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Flashcards in Pancreas (normal and abnormal) Deck (166):
1

The pancreas is located in this area of the abdomen

epigastrium

2

The pancreas is _____ to the stomach, in the lap of the _____.

posterior
duodenum

3

The pancreas is a _____ _____ structure that lies between the duodenal loop and the splenic _____.

non-encapsulated
retroperitoneal
hilum

4

Pancreas is divided into these 5 parts:

head
uncinate process
neck
body
tail

5

The pancreas normally measures between _____ and _____ in length (about _____ inches long).

12-15 cm
6

6

This is the most bulbous part of the pancreas, which then narrows at the neck.

head

7

The pancreas head measures less than/equal to _____.

3cm

8

The porto-splenic confluence marks the anatomic position of this part of the pancreas.

neck

9

The lesser sac lies _____ to the body of the pancreas, while the SV runs along the _____ surface.

anterior
posterosuperior

10

The pancreas body measures _____.

1.5 cm

11

This part of the pancreas is related to the spleen, left adrenal glands, and upper pole of the left kidney.

tail

12

The pancreas tails measures _____.

2.4 cm

13

The tail of the pancreas is related to the _____, _____, and _____.

spleen
left adrenal glands
upper pole of left kidney

14

This extends inferior to the main body of the pancreas; thus, it is important to scan the full extent of the pancreas, or carcinoma of the _____ may be missed.

uncinate process
uncinate process

15

The pancreas has 2 functions:

1) exocrine
2) endocrine

16

The exocrine function of the pancreas secretes _____, _____, and _____ through the _____ system and _____ cells.

trypsin
lipase
amylase
ductal
acinar

17

The exocrine part of the pancreas comprises _____% of the pancreatic tissue.

80

18

The endocrine function of the pancreas secretes _____ via the _____.

insulin
islets of Langerhans

19

The endocrine part of the pancreas forms _____% of the pancreatic tissue.

2

20

The remaining 18% of the pancreatic tissue consists of fibrous _____ that contains _____, _____, and _____.

stroma
blood vessels
nerves
lymphatics

21

Amylase is a digestive enzyme for _____.

carbs

22

Amylase is produced by the pancreas and salivary glands, thus, _____ and salivary gland dysfunction causes increased levels of amylase.

pancreatitis

23

Amylase is also excreted by the _____, so increased levels of amylase are also seen with _____ disease.

kidneys
renal

24

_____ levels parallel the _____ levels.

Lipase
amylase

25

_____ levels rise first and _____ levels rise later, but persist longer.

Amylase
lipase

26

Sometimes the normal pancreas echotexture has a _____ appearance.

mottled

27

The contour of the pancreas is distinct when its echogenicity is _____ (more/less) than the surrounding retroperitoneal fat. It usually appears _____ (roughly/smoothly) contoured.

less
smoothly

28

With aging and obesity, the pancreas becomes more _____ (echogenicity), as a result of the presence of _____, and may be as _____ as the adjacent retroperitoneal fat. This echogenicity is _____ (reversible/irrereversible).

echogenic
fatty infiltration
echogenic
reversible

29

A technique used to better visualize the pancreas involves having the patient drink water to fill the stomach, while in the _____ position. While scanning the pancreas, the patient is then turned to the _____ or _____ position. The water in the stomach and duodenum is used as a(n) _____.

LLD
supine
RLD
acoustic window

30

The posterior wall of the stomach overlies the _____ border of the pancreas body and tail.

anterior

31

The duodenal loop, except for the _____ segment, encircles the pancreas _____.

