Terms in this set (100)
(2) Pancreas Divisum
(3) Ectopic Pancreatic Tissue
(4) Annular Pancreas
What are the following congenital anomalies of the pancreas?
This rare condition is caused by the lack of fusion of the dorsal and ventral pancreatic buds. Failure of the pancreas to join together.
body and tail; head
Agenesis of the ____ and ____, with hypertrophy of the pancreatic ____, is a congenital defect.
Ectopic Pancreatic Tissue
Refers to pancreatic tissue outside and separate from the pancreas affecting 1-10% of the population.
Ectopic pancreatic tissue
slight bulge in the small intestines as in the ilium
is a ring of pancreatic tissue that encircles the first part of the duodenum; more common in male
Ectopic Pancreatic Tissue
Most common of the anomalies
Frequent sites for ectopic pancreatic tissue
exocrine and endocrine
The pancreas is both a _____ and _____ gland.
deals with digestion & enzymes
deals with hormones
Exocrine function is performed by _____ of the pancreas.
Acini cells complete the digestion in the
thick acidic liquid
-Lipase (digest fats)
-Amylase (digest carbohydrates)
-Trypsin, chymotrypsin, and carboxypeptidase (digest protein)
-Ribonuclease and deoxyribonuclease (degrades RNA)
The enzymes of the pancreatic juice that aid in digestion include:
islets of langerhans
The endocrine function is located in the
Specialized cells within the islets are called
Alpha cells produce _____ a hormone that causes the cells to release _____
Beta cells produce ______, a hormone that causes _____ formation from glucose.
Delta cells are the ____ composition of endocrine tissue and produce ______, a hormone that inhibits insulin and glucagon.
Which is more common Alpha, Beta, or Delta?
A ______ level of twice normal usually indicates acute pancreatitis.
_____ is excreted specifically by the pancreas and that parallels the elevation in amylase levels.
False. Lipase persists for a longer period.
True or False. Both lipase and amylase rise at the same rate, but the elevation in amylase concentration persists for a longer period.
-obstruction of the pancreatic duct,
Lipase may be elevated with _____, _____, and _____.
_____ controls blood sugar.
chronic liver disease
An increase blood glucose level is found in ____ and ___.
There may be a _____ blood sugar level in tumors of the islets of Langerhans
hyperechoic or isoechoic
The normal pancreas has an echo pattern that is slightly more _____ or ____ to the liver.
Patient's position when scanning the pancreas
Adult: 3-5 MHz broadband width (mid focal zone)
Pediatric: 5-7 MHz
Sag & Trans
Scan the pancreas head body and tail in ____ and ___ planes.
shape, contour, lie, and texture
Evaluate the ____, ____, ___ and ____ (compare to liver parenchyma)
Portal & Splenic veins,
Left renal vein,
Posterior wall of the stomach,
Following surrounding structures should be identified
Small left lobe of the liver
Transducer is angled slightly caudally
-Causes inferior displacement of the pancreas
-Concave abdomen , full inspiration and push out abdomen
___ ingestion for better visualization
inflammation of the pancreas. May be acute or chronic.
is an inflammation of the pancreas caused by the inflamed acini releasing pancreatic enzymes into the surrounding pancreatic tissue.
biliary tract and alcoholism
An acute attack of pancreatitis is commonly related to ______ disease and ____.
Biliary track disease (Gallstones 5%)
The most common cause of acute pancreatitis in the U.S. is
ETOH (alcohol abuse)
second most common cause of acute pancreatitis is
Less common causes
Increase AP diameter (size)
Diffuse decrease in echogenicity
Hypoechoic to the liver
Dilated Pancreatic Duct
Possibly Dilated CBD
Sonographic Appearance of Acute Pancreatitis
Stone distal CBD
Mass head pancreas
Associated findings with Acute Pancreatitis
Common in the tail
-Fluid collection as part of inflammation
-Simple cystic appearance
-Poorly defined borders
-Evolve to complex or septated masses
Associated Findings Pseudocyst
pancreatic and parapancreatic
_____ and ____ fluid collections are most often complications of pancreatitis.
_____ is an inflammatory process that spreads along fascia pathways causing localized areas of diffuse inflammatory edema of soft tissue that may proceed to necrosis and suppuration (pus formation).
Phlegmon is a complication of ____ pancreatitis and is a ____ mass of the swollen inflamed pancreas.
