Pancreas - Part 3

Question 1

What remains increased longer than serum amylase in episodes of acute pancreatitis?

Answer 1

Urine amylase

Question 2

What is the normal range for serum lipase?

Answer 2

10-140U/L

Question 3

What does serum lipase increase with? (6)

Answer 3

1. Pancreatitis
2. Obstruction of the pancreatic duct
3. Pancreatic carcinoma
4. Acute cholecystitis
5. Cirrhosis
6. Severe renal disease

Question 4

What is the normal range of glucose in a fasting patient?

Answer 4

< 100mg/dL

Question 5

What is the normal range of glucose in a patient 2 hours postprandial?

Answer 5

< 145 mg/dL

Question 6

What does glucose increase with? (3)

Answer 6

1. Severe diabetes mellitus
2. Chronic liver disease
3. Overactivity of several of the endocrine glands

Question 7

What does glucose decrease with?

Answer 7

Tumours of the islets of Langerhans in the pancreas

Question 8

What are causes of acute pancreatitis? (5)

Answer 8

1. Biliary disease
2. Alcohol abuse
3. Trauma
4. Peptic ulcer disease
5. Idiopathic

Question 9

What are the clinical findings of acute pancreatitis? (4)

Answer 9

1. Abrupt onset of epigastric pain
2. Nausea/vomiting
3. Elevated lipase and amylase
4. Paralytic ileus

Question 10

What is the US appearance of acute pancreatitis? (4)

Answer 10

1. Normal findings
   - 30%
2. Decrease in parenchymal
   echogenicity
3. Smooth borders
4. Enlargement

Question 11

What are 2 differential diagnosis for acute pancreatitis?

Answer 11

1. Normal pancreas

2. Neoplasm

Question 12

Chronic pancreatitis

Answer 12

Repeated, prolonged, or persistent attacks of pancreatitis

Question 13

What are the causes of chronic pancreatitis? (2)

Answer 13

1. Hypocalcemia

2. Hyperlipidemia

Question 14

What are the clinical findings of chronic pancreatitis? (5)

Answer 14

1. Chronic RUQ or epigastric pain
2. Nausea/vomiting
3. Weight loss
4. Abnormal glucose tolerance test
5. Normal amylase and lipase values

Question 15

What is the US appearance of chronic pancreatitis? (6)

Answer 15

1. Increase in parenchymal echogenicity
2. Irregular borders
3. Calcifications
4. Pseudocyst formation
5. Atrophy
6. Prominent pancreatic duct

Question 16

What are 2 differential diagnosis of chronic pancreatitis?

Answer 16

1. Fatty replacement

2. Neoplasm

Question 17

What are 5 complications of pancreatitis?

Answer 17

1. Abscess
2. Duodenal obstruction
3. Hemorrhage
4. Phlegmon
5. Pseudocyst

Question 18

Why does an abscess develop result from?

Answer 18

An infection of the necrotic pancreas

Question 19

When can an abscess begin to form following an episode of acute pancreatitis?

Answer 19

2-4 weeks

Question 20

What are the clinical features of an abscess? (4)

Answer 20

1. Abdominal pain
2. Leukocytosis
3. Nausea/vomiting
4. Fever

Question 21

What is the US feature of an abscess? (3)

Answer 21

1. Ranges from anechoic to echogenic
2. Irregular or smooth borders
3. Fluid-debris levels

Question 22

Duodenal obstruction

Answer 22

High protein concentration in the pancreas enzymes can irritate the duodenum

Question 23

What are clinical findings of duodenal obstruction? (4)

Answer 23

1. Abdominal pain
2. Abdominal distention
3. Nausea/vomiting
4. Constipation

Question 24

What is the US appearance of duodenal obstruction?

Answer 24

Limited bowel peristalsis

Question 25

Hemorrhage

Answer 25

Rapid development of inflammation causing necrosis and hemorrhage

Question 26

What are the clinical findings of hemorrhage? (4)

Answer 26

1. Severe abdominal pain 2. Nausea/vomiting 3. Elevated amylase 4. Decrease in hematocrit level

Question 27

What is the US appearance of hemorrhage? (3)

Answer 27

1. Well-defined homogeneous mass 2. Cystic mass with debris 3. Fluid-debris levels

Question 28

Phlegmon

Answer 28

Extension of pancreatic inflammation into the peripancreatic tissues

Question 29

What are clinical findings of phlegmon? (3)

Answer 29

1. Severe abdominal pain 2. Nausea/vomiting 3. Elevated amylase

Question 30

What is the US appearance of phlegmon? (3)

Answer 30

1. Hypo echoic solid mass adjacent to the pancreas 2. Posterior acoustic enhancement Irregular borders 3. Usually involves the lesser sac, transverse mesocolon, and anterior pararenal space

Question 31

Pseudocyst

Answer 31

Focal collection of inflammatory necrotic tissue, blood, and pancreas secretions

Question 32

Where is a pseudocyst most often located?

Answer 32

In the lesser sac followed by the anterior pararenal space

Question 33

What are the clinical findings of pseudocyst? (3)

Answer 33

1. Abdominal pain 2. Palpable mass 3. Persistent elevated amylase

Question 34

What is the US appearance of pseudocyst? (3)

Answer 34

1. Anechoic or complex mass 2. Well-defined borders 3. Variable shape