Pathology of Pancreas test 4 Flashcards Preview

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Flashcards in Pathology of Pancreas test 4 Deck (66):
0

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

1

What is an annular pancreas?

persistence of the dorsal and ventral pancreas with the head encircling the duodenum

congenital abnormality

may cause obstruction

more common in males

2

What is the failure of fusion of the panc ducts?

pancreatic divisum

unable to accurately diagnosis with ultrasound

3

The pancreas is an _____________ and ___________ gland

excocrine

endocrine

4

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

5

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

6

what is amylase enzyme for?

digestive enzume for carbs.

twice the normal value = pancreatitis

7

what is lipase for?

an enzyme excreted specifically by the pancreas

lipase elevates in pancreatic disease

finish slide 37

8

What are the pancreatic exocrine functions?

enzymes of pancreatic juice digestive action

lipase >>>>>>>>>>>>>>>>> fats

amylase >>>>>>>>>>>>>>>>>>>>>>>carbohydrates

Trypsin, chymotrypinogen, carboxypeptidase>>>>>proteins

nucleases >>>>>>>>>>>>>>>>>>>>>>>>>>>nucleic acids

9

How is the endocrine function of the pancreas represented/

by the islets of langerhans

10

what is the most important agent of the pancreas?

secretin

11

What is the main hormone produced by the endocrine portion include?

insulin and glucagon

12

What are the cell types in the endocrine aspect?

beta

alpha delta

13

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

14

what does glucose do?

Controls the blood - sugar level in the body

15

What are the lab values for pancreatitis?

serum amylase rises

urine amylase rises

serum lipase rises - for a longer time

16

how do we scan the pancreas?

NPO 6-8 hrs

3-5MHz transducer with a mid focal zone

peds use 5-7.5 MHz

17

What are some reasons to scan the pancreas?

severe epigastric pain

abd distention

abnormal lab values

unexplained weight loss

nausea and vomiting

18

What do you identify when you scan?

head, neck, body, tail in sag and trv

evaluate shape, contour, lie and texture

19

What technique might help visualize the pancreas?

WATER TECHNIQUE

water or fluid may be used to fill the stomach for better visualization of the pancreatic area

roll to side and then roll back

20

Echogenicity of the pancreas _________ with age.

increases

21

Where is the pancreatic duct seen more?

in the body than in the tail

22

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

23

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

24

How does the pancreatic duct appear sonographically?

as an echogenic line or lucency bordered by two echogenic lines

25

what is the measurement of the pancreatic duct?

2mm

26

Does the pancreatic duct increase or decrease toward the tail?

decreases

27

what might you confuse the pancreatic duct with?

vascular structures

28

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

29

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

30

What is the most common cause of pancreatitis in children?

trauma - child abuse

others:

infectious process

toxic exposure

hereditary

31

What cells get inflamed in pancreatitis?

acini cells

32

What is the most common complication when the acini cells get inflamed?

pseudocyst

risk for abscess and hemorrhage

***most common cause is biliary obstruction***

second common cause is alcoholism

33

What increases with acute pancreastitis?

pancreatic enzymes

amylase: increases sig within 24 hrs

Lipase: increases within 72-94 hours REMAINS ELEVATED

34

What are the symptoms of acute pancreatitis?

slide 9

35

Can pancreatitis resolve itself?

mild cases can

the disease can progress to necrosis and hemorrhage

*decrease in hematocrit*

36

What are the sonographic findings of acute pancreatitis?

swelling

less echogenic than the liver

smooth to indistinct borders

anterior compression of the IVC

enlargement

duct may be obstructed

fluid collections

may be subtle

37

Acute pancreatitis may obstruct what?

pancreatic duct

38

What is adenopathy?

when the lymph nodes are enlarged

39

What is chronic pancreatitis?

repeated and persistent

symptoms:

chronic pain

nausea and vomiting

jaundice

weightloss

40

What are the sonographic findings of chronic pancreatitis?

increased echogencity

reduced size of the gland

**CALCIFICATIONS**

41

What are some reasons for chronic pancreatitis?

recurrent acute

hypercalcemia

hyperlipidemia

fibrotic scarring

pseudocysts

dilated ducts

thrombosis of the splenic vein

increased risk of cancer

42

What is a progression of pancreatitis?

Finish slide28

Hemorrhagic pancreatitis

progression of acute

43

What is Grey Turner's sign?

the hemorrhaging can be seen on the outside

discoloration of flanks

44

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

45

How does phlegmonous pancreatitis appear sonographically?

finish slide 31

hypoechoic

ill defined mass

irregular borders

involves lesser sac

46

What are the symptoms of pancreatic abscess?

secondary to pancreatitis

may spread

leukocytosis

fever

nausea/vomiting

47

how does a pancreatic abscess appear sonographically?

finish slide 33

poorly defined hypoechoic mass

if air is present = shadowing

fluid debis level

48

Are pseudocysts congential or aquired?

aquired

not a simple cyst...enzymes are leaking, eventually infection

49

What do pseudocysts arise from?

finish slide 34

fluid collections that arise from

50

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

51

What happens if a pseudocyst ruptures?

shock and peritonitis

erosion into other organs

(because it is filled with enzymes)

52

What are congenital cystic lesions?

associated with underlying congenital disease that affect other organs

53

What is autosomal dominant polycystic disease?

comes from polycystic kidneys and get them in other organs

54

What is Von Hippel-Lindau Disease?

autosomal dominant condition

***central nervous system and retinal hemangioblastomas***

visceral cysts

pheochromocytomas

renal cell carcinoma

pancreatic cysts

55

What is cystic fibrosis?

hereditary disease

autosomal recessive

excessive production of mucus

56

What does cystic fibrosis look like sonographically?

increase in echogenicity

small cysts

biliary sludge

thick folds in GB

57

What is fibrocystic disease?

finish slide 46

is a

58

What is a cystic pancreatic neoplasm?

macrocystic adenoma

mucinous:

malignant or benign

middle age females

body and tail

well defined cysts with thick fluid and septations or mural nodules

59

What is microcystic adenoma?

slide 48?

60

What is adenocarcinoma?

slide 49

most common primary neoplasm

exocrine portion

5% of all cancer deaths

4th cause of cancer mortality

61

What is the most common site of adenocarcinoma?

head of the pancreas (60-70%)

body (20-30%)

tail (5-10%)

62

When there is an adenocarcinoma in the head of the pancreas what does it cause?

slide 53

63

How does adenocarcioma appear sonographically?

finish slide 54

loss of panc

64

slides 55-66

finish

65

Whipple - know what is removed and how it is reattached

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