1st
head

32

The _____, _____ layers (lesser and greater omentum), and the _____ sac come in close contact with the pancreas.

colon
peritoneal
lesser

33

The head of the pancreas is _____ to the IVC.

anterior

34

The head of the pancreas is _____ to the duodenum.

medial

35

The CBD is _____ to the pancreas head.

posterior

36

The GDA is _____ to the pancreas head.

anterior

37

The SMA and SMV are _____ to the pancreas neck.

posterior

38

The SMA and SMV are _____ to the uncinate process and the _____ portion of the duodenum.

anterior
3rd

39

The abdominal AO runs _____ to the pancreas body.

posterior

40

The CA arises from the AO at the _____ border of the pancreas.

superior

41

The CHA proceeds _____ to the right, _____ to the pancreas head.

anteriorly
cephalad

42

The CHA divides into the _____ and the _____.

PHA
GDA

43

The PHA travels _____ towards the liver, along the free edge of the _____ omentum, _____ to the MPV and to the _____ of the CBD.

superiorly
lesser
anterior
left

44

The GDA travels a short distance _____ to the junction of the _____ and the _____ portion of the duodenum, within a groove on the _____ border of the pancreas, _____ to the neck. It passes _____ to the head of the pancreas and divides into _____ and _____ arteries.

posterior
pylorus
1st
superior
lateral
anterior
gastroepiploic
superior pancreaticoduodenal

45

The SA follows a _____ (adjective) course along the _____ border of the pancreas body and tail.

tortuous
superior

46

The SMA arises from the AO just _____ to the pancreas body, descending _____ to the uncinate process and the _____ portion of the duodenum.

posterior
anterior
3rd

47

The IVC lies _____ to the pancreas head.

posterior

48

The SV runs from its origin in the splenic hilum along the _____ aspect of the pancreas to join the _____.

posteroinferior
SMV

49

The SMV and SV join _____ to the pancreas neck to form the _____, hence the MPV. The MPV ascends toward the porta hepatis _____ to the pancreas head.

posterior
portal confluence
cephalad

50

The CBD travels _____ to the 1st portion of the duodenum and the pancreas head, to lie to the _____ of the main pancreatic duct. It opens into the duodenum at the _____ after forming a common trunk with the _____.

posterior
right
Ampulla of Vater
main pancreatic duct

51

The duodenum is divided into _____ portions.

4

52

The _____ and _____ portion of the duodenum are transverse.

1
3

53

The _____ and _____ portion of the duodenum are long.

2
4

54

Another term for the main pancreatic duct is the

Duct of Wirsung

55

The normal pancreatic duct may be imaged but is considered abnormal if it is more than _____ in size.

2 mm

56

Pancreatic duct dilation is typically due to stones within the _____, from chronic _____ or a stone at the _____.

Duct of Wirsung
pancreatitis
Ampulla of Vater

57

Another term for the Duct of Santorini is

Accessory Duct

58

The Duct of Santorini branches off the _____ in the pancreas head and drains the _____.

main pancreatic duct
uncinate process

59

Agenesis of the pancreas is

Absence of the body and tail, with head remaining and showing compensatory hypertrophy.

60

T or F? Congenital cysts are common.

False (they are rare)

61

This is characterized by viscous secretions and dysfunction of multiple glands, including the pancreas, leading to pancreatic insufficiency.

Cystic Fibrosis

62

The pancreas has _____ (increased/decreased) echogenicity with cystic fibrosis, and is _____ (shrunken/enlarged) with marked _____, fatty replacement, and cysts secondary to the obstruction of the _____.

increased
shrunken
fibrosis
small ducts

63

The failure of the dorsal and ventral pancreatic ducts to fuse during embryonic development is

pancreas divisum

64

The most common congenital variant of pancreatic anatomy is

pancreas divisum

65

Pancreas divisum results in the smaller _____ draining the body and tail, and is associated with _____ (condition).

Santorini's ducts
pancreatitis

66

Pancreas divisum literally means

"divided pancreas"

67

The small buds that develop into the pancreas during early life arise from the _____.

foregut

68

In the _____ week of pregnancy, the 2 buds rotate in a such a way that they are close together and can fuse into the pancreas.

