Flashcards in Pancreas (normal and abnormal) Deck (166):
The pancreas is located in this area of the abdomen
The pancreas is _____ to the stomach, in the lap of the _____.
The pancreas is a _____ _____ structure that lies between the duodenal loop and the splenic _____.
Pancreas is divided into these 5 parts:
The pancreas normally measures between _____ and _____ in length (about _____ inches long).
This is the most bulbous part of the pancreas, which then narrows at the neck.
The pancreas head measures less than/equal to _____.
The porto-splenic confluence marks the anatomic position of this part of the pancreas.
The lesser sac lies _____ to the body of the pancreas, while the SV runs along the _____ surface.
The pancreas body measures _____.
This part of the pancreas is related to the spleen, left adrenal glands, and upper pole of the left kidney.
The pancreas tails measures _____.
The tail of the pancreas is related to the _____, _____, and _____.
left adrenal glands
upper pole of left kidney
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.
The pancreas has 2 functions:
The exocrine function of the pancreas secretes _____, _____, and _____ through the _____ system and _____ cells.
The exocrine part of the pancreas comprises _____% of the pancreatic tissue.
The endocrine function of the pancreas secretes _____ via the _____.
islets of Langerhans
The endocrine part of the pancreas forms _____% of the pancreatic tissue.
The remaining 18% of the pancreatic tissue consists of fibrous _____ that contains _____, _____, and _____.
Amylase is a digestive enzyme for _____.
Amylase is produced by the pancreas and salivary glands, thus, _____ and salivary gland dysfunction causes increased levels of amylase.
Amylase is also excreted by the _____, so increased levels of amylase are also seen with _____ disease.
_____ levels parallel the _____ levels.
_____ levels rise first and _____ levels rise later, but persist longer.
Sometimes the normal pancreas echotexture has a _____ appearance.
The contour of the pancreas is distinct when its echogenicity is _____ (more/less) than the surrounding retroperitoneal fat. It usually appears _____ (roughly/smoothly) contoured.
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).
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) _____.
The posterior wall of the stomach overlies the _____ border of the pancreas body and tail.
The duodenal loop, except for the _____ segment, encircles the pancreas _____.
The _____, _____ layers (lesser and greater omentum), and the _____ sac come in close contact with the pancreas.
The head of the pancreas is _____ to the IVC.
The head of the pancreas is _____ to the duodenum.
The CBD is _____ to the pancreas head.
The GDA is _____ to the pancreas head.
The SMA and SMV are _____ to the pancreas neck.
The SMA and SMV are _____ to the uncinate process and the _____ portion of the duodenum.
The abdominal AO runs _____ to the pancreas body.
The CA arises from the AO at the _____ border of the pancreas.
The CHA proceeds _____ to the right, _____ to the pancreas head.
The CHA divides into the _____ and the _____.
The PHA travels _____ towards the liver, along the free edge of the _____ omentum, _____ to the MPV and to the _____ of the CBD.
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.
The SA follows a _____ (adjective) course along the _____ border of the pancreas body and tail.
The SMA arises from the AO just _____ to the pancreas body, descending _____ to the uncinate process and the _____ portion of the duodenum.
The IVC lies _____ to the pancreas head.
The SV runs from its origin in the splenic hilum along the _____ aspect of the pancreas to join the _____.
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.
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 _____.
Ampulla of Vater
main pancreatic duct
The duodenum is divided into _____ portions.
The _____ and _____ portion of the duodenum are transverse.
The _____ and _____ portion of the duodenum are long.
Another term for the main pancreatic duct is the
Duct of Wirsung
The normal pancreatic duct may be imaged but is considered abnormal if it is more than _____ in size.
Pancreatic duct dilation is typically due to stones within the _____, from chronic _____ or a stone at the _____.
Duct of Wirsung
Ampulla of Vater
Another term for the Duct of Santorini is
The Duct of Santorini branches off the _____ in the pancreas head and drains the _____.
main pancreatic duct
Agenesis of the pancreas is
Absence of the body and tail, with head remaining and showing compensatory hypertrophy.
T or F? Congenital cysts are common.
False (they are rare)
This is characterized by viscous secretions and dysfunction of multiple glands, including the pancreas, leading to pancreatic insufficiency.
