lab signs of acute pancreatitis
Elevated amylase in the 1st 24 hrs, return to normal after 72 hrs Elevated lipase after 48 hrs and continues to rise for 1-2 weeks Elevated WBC
29
What are the complications of acute pancreatitis?
``` Pancreatic pseudocyst Peripancreatic fluid collection Phlegmon or phlegmatous pancreatitis Hemorrhagic pancreatitis Abscess Pseudoaneurysm ```
30
What is pancreatic pseudocyst?
Results from acute pancreatitis or flare ups of chronic pancreatitis It is an accumulation of fluid and necrotic debris confined by retroperitoneum. This occurs in an attempt to wall off the panc solutions to prevent further tissue damage Can form anywhere in the body where fluid traps Most commonly found in lesser sac (between stomach and panc)
31
What is used to differentiate between cancer and pseudopancreatitis?
Normal serum amylase
32
What is chronic pancreatitis?
Irreversible destruction by repeated bouts of pancreatic inflammation
33
What causes chronic pancreatitis?
``` Alcoholism- most common cause Hereditary recurrent pancreatitis Cystic fibrosis High levels of calcium in blood High blood fat When digestive enzymes attacking and destroy the panc and nearby tissue. May also be triggered by one acute attack ```
34
What is the sonographic appearance of chronic pancreatitis?
``` Small, echogenic Microcalcifications Irregular contours Dilated duct of wirsung Bile duct dilation Pseudocyst formation Portal vein thrombosis ```
35
Lab signs of chronic pancreatitis?
Non specific | Later stages- endocrine and exocrine dysfunction
36
What is the treatment for chronic pancreatitis?
Whipple procedure
37
What is hemorrhagic pancreatitis?
Form of acute pancreatitis with significant fat necrosis leading to rupture of pancreatic vessels and secondary hemorrhage Incidence: 2-5% of all acute pancreatitis cases
38
What is the clinical presentation of hemorrhagic pancreatitis?
``` Severe abdominal pain Nausea and vomiting Abdominal distention and varying degree of ileus Periumbilical ecchymosis (Cullen sign) Flank ecchymosis (grey-turner sing) Infrainguinal ecchymosis (fox sign) ```
39
Lab signs of hemorrhagic pancreatitis
Increased serum and urine amylase and serum lipase | Decreased hematocrit and serum calcium
40
What percentage of neoplasm in panc will be in the head?
70%
41
What is serous cystadenoma?
Aka microcystic cystadenoma Benign Associated with Von Hipple-Lindau syndrome Well defined lobulated mass Appearance varies from echogenic mass (microcystic) to a multicystic mass (small cysts)
42
Risk factors for pancreatic cancer
``` More common in men African American >30 years of age Smoker Fatty diet Chronic pancreatitis Cirrhosis or diabetes ```
43
Which is the most common pancreatic cancer and where does it arise from?
Adenocarcinoma | Acinar cells
44
Associated findings of adenocarcinoma
``` Bile duct dilation Courvoisier GB Dilated panc duct Pancreatitis Ascites Liver mets Lymphadenopathy Pseudocyst formation ```
45
What are other names for mucinous cystadenoma?
Cystadenocarcinoma, macrocystic cystadenoma
46
Sonographic appearance of mucinous cystadenoma
``` Well defined, multicystic mass Solid component (papillary projections)within cystic mass ```
47
What lab sign will be present with cystadenocarcinoma?
Increased CEA (carcino embryogenic antigen)
48
What kind of rumors can arise from islet cells?
Alpha cells: glucagononma Beta cells: insulinoma Delta cells: gastrinoma Typically located in the pancreatic tail Associated with MEN syndrome (multiple endocrine neoplasia)
49
Which is the most common islet cell tumor?
Insulinoma Usually benign Hyperglycemic symptoms due to hyperinsulinism
50
What is the second most common islet cell tumor?
Gastrinoma Causing gastric and duodenal ulceration Zollinger-Ellison syndrome is another name for it
51
Sonographic appearance of Zollinger-Ellison Syndrome
Round mass with variable echogenicity Usually 1-2 cm in size Lymphadenopathy, especially in periportal region

Abdomen (10 decks)

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