6th

69

If pancreas divisum occurs, this means the _____ bud and the _____ bud did not fuse.

dorsal
ventral

70

This is an uncommon congenital anomaly wherein a ring of normal pancreatic tissue encircles the duodenum, secondary to the abnormal migration of the _____ pancreas.

annular pancreas
ventral

71

Annular pancreas in children is frequently diagnosed in infancy due to its association with _____ obstruction.

duodenal

72

This is an inflammatory disease producing temporary pancreatic changes.

acute pancreatitis

73

The 2 most common causes of acute pancreatitis are

1) biliary tract disease
2) chronic ETOH abuse

74

It used to be assumed that the cause of acute pancreatitis was

that the person didn't take care of themselves and generally unhealthy habits

75

This is a condition characterized by just one area of inflammation in the pancreas.

focal pancreatitis

76

In what region of the pancreas is focal pancreatitis usually found?

pancreas head

77

T or F? Focal pancreatitis is difficult to differentiate from a neoplasm.

True

78

With normal _____ (enzyme), a pancreatic mass is likely to represent a neoplasm.

amylase

79

Pancreatitis in the pediatric patient is most likely associated with _____, _____ (most common), or _____.

choledochal cysts
cystic fibrosis (most common)
hereditary autosomal dominant pancreatitis

80

This condition causes the pancreas to become increasingly hypoechogenic, relative to normal liver, and increases in size.

diffuse pancreatitis

81

Also seen with diffuse pancreatitis is (5)

ductal dilation
mass effect from phlegmon or hemorrhage
peripancreatic fluid collections
thickening of adjacent fascial planes
ascites

82

The most common cystic lesion of the pancreas is a

pseudocyst

83

What are the 3 enzymes found inside a pseuodcyst?

amylase
lipase
trypsin

84

This is an accumulation of pancreatic fluid and necrotic debris, confined by the retroperitoneum, that contains high amounts of amylase, lipase, and trypsin.

pseudocyst

85

A pseudocyst is generally spherical and takes _____ - _____ weeks to enclose itself by forming a wall composed of _____ and vascular _____.

4-6
collagen
granulation tissue

86

This lesion occurs in 10%-20% of patients who have had acute pancreatitis.

pseudocyst

87

You can tell a pseudocyst is newer because it hasn't started _____ within itself.

bleeding

88

What symptoms are some of the main indicators of pseudocysts? (2)

persistant pain
elevated amylase levels

89

A well-defined, smooth-walled anechoic structure with acoustic enhancement in the pancreas is probably a

pseudocyst

90

Debris may occur within a pseudocyst due to _____ or _____.

hemorrhage
infection

91

This condition is most commonly associated with alcoholic or biliary etiology, blunt abdominal trauma in children, or pancreatic malignancy.

pseudocyst

92

Pseudocysts that persist beyond _____ weeks or grow larger than _____ in diameter, with evidence of regression, may require non-surgical decompression.

6 weeks
5cm

93

This is where percutaneous gastrostomy is combined with cystogastrostomy, under fluoroscopy. And ultrasound guidance is used to drain the pseudocyst.

non-surgical decompression
(needle draining)

94

This is irreversible destruction to the pancreas due to repeated bouts of pancreatic inflammation.

chronic pancreatitis

95

With chronic pancreatitis, the fibrous _____ proliferates around the ducts and between the lobules, causing interstitial _____. This leads to an irregular, _____ appearance of the pancreas surface.

connective tissue
scarring
nodular

96

What are some complications of a pseudocyst?