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 _____.
The failure of the dorsal and ventral pancreatic ducts to fuse during embryonic development is
The most common congenital variant of pancreatic anatomy is
Pancreas divisum results in the smaller _____ draining the body and tail, and is associated with _____ (condition).
Pancreas divisum literally means
The small buds that develop into the pancreas during early life arise from the _____.
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.
If pancreas divisum occurs, this means the _____ bud and the _____ bud did not fuse.
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 in children is frequently diagnosed in infancy due to its association with _____ obstruction.
This is an inflammatory disease producing temporary pancreatic changes.
The 2 most common causes of acute pancreatitis are
1) biliary tract disease
2) chronic ETOH abuse
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
This is a condition characterized by just one area of inflammation in the pancreas.
In what region of the pancreas is focal pancreatitis usually found?
T or F? Focal pancreatitis is difficult to differentiate from a neoplasm.
With normal _____ (enzyme), a pancreatic mass is likely to represent a neoplasm.
Pancreatitis in the pediatric patient is most likely associated with _____, _____ (most common), or _____.
cystic fibrosis (most common)
hereditary autosomal dominant pancreatitis
This condition causes the pancreas to become increasingly hypoechogenic, relative to normal liver, and increases in size.
Also seen with diffuse pancreatitis is (5)
mass effect from phlegmon or hemorrhage
peripancreatic fluid collections
thickening of adjacent fascial planes
The most common cystic lesion of the pancreas is a
What are the 3 enzymes found inside a pseuodcyst?
This is an accumulation of pancreatic fluid and necrotic debris, confined by the retroperitoneum, that contains high amounts of amylase, lipase, and trypsin.
A pseudocyst is generally spherical and takes _____ - _____ weeks to enclose itself by forming a wall composed of _____ and vascular _____.
This lesion occurs in 10%-20% of patients who have had acute pancreatitis.
You can tell a pseudocyst is newer because it hasn't started _____ within itself.
What symptoms are some of the main indicators of pseudocysts? (2)
elevated amylase levels
A well-defined, smooth-walled anechoic structure with acoustic enhancement in the pancreas is probably a
Debris may occur within a pseudocyst due to _____ or _____.
This condition is most commonly associated with alcoholic or biliary etiology, blunt abdominal trauma in children, or pancreatic malignancy.
Pseudocysts that persist beyond _____ weeks or grow larger than _____ in diameter, with evidence of regression, may require non-surgical decompression.
This is where percutaneous gastrostomy is combined with cystogastrostomy, under fluoroscopy. And ultrasound guidance is used to drain the pseudocyst.
This is irreversible destruction to the pancreas due to repeated bouts of pancreatic inflammation.
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.
What are some complications of a pseudocyst?
May become large and cause obstruction of the
or bile ducts
This can ensue with a rupture of a pseudocyst into the peritoneal cavity.
The 2 main causes of chronic pancreatitis are (6 total)
cystic fibrosis **
(hereditary pancreatitis, congenital abnormalities, blunt abdominal trauma, idiopathic chronic pancreatitis)
These sonographic findings may represent _____:
small echogenic pancreas **
pancreatic duct dilation
bile duct dilation
portal vein thrombosis
A non-encapsulated inflammatory process =
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.
What is the sonographic appearance of phlegmon pancreatitis?
with good through transmission
What is the 4th largest cancer killer in adults, with a dismal prognosis, for which surgical resection is the only chance for cure?
What is the only chance for cure with pancreatic cancer?
Adenocarcinoma has these main symptoms (2) with these sonographic findings (3)
solid, hypoechoic mass
usually in pancreas head
90% of patients with pancreatic carcinoma present with _____ and _____ spread of the tumor.
Where does pancreatic carcinoma (adenocarcinoma) usually arise from (80% of the time)?
The 5-year survival rate for adenocarcinoma (pancreatic carcinoma) is
less than 2%
What may be the condition of a patient with these findings:
BD dilation (Courvoisier's GB)
dilated pancreatic duct
lyphadenopathy around AO
adenocarcinoma (pancreatic carcinoma)
Elevated bilirubin and alkaline phosphatase, with possible elevation of amylase, could point to what pancreatic condition?
adenocarcinoma (pancreatic carcinoma)
T or F? When adenocarcinoma (pancreatic cancer) is in its early stages, the patient does not feel symptoms.
