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Flashcards in Pancreas Deck (55):
1

What is the balthazar system?

Staging of pancreatitis

a - normal
b - focal/diffuse enlargement
c - intrinsic pancreatic abnl with peripancreatic inflammation
d - fluid collection/phlegmon
e - 2 or more large phlegmonous collections or peripancreatic gas

2

What are the two main appearances of pancreatitis

Diffuse gland enlargement

Normal sized gland with peripancreatic fluid

3

What is the diagnostic key for pancreatic parenchymal necrosis?

Nonperfusion of a pancreatic segment

4

Which part of the pancreas is most susceptible to necrosis?

The body - doesnt have dedicated blood supply

5

What is the natural progression of peripancreatic fluid collections?

Most resorp in 2-3 weeks

6

What is a pseudocyst? What does it indicate?

A peripancreatic fluid collection with a thick fibrous wall lasting more than 6 weeks

Persistent communication with the pancreatic duct

7

When are pseudocysts usually drained?

4cm

8

Irregular fluid collection within a fluid collection surrounding pancreas suggestS?

Pseudoaneurysm

9

What causes the colon cutoff sign with regards to pancreatitis?

Pancreatic inflammatory fluid occupies the left pararenal space and causes colonic spasm

10

What are the helpful signs that distinguish IPMN and chronic pancreatitis?

IPMN will have mainly ductal dilation

Chronic pancreatitis will have parenchymal atrophy

11

What percentage of pancreatic parenchymal loss must occur for pancreatic insufficiency?

90%

12

Chain of lakes appearance of the pancreatic ducts is seen with what

chronic pancreatitis

13

What are the two types of familial pancreatitis

1) familial occurence associated with hyperlipidemia, hyperparathyroidism, CF, cholelithiasis

2) AD inherited syndrome

14

What is hereditary pancreatitis?

AD inherited

early bouts of pancreatitis as a kid, increased risk of pancreatic cnacncer

15

Subtype of pancreatitis seen in older men, milder symptoms. What is the marker?

Autoimmune pancreatitis

IgG4

16

How are most pancreatic cancers on CT?

hypoattenuating mass

17

What US finding is specific for ductal adenocarcinoma?

Ductal dilation

18

What are the two important phases in detection of pancreatic tumors?

Pancreatic phase (45 seconds) - will have maximal contrast between hypoattenuating mass and parenchyma

Portal venous - detects hepatic mets and lymphadenoapthy

19

How do most pancreatic tumors present on MRI?

Hypo in T1 and hyper on T2

20

What does obliteration of the pancreatic - SMA fat plane suggest?

Pancreatic mass

21

What are the causes of nonresectibility in pancreatic cancer?

Arterial invasion - celiac or SMA
Venous invasion - *limited involvement of SMV and portal can be resected
Regional lymphadenopathy with metastatic tumor
Distant mets

22

Multiple collateral vessels in the upper abdomen in a patient with pancreatic cancer should prompt search for what?

splenic/mesenteric vein occlusion

23

What 3 features help distinguish islet cells tumors?

Hypervascularity
Lack of vascular encasement
Propensity to calcify

24

What are the common hyperfunctioning islet cell tumors?

Insulinoma and gastrinoma

25

Which type of islet cell tumor are worse?

Nonfunctioning because they dont have symptoms and can grow to big sizes before detection

26

What is the gastrinoma triad?

Location of half of gastrinomas (arise out of pancreas)

Amuplla vater, junction of cystic duct and CBD, and junction of neck and body of pancreas

27

Gastrinomas are associated with what syndrome?

MEN I

28

What percentage of gastrinoma are malignant?

75%

29

What NM test can detect gastrinoma? Why?

Octreotide scintigraphy

High concentration of somatostatin receptiors

30

What is the US difference between primary and metastatic islet cell tumor? Between cavernous hemangioma?

PRimary - hypoechoic

Metastatic - hyperechoic with posterior acoustinc shadowing

Hemangioma - no shadowing

31

What is the difference between islet cell tumors associated with MEN and those that arise sporadically?

MEN I - tend to be small, multiple, and biologically less aggressive

32

What are the symptoms with glucagonoma

necrolytic erythema migrans, diarrhea, diabetes, glossitis

33

What is unique about hepatic mets in hypervascular primary tumors, such as islet cell?

Can contain fluid air level

34

Intratumoral calcification with solid and cystic elements in a young african woman

Solid and papillary epithelial neoplasm

35

What is the treatment of SPEN

total cure with resection

36

What are the unique features of acinar neoplasm?

Larger than ductal
Encapsulated
Has metastatic fat necrosis due to systemic release of lipase

37

What tumor causes metastatic fat necrosis

Acinar cell carcinoma

38

Most common met to the pancreas?

Renal cell

39

What are the two main types of cystic pancreatic masses? Which are benign?

Serous - benign

Mucinous - pre/malignant

40

Honeycombed appearance, many (>6) small (

Serous "Serous has Several"

41

Few large cysts

Mucinous

42

What is the main differential for a mucinous cystadenoma

Pseudocyst - will have history of pancreatitis

43

What are malignant features of mucinous neoplasms

Thick septation
mural nodules

44

Mucin eminating from the papilla of vater is pathognomonic for what

IMPN

45

What is the imaging in IPMN

pancreatic ductal dilation with filing defects

46

Identification of a dilated side branch is suggestive of what diagnosis?

side branch IPMN

47

What is the size cutoff for resection of side branch IPMN

3cm

48

What is the grandma tumor? mother tumor? daughter tumor?

Grandma - serous
Mother - "M"ucinous
Daughter - SPEN

49

What are the pancreatic manifestations of VHL?

Numerous cysts
Serous cystadenoma
Islet cell tumor

50

Where do pancreatic lacerations most often occur

Between the neck and body

51

What is pancreatic divisum?What are the drainage pathways?

Failure of the dorsal and ventral portions of the pancreas to fuse

The duct of santorini empties via the accessory papilla

52

What are the two theories of pancreatic annulus forms?

Failure of pancreatic atrophy

Ventral portion adheres to duodenum and stretches around it as it rotates into position

53

Calcifications in the pancreas that are not intraductal and without ductal dilation?

Sarcoidosis

54

Where are the calcifications with chronic pancreatitis seen

Intraductal

55

What does a sausage shaped and with an apparent hypoattenuating halo surrounding an enlarged pancreas suggest?

Autoimmune pancreatitis