May become large and cause obstruction of the
stomach
small bowel
colon
or bile ducts

jaundice

obstructive cholangitis

97

This can ensue with a rupture of a pseudocyst into the peritoneal cavity.

acute peritonitis

98

The 2 main causes of chronic pancreatitis are (6 total)

alcoholism **
cystic fibrosis **



(hereditary pancreatitis, congenital abnormalities, blunt abdominal trauma, idiopathic chronic pancreatitis)

99

These sonographic findings may represent _____:
small echogenic pancreas **
calcifications **
pancreatic duct dilation
pseudocyst formation
bile duct dilation
portal vein thrombosis

chronic pancreatitis

100

A non-encapsulated inflammatory process =

phlegmon

101

This is a non-encapsulated inflammatory process that spreads along peripancreatic tissue, causing localized areas of diffuse inflammatory edema or soft tissue that may proceed to necrosis and suppuration.

phlegmon pancreatitis

102

What is the sonographic appearance of phlegmon pancreatitis?

hypoechoic
with good through transmission

103

What is the 4th largest cancer killer in adults, with a dismal prognosis, for which surgical resection is the only chance for cure?

pancreatic cancer

104

What is the only chance for cure with pancreatic cancer?

surgical resection

105

Adenocarcinoma has these main symptoms (2) with these sonographic findings (3)

abdominal pain
jaundice

solid, hypoechoic mass
usually in pancreas head
poorly defined

106

90% of patients with pancreatic carcinoma present with _____ and _____ spread of the tumor.

lymphatic
metastatic

107

Where does pancreatic carcinoma (adenocarcinoma) usually arise from (80% of the time)?

pancreatic head

108

The 5-year survival rate for adenocarcinoma (pancreatic carcinoma) is

less than 2%

109

What may be the condition of a patient with these findings:

BD dilation (Courvoisier's GB)
painless jaundice
dilated pancreatic duct
pancreatitis
liver mets
ascites
lyphadenopathy around AO
pseudocyst formation

adenocarcinoma (pancreatic carcinoma)

110

Elevated bilirubin and alkaline phosphatase, with possible elevation of amylase, could point to what pancreatic condition?

adenocarcinoma (pancreatic carcinoma)

111

T or F? When adenocarcinoma (pancreatic cancer) is in its early stages, the patient does not feel symptoms.

True

112

An adenocarcinoma tumor usually appears as a _____ (echogenicity), solid mass.

hypoechoic

113

The most striking clinical condition leading to diagnostic imaging for the detection of adenocarcinoma is _____, which is caused by compression or ingrowth of the _____.

painless obstructive jaundice
distal CBD

114

_____ is the first imaging test for the evaluation of adenocarcinoma patients.

U/S

115

Typically, patients with a pancreatic head tumor show dilation of the _____ and _____, creating a double duct sign.

CBD
pancreatic duct

116

This finding is very suggestive for a mass in the pancreatic head, even in the absence of a visible mass.

double duct sign (dilation of CBD and MPD)

117

This kind of carcinoma accounts for 85%-90% of all pancreatic tumors.

ductal adenocarcinoma

118

What are treatment options for pancreatic cancer? (4)

surgery
chemotherapy
radiation therapy
palliative care (hospice)

119

If a adenocarcinoma tumor is deemed resectable, the two surgical procedures offered are

Whipple Procedure
Distal Pancreatectomy Splenectomy

120

What is the Whipple Procedure?

it removes the head of the pancreas

121

Another term for the removal of the pancreas head is

pancreaticoduodenectomy

122

What is removed during a pancreaticoduodenectomy (4)?

pancreas head
portion of bile duct
GB
duodenum

123

After a pancreaticoduodenectomy, what is done with the remaining pancreas and bile duct?

They are sutured back to the intestines to direct secretions back to the gut

124

The type of procedure suggested for an adenocarcinoma tumor depends on

the location of the tumor

125

This procedure is the end of the pancreas is removed, the pancreas head is left attached.

distal pancreatectomy and splenectomy

126

What is a distal pancreatectomy and splenectomy meant to treat (main)?

pancreatic cancer localized in the end of the pancreas

127

Distal pancreatectomy and splenectomy may also be used for these 3 reasons

chronic pancreatitis
pancreatic pseudocysts
injury due to trauma

128

When pancreas cancer affects the SA or _____, the adjacent _____ is often removed. (referring to distal pancreatectomy/splenectomy topic)

SV
spleen

129

What are the 2 main cystic neoplasms of the pancreas?