An adenocarcinoma tumor usually appears as a _____ (echogenicity), solid mass.
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
_____ is the first imaging test for the evaluation of adenocarcinoma patients.
Typically, patients with a pancreatic head tumor show dilation of the _____ and _____, creating a double duct sign.
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)
This kind of carcinoma accounts for 85%-90% of all pancreatic tumors.
What are treatment options for pancreatic cancer? (4)
palliative care (hospice)
If a adenocarcinoma tumor is deemed resectable, the two surgical procedures offered are
Distal Pancreatectomy Splenectomy
What is the Whipple Procedure?
it removes the head of the pancreas
Another term for the removal of the pancreas head is
What is removed during a pancreaticoduodenectomy (4)?
portion of bile duct
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
The type of procedure suggested for an adenocarcinoma tumor depends on
the location of the tumor
This procedure is the end of the pancreas is removed, the pancreas head is left attached.
distal pancreatectomy and splenectomy
What is a distal pancreatectomy and splenectomy meant to treat (main)?
pancreatic cancer localized in the end of the pancreas
Distal pancreatectomy and splenectomy may also be used for these 3 reasons
injury due to trauma
When pancreas cancer affects the SA or _____, the adjacent _____ is often removed. (referring to distal pancreatectomy/splenectomy topic)
What are the 2 main cystic neoplasms of the pancreas?
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)
What was serous cystadenoma formerly called?
What condition does a "cluster of grapes" refer to with pancreatic disease?
This is the micro form of cystic neoplasm.
When serous cystadenomas are small, the mass may be _____ (echogenicity) and appear _____ (structure/texture) with through transmission.
What were mucinous cystic neoplasms formally called?
The sonographic appearance of a mucinous cyst is a
well-defined multicystic mass (large cysts)
With mucinous cysts, what lab test level is increased?
CEA (Carcinoembryonic antigen)
What is the macro form of cystic neoplasms of the pancreas?
mucinous cystic neoplasm (formerly called macrocystic neoplasms
The suggestion for treatment of mucinous cystic neoplasms is _____, due to the possibility of _____.
Mucinous cystic neoplasms, 90% of the time, develop in the pancreas _____ (region).
Compared to serous cystic neoplasms of the pancreas, mucinous cystic neoplasms are _____ (larger/smaller) and _____ (more/less) numerous.
What is the most common islet cell tumor?
Is insulinoma benign or malignant?
usually benign (90%)
Insulinoma is a tumor of the pancreas that produces excessive amounts of _____.
Insulinomas are more common in _____ (men/women).
Insulinomas tumors are usually small, about less than _____.
These are hormonally active tumors arising from islet cells that produce insulin.
Islet cell tumors are _____ (shape) or _____ (shape) and are a well-_____, _____ (echogenicity) mass.
This is the 2nd most common islet cell tumor.
Are gastrinomas malignant or benign?
often malignant (60%)
Gastrinoma is also known as
People with _____ are commonly people that get gastrinomas.
This is a tumor in the pancreas that secretes excess gastrin, leading to ulceration the duodenum, stomach and the small intestine.
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.
What does MEN stand for?
multiple endocrine neoplasia
This is a group of heritable syndromes, characterized by abherant growth of benign or malignant tumors in a subset of endocrine tissues.
What are the 3 types of MEN?
These are tumors involving the parathyroid glands:
endocrine pancreas and the pituitary
This is medullary carcinoma of the thyroid gland:
pheochromocytoma and hyperparathyroidism
This is medullary carcinoma of the thyroid:
multiple neuromas and pheochromocytoma
MEN is associated with (6)
medullary thyroid carcinoma
parathyroid gland hyperplasia
This deals with masses and tumors that can form with all the endocrine glands in the body.
3 possible reasons for increased amylase production are
Salivary gland dysfunction
(Pancreas, salivary glands, kidneys produce amylase)
Which persists longer? Amylase or lipase?
What is the usual size of the pancreas neck?