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