Flashcards in Pathology of Pancreas test 4 Deck (66):
What is the most common pancreatic anomaly?
ectopic pancreatic tissue
found in the form of of intramural nodules in various places in the GI tract
acute pancreatitis may develop within this tissue
What is an annular pancreas?
persistence of the dorsal and ventral pancreas with the head encircling the duodenum
may cause obstruction
more common in males
What is the failure of fusion of the panc ducts?
unable to accurately diagnosis with ultrasound
The pancreas is an _____________ and ___________ gland
As an exocrine gland what kind of cells does the panc have?
numerous, small, glands (ACINI)
aggregate into lobular acini and are separated by connective tissue
what enzymes does the pancreas secrete?
trypsin and chymotrypsin are secreted and are important in protein digesting
the enzymes AMYLASE, LIPASE, phospholipase, and elastases are all elaborated by the panc and activated in the duodenum
what is amylase enzyme for?
digestive enzume for carbs.
twice the normal value = pancreatitis
what is lipase for?
an enzyme excreted specifically by the pancreas
lipase elevates in pancreatic disease
finish slide 37
What are the pancreatic exocrine functions?
enzymes of pancreatic juice digestive action
lipase >>>>>>>>>>>>>>>>> fats
Trypsin, chymotrypinogen, carboxypeptidase>>>>>proteins
nucleases >>>>>>>>>>>>>>>>>>>>>>>>>>>nucleic acids
How is the endocrine function of the pancreas represented/
by the islets of langerhans
what is the most important agent of the pancreas?
What is the main hormone produced by the endocrine portion include?
insulin and glucagon
What are the cell types in the endocrine aspect?
What are the pancreatic endocrine functions?
Panc hormone cell type action
insulin >>>>>>>> Beta >>>>>>>>>>glucose to glycogen
glucagon >>>>>>>>>>Alpha >>>>>>>>glycogen to glucose
somatostatin >>>>>>>>Delta >>>>>>>>alpha and beta inhibitor
what does glucose do?
Controls the blood - sugar level in the body
What are the lab values for pancreatitis?
serum amylase rises
urine amylase rises
serum lipase rises - for a longer time
how do we scan the pancreas?
NPO 6-8 hrs
3-5MHz transducer with a mid focal zone
peds use 5-7.5 MHz
What are some reasons to scan the pancreas?
severe epigastric pain
abnormal lab values
unexplained weight loss
nausea and vomiting
What do you identify when you scan?
head, neck, body, tail in sag and trv
evaluate shape, contour, lie and texture
What technique might help visualize the pancreas?
water or fluid may be used to fill the stomach for better visualization of the pancreatic area
roll to side and then roll back
Echogenicity of the pancreas _________ with age.
Where is the pancreatic duct seen more?
in the body than in the tail
What is the sonographic blood vessel evaluation of the panc head?
The head is to the RIGHT of the SMV
the IVC is POSTERIOR
the GDA is the ANTERIOR LATERAL border
the CBD is LATERAL to the GDA
the PV is CRANIAL to the head
the Uncinate Process is directly POSTERIOR to the SMV
head measurement < or = 3cm
What is the blood vessel sonographic evaluation of the panc neck?
the NECK is directly ANTERIOR to the SMV
the PV is formed behind the neck by the JUNCTION of the SMV and Splenic vein
neck measurement < or = 2.5cm
How does the pancreatic duct appear sonographically?
as an echogenic line or lucency bordered by two echogenic lines
what is the measurement of the pancreatic duct?
Does the pancreatic duct increase or decrease toward the tail?
what might you confuse the pancreatic duct with?
What is panreatitis?
inflammation of the pancreas
malfunctions due to increased secretion and blockage of ducts
pancreatic tissue may be digested by its own enzyme
What are the 5 B's of pancreatitis?
Bile - biliary disease (most common)
booze - alcoholism second most common
blood - trauma
bug - infectious process
birth - congenital
What is the most common cause of pancreatitis in children?
trauma - child abuse
What cells get inflamed in pancreatitis?
What is the most common complication when the acini cells get inflamed?
risk for abscess and hemorrhage
***most common cause is biliary obstruction***
second common cause is alcoholism
What increases with acute pancreastitis?
amylase: increases sig within 24 hrs
Lipase: increases within 72-94 hours REMAINS ELEVATED
What are the symptoms of acute pancreatitis?
Can pancreatitis resolve itself?
mild cases can
the disease can progress to necrosis and hemorrhage
*decrease in hematocrit*
What are the sonographic findings of acute pancreatitis?
less echogenic than the liver
smooth to indistinct borders
anterior compression of the IVC
duct may be obstructed
may be subtle
Acute pancreatitis may obstruct what?
What is adenopathy?
when the lymph nodes are enlarged
What is chronic pancreatitis?
repeated and persistent
nausea and vomiting
What are the sonographic findings of chronic pancreatitis?
reduced size of the gland
What are some reasons for chronic pancreatitis?
thrombosis of the splenic vein
increased risk of cancer
What is a progression of pancreatitis?
progression of acute
What is Grey Turner's sign?
the hemorrhaging can be seen on the outside
discoloration of flanks
What is phlegmonous pancreatitis?
areas of edema
extension outside the gland in 18-20%
extension into the peripancreatic tissue
phlegmon -- just oozes into the space...no pseudocyst just a blob of pus
How does phlegmonous pancreatitis appear sonographically?
finish slide 31
ill defined mass
involves lesser sac
What are the symptoms of pancreatic abscess?
secondary to pancreatitis
how does a pancreatic abscess appear sonographically?
finish slide 33
poorly defined hypoechoic mass
if air is present = shadowing
fluid debis level
Are pseudocysts congential or aquired?
not a simple cyst...enzymes are leaking, eventually infection
What do pseudocysts arise from?
finish slide 34
fluid collections that arise from
Where might you find a pseudocyst?
finish slide 35-36
form in the potential spaces where enzymes have escaped
develop through the lesser omentum and lesser sac
What happens if a pseudocyst ruptures?
shock and peritonitis
erosion into other organs
(because it is filled with enzymes)
What are congenital cystic lesions?
associated with underlying congenital disease that affect other organs
What is autosomal dominant polycystic disease?
comes from polycystic kidneys and get them in other organs
What is Von Hippel-Lindau Disease?
autosomal dominant condition
***central nervous system and retinal hemangioblastomas***
renal cell carcinoma
What is cystic fibrosis?
excessive production of mucus
What does cystic fibrosis look like sonographically?
increase in echogenicity
thick folds in GB
What is fibrocystic disease?
finish slide 46
What is a cystic pancreatic neoplasm?
malignant or benign
middle age females
body and tail
well defined cysts with thick fluid and septations or mural nodules
What is microcystic adenoma?
What is adenocarcinoma?
most common primary neoplasm
5% of all cancer deaths
4th cause of cancer mortality
What is the most common site of adenocarcinoma?
head of the pancreas (60-70%)
When there is an adenocarcinoma in the head of the pancreas what does it cause?
How does adenocarcioma appear sonographically?
finish slide 54
loss of panc