65 terms

CAHE ABDOMEN II- Pancreas

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normal echogenicity of the pancreas
iso or hyper compared to liver
pediatric pancreas
appears more hypo b/c lack of fat
anterolateral structure in pancreas head
gastroduodenal artery in transverse
posterolateral structure in pancreas head
common bile duct in transverse
main pancreatic duct AP measurement
-not exceed 3 mm in head/neck

-not exceed 2 mm as it reaches tail
location of head of pancreas
-anterior to IVC
-medial to 2nd portion of duodenum
-inferior to caudate lobe & MPV
SMA/SMV location
-posterior to neck
-anterior to uncinate process/3rd part of duodenum
splenic artery location in pancreas
along superior/anterior border of body & tail
splenic vein location in pancreas
on the posteroinferior aspect of pancreas
CBD location
-travels posterior to 1st portion of duodenum/pancreas head
-to the right of main pancreatic duct
location of tail of pancreas
-anterior to left kidney
-medial to splenic hilum
agenesis
congenital anomaly

failure of body/tail to develop with hypertrophy of pancreatic head
pancreas divisum
failure of dorsal/ventral pancreatic ductal systems to fuse during embryonic development

*most common congenital variant of pancreatic anatomy*
annular pancreas
rare anomaly where pancreatic head surrounds 2nd portion of duodenum b/s ventral bud fails to rotate with duodenum
ectopic pancreatic tissue
ectopic tissue fund in various places in GI tract
serum amylase
increases with acute pancreatitis/pseudocyst
urine amylase
remains increased longer than serum amylase with acute pancreatitis
serum lipase
-increases with pancreatitis, obstruction of pancreatic duct, pancreatic carcinoma

-remains elevated for up to 14 days
glucose
increases with severe diabetes mellitus
normal range of glucose fasting
≤100 mg/dL
normal range of glucose 2 hours postprandial
≤145 mg/dL
acute pancreatitis
inflammation of pancreas secondary to leakage of pancreatic enzymes into parenchyma of organ

can be focal or diffuse
causes of acute pancreatitis
-obstruction of pancreatic duct by biliary calculi (most common)
-alcoholism
-divisum
-trauma
outcomes of acute pancreatitis
-resolution
-pseudocyst formation
-chronic pancreatitis
clinical findings of acute pancreatitis
-abdominal pain radiated to back
-fever
-nausea/vomiting
-leukocytosis
-elevated amylase levels within 24 hours
-elevated lipase levels within 72 hours
complications of acute pancreatitis
-pseudocyst formation (most common)
-abscess
-necrosis
-hemorrhage
-venous thrombosis
-pseudoaneurysm formation
sonogram findings of acute pancreatitis
-may appear normal (mild case)
-entire gland = enlarged/hypoechoic from edema (diffuse)
-margins= ill defined with areas of fluid collections within pancreas or surrounding all/part of pancreas
-focal hypoechoic area within pancreas (focal)
-main duct = dilated or prominent
diffuse pancreatitis sonogram
focal pancreatitis sonogram
sonogram landmarks for acute pancreatitis
-pancreatic enlargement
-decreased echogenicity
color doppler for acute pancreatitis complications
used to exclude vascular complications such as splenic or portal vein thrombosis & pseudoaneurysms (splenic artery)
pancreatic pseudocysts
accumulation of pancreatic fluid/necrotic debris confined by retorperitoneum occurring in attempt to wall off pancreatic secretions to prevent further tissue damage
what do pseudocysts contain high amounts of?
-amylase
-lipase
-trypsin
common causes of pancreatic pseudocysts
-acute/chronic pancreatitis
-trauma
-pancreatic ductal obstruction
-pancreatic neoplasms
common sites for pancreatic pseudocysts
-in lesser sac (b/w pancreas & stomach)
what do pseudocysts not have?
a capsule of epithelium
sonogram of pancreatic pseudocysts
-anechoic mass with posterior enhancement
-may contain some internal echoes or septations
chronic pancreatitis
irreversible destruction due to repeated inflammation
results of chronic pancreatitis
-atrophy
-fibrosis
-scarring
-calcification development in gland
causes of chronic pancreatitis
-alcoholism
-congenital abnormalities (pancreas divisum)
-trauma
clinical findings of chronic pancreatitis
-asymptomatic
-persistent epigastric pain
-jaundice
-back pain
-possible elevation in amylase/lipase
sonogram of chronic pancreatitis
-heterogeneous, small, echogenic with poor margins
-calcifications throughout parenchyma or confined to ducts
-pancreatic pseudocyst
-dilated pancreatic duct
-stone(s) within duct- possible biliary obstruction
-possible portosplenic vein thrombosis
pancreatic adenocarcinoma
most common primary pancreatic malignancy
most common location of pancreatic adenocarcinoma
within pancreatic head- can be seen in other parts of pancreas
clinical findings of pancreatic adenocarcinoma
-weight loss
-decreased appetite
-vomiting
-pain radiating to back
-painless jaundice
-metastases
courvoisier gallbladder
clinical detection of enlarged, palpable GB that may be caused by malignant pancreatic head mass or other obstructing etiology in area of pancreatic head
courvoisier GB sonogram
-enlarged
-measures greater than 5 cm in width
-contains sludge
-associated with malignant pancreatic head mass
sonogram of pancreatic adenocarcinoma
most common appearance = hypoechoic mass in pancreas head
surgical procedure for pancreatic adenocarcinoma
referred to as the Whipple procedure
pancreatic cystadenomas
found in body and tail of pancreas
serous cystademonas
small and always benign
sonogram of serous cystademonas
-cystic mass appearing solid and echogenic secondary to small size of cysts
mucinous cystadenoma
larger and may be benign or malignant
sonogram of mucinous cystadenoma
-multilocular cystic masses and calcifications
-may be associated with dilation of pancreatic duct
islet cell tumors (endocrine tumors)
-tumors of pancreatic islet cells = uncommon
-2 types = insulinoma & gastrinomas
Insulinoma
-generally benign
-usuall solitary
-more common type
gastrinomas
-frequently malignant
-multiple
-more difficult to image
sonogram of islet cell tumor
-small
-hypoechoic mass
-may contain calcifications
pancreatic cysts
-benign true cysts
-rare
-associated with conditions such as polycystic disease & Von Hippel-Lindau disease
sonogram of pancreatic cysts
-well-defined
-anechoic mass
-posterior enhancement
focal fatty sparing of pancreas
-due to lack of fatty deposition
-more noticeable in older patients where pancreas = normally hyperechoic
-significance = not to confuse with focal pancreatic mass
sonogram of focal fatty sparing of pancreas
-uncinate process = sometimes hypoechoic compared to rest of gland- regarded as normal variation in u/s appearances

-area of sparing = well-defined
-no enlargement or mass effect
echogenicity of pancreas in children
-quite bulky
-relatively HYPOechoic compared to liver
echogenicity of pancreas in adulthood
-slightly more echogenic than liver
echogenicity of pancreas in elderly
-becomes increasingly HYPERechoic & infiltrated with fat

-tends to atrophy
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