Unresolved Acute Pancreatitis symptoms in 5 days
Signs of Phlegmon
Serum Amylase persistently elevated
Lab values for Phlegmon
Secondary pancreatic infection
Complications of Phlegmon
results from recurrent attacks of acute pancreatitis
True or False. Chronic Pancreatitis: Pain episodes may resolve once pancreatic function fails completely
Most common cause of chronic pancreatitis
-Idiopathic (25% of cases)
-Autoimmune Pancreatitis related conditions
-Hyperparathyroidism or Hypercalcemia
-Occult neoplasm or other causes of pancreatic obstruction
-Chronic Renal Failure
Other causes of Chronic Pancreatitis
-Inflammatory Bowel Disease
-Primary Biliary Cirrhosis
Autoimmune pancreatitis related conditions
chronic autoimmune disease in which the body's white blood cells destroy the exocrine glands
Autoimmune Pancreatitis typically causes
-Chronic and disabling abdominal pain radiating to back (relived by sitting upright or leaning forward)
-Steatorrhea (excess fat in the feces)
-Vitamin Deficiency A, D, E, K, & B12 (rare)
Symptoms of Chronic Pancreatitis
Peptic Ulcer Disease
Differential Diagnosis chronic pancreatitis
(Pancreatic calcifications 30-60% of cases)
CT Abdomen (preferred first-line test)
Imaging for chronic pancreatitis
Pancreatic duct dilatation
Patients with chronic pancreatitis may have ___ and ____.
Causes of pancreatic abscess
Persistent fever & leukocytosis
Chills, hypotension, tender abdomen
Signs/Symptoms of Pancreatic Abscess
Few internal echoes
Sonographic Appearance of Pancreatic Abscess
Jaundice (if biliary duct obstruction)
Lymphadenopathy involving virchow's node
Signs for Pancreatic CA
Non-tender, but distended (hydrops), palpable GB
Test sensitivity <56%, but specificity >82%
Alkaline Phosphatase increased
Conjugated Serum Bilirubin increased
lab values for Pancreatic CA
is weight loss, wasting of muscle, loss of appetite and general debility that can occur during a chronic disease
Located in the left supraclavicular fossa. May indicate the presence of cancer in the abdomen
Pancreatitic Neoplasms (carcinoma)
4th leading cause of cancer deaths in the US. 2% incidence rate of new cancers.
Family History of certain familial cancer syndromes
Increasing age (starting at 50 years old)
Other possible risks: Alcohol, Caffeine
Risk Factors for Pancreatitic Neoplasms
Most common primary neoplasm of the pancreas
exocrine; epithelium; 90%
Adenocarcinoma involves the ___ portion of the pancreas (ductal ____) and accounts for greater than ____ of all malignant pancreatic tumors.
Adenocarcinoma onset usually in the ___ of the pancreas
Dilated Biliary system
Associate findings of adenocarcinoma
islets cells; benign or malignant; functional or nonfunctional
Endocrine tumors may rise from the ____, classified as ___ or ____ and may be ____ or ____
Functional Islet Cell Tumors
Produce excess of hormones
Insulinoma (most common)
The most common functioning islet cell tumor is _____ (60%), followed by _____ (18%)
beta; hyperinsulism and hypoglycemia
Insulinama derived from the ____ cells that produce insulin. Occur in patients with ____ and ___.
Are malignant, with up to 40% metastasized before diagnosis
Vipomas (Neuroendocrine tumors)
Other functional islet cell tumor are
associated with GB dilation, fluid filled distended bowels loops, and excessive secretion of fluid and electrolytes. Thickening of the gastric wall may also be present (common in the tail of the pancreas)
nonfunctional islet tumors
Does not produce excess amounts of hormones
Nonfunctional islet tumors comprise ___% of all islet cell tumors with ___% being malignant
large tumors in the head of the pancreas
Presentation of nonfunctional islet cell tumors
Nonfunctional islet cell tumors are ____ growing, usually do not spread beyond the regional lymph nodes and liver.
True or False.
Sonography cannot pathologically identify they types of tumors, but the specific findings may help to identify the differential diagnosis of pancreatic tumors
Metastatic disease to the pancreas is ___ (10%)
melanomas, breast gastrointestinal and lung tumors
Primary tumors that can metastasize to the pancreas include
intrahepatic Biliary system; double channel
Another important finding of neoplasm is the dilation of the _____. This is known as the ____ sign
Procedure used when there is an indication of cancer of the head of the pancreas
-Head and uncinate process of Pancreas
-Duodenum and first 15 cm of jejunum
-Gallbladder and common bile duct
Structures removed by the whipple procedure
-Stomach to jejunum
-Common hepatic duct to jejunum
-Pancreas to jejunum
Alternative to Whipple with same survival results; Shorter procedure and less blood loss than Whipple