serious cystadenoma
mucinous cystic

130

Which of the 2 main cystic neoplasms is typically benign and which is malignant (or potentially malignant)?

serous cystadenoma is benign
mucinous cystic is malignant (or possibly malignant)

131

What was serous cystadenoma formerly called?

microcystic cystadenomas

132

What condition does a "cluster of grapes" refer to with pancreatic disease?

serous cystadenoma

133

This is the micro form of cystic neoplasm.

serous cystadenoma

134

When serous cystadenomas are small, the mass may be _____ (echogenicity) and appear _____ (structure/texture) with through transmission.

echogenic
solid

135

What were mucinous cystic neoplasms formally called?

macrocystic neoplasms

136

The sonographic appearance of a mucinous cyst is a

well-defined multicystic mass (large cysts)

137

With mucinous cysts, what lab test level is increased?

CEA (Carcinoembryonic antigen)

138

What is the macro form of cystic neoplasms of the pancreas?

mucinous cystic neoplasm (formerly called macrocystic neoplasms

139

The suggestion for treatment of mucinous cystic neoplasms is _____, due to the possibility of _____.

resection
malignant transformation

140

Mucinous cystic neoplasms, 90% of the time, develop in the pancreas _____ (region).

tail

141

Compared to serous cystic neoplasms of the pancreas, mucinous cystic neoplasms are _____ (larger/smaller) and _____ (more/less) numerous.

larger
less

142

What is the most common islet cell tumor?

insulinoma

143

Is insulinoma benign or malignant?

usually benign (90%)

144

Insulinoma is a tumor of the pancreas that produces excessive amounts of _____.

insulin

145

Insulinomas are more common in _____ (men/women).

women

146

Insulinomas tumors are usually small, about less than _____.

2cm

147

These are hormonally active tumors arising from islet cells that produce insulin.

insulinoma

148

Islet cell tumors are _____ (shape) or _____ (shape) and are a well-_____, _____ (echogenicity) mass.

round
oval
circumscribed
hypoechoic

149

This is the 2nd most common islet cell tumor.

gastrinoma

150

Are gastrinomas malignant or benign?

often malignant (60%)

151

Gastrinoma is also known as

Zollinger-Ellison syndrome

152

People with _____ are commonly people that get gastrinomas.

peptic ulcers

153

This is a tumor in the pancreas that secretes excess gastrin, leading to ulceration the duodenum, stomach and the small intestine.

gastrinoma

154

Gastrinoma is most commonly found in the _____ (50%-70%) and less commonly in the _____ (20%-40%). Those occurring in the _____ have a greater potential for malignancy.

duodenum
pancreas
pancreas

155

What does MEN stand for?

multiple endocrine neoplasia

156

This is a group of heritable syndromes, characterized by abherant growth of benign or malignant tumors in a subset of endocrine tissues.

MEN

157

What are the 3 types of MEN?

MEN I
MEN IIA
MEN IIB

158

These are tumors involving the parathyroid glands:

endocrine pancreas and the pituitary

MEN I

159

This is medullary carcinoma of the thyroid gland:

pheochromocytoma and hyperparathyroidism

MEN IIA

160

This is medullary carcinoma of the thyroid:

multiple neuromas and pheochromocytoma

MEN IIB

161

MEN is associated with (6)

insulinoma
gastrinoma
medullary thyroid carcinoma
pheochromacytoma
parathyroid gland hyperplasia
pituitary tumors

162

This deals with masses and tumors that can form with all the endocrine glands in the body.

MEN

163

3 possible reasons for increased amylase production are

Pancreatitis
Salivary gland dysfunction
Renal dysfunction
(Pancreas, salivary glands, kidneys produce amylase)

164

Which persists longer? Amylase or lipase?

Lipase

165

What is the usual size of the pancreas neck?

10 mm

166

With this, MULTIPLE CYSTS ARE ASSOCIATED WITH ADULT TYPE POLYCYSTIC KIDNEY DISEASE

Congenital cysts