ARDMS Abdomen UltraPASS Review (Pancreas)
Abdomen ultrasound registry review, content from UltraPASS registry review book. Section 3 Pancreas
Terms in this set (53)
The pancreatic head is the most ______ portion, cradled by the ______. The IVC is ______ and the portal vein is _______ to the head.
c-loop of the duodenum
The ____ is seen at the anterolateral border and the _____ is seen posterior and lateral to the pancreatic head.
gastroduodenal artery (GDA)
The _____ is a tongue-like projection of the pancreatic head, located anterior to the ____ and posterior to the _____.
uncinate process (aka lingula)
anterior to IVC
posterior to SMV
The neck of the pancreas is directly anterior to the _____. The posterior border is made up of the ________, formed by the _____ and _____.
SMV and splenic vein
The _____ lies anterior to the body of the pancreas and the ____ forms the posterior-medial border.
antrum of the stomach
The _____ and the _____ are posterior to the tail, the ______ is anterior to to the tail, and the ______ makes the left lateral border of the pancreas tail
splenic vein and left kidney
normal pancreatic length and AP measurements
AP head 2-3.cm
AP neck 1.5-2.5cm
AP tail 1-2cm
The SMA is the _____ branch of the aorta and has a ______ appearance.
target or bulls-eye sign
The splenic vein courses ____ to the SMA, is joined by the ____ and the ____.
IMV and SMV
The celiac artery is the _____ branch of the aorta, giving rise to the _____ (to the left), the ____ (to the right), and the _____.
splenic artery-left, common hepatic artery-right, left gastric artery
The CHA courses _____ to the duodenum and bifurcates into the _____ and the _____.
proper hepatic artery and gastroduodenal artery
The CBD joins the pancreatic duct close to the ________.
ampulla of Vater
The main pancreatic duct or ________ courses the entire length of the pancreas, entering the duodenum via the _______.
Duct of Wirsung
ampulla of Vater
The accessory duct or _______ drains the anterior head of the pancreas.
Duct of Santorini
Ductal measurements _____ or _______ walls are considered abnormal.
The ____ function of the pancreas is to produce pancreatic juices to aid in digestion and the ____ function is to produce glucagon and insulin.
endocrine-glucagon and insulin
Pancreatic secretions are controlled by ____ (3).
Hormonal agents, secretin and pancreozymin
Three pancreatic enzymes and responsibilities (exocrine function)
lipase-break down fats
*pancreatic juices also contain sodium bicarbonate-neutralizes gastric acids
pancreatic cells connected to excretory ducts
The _____ (3) cells within the _____ produce insulin which directly enters the bloodstream.
alpha, beta, delta cells
islets of langerhans
Three endocrine secretions and responsibilities
Insulin-regulates sugar metabolism
glucagon-changes sugar forms
Lab values indicative of pancreatic disease
glucose-increase with diabetes, liver dz, overactivity of endocrine glands
glucose-decrease with pancreatic tumors involving islets of langerhans
pancreas sonogram indications
RUQ pain, N&V, fever, jaundice, weight loss, ileus, elevated amylase, lipase, alkaline phosphatase, bilirubin or WBC, alcohol abuse, dx and monitor pancreatitis, obstruction or CA
smooth contours and echogenicity
isoechoic or hyperechoic compared to liver
_____ is generally related to biliary tract disease and alcoholism, causing severe pain, acute adult respiratory distress syndrome, and acute tubular necrosis. ______ will increase in 24 hrs and _______ increase within 72-94 hrs.
serum amylase-24 hrs
serum lipase-72 hrs
acute pancreatitis features
enlarged with textural changes
hypoechoic or anechoic compared to liver
smooth but ill defined borders
ill defined vascular landmarks
dilated pancreatic duct
peri-pancreatic fluid collections
escape of pancreatic enzymes into parenchyma, caused by focal fat necrosis leading to rupture of vessels and hemorrhage, resulting in destruction of pancreatic tissue
hemorrhagic pancreatitis features
severe abdominal pain, N&V, hypotension, metabolic acidosis, adult respiratory distress syndrome
Increased serum amylase and lipase, decreased hematocrit and serum calcium
Appearance varies by age of hemorrhage
Hemorrhagic Pancreatitis sonographic features:
acute-well defined homogeneous mass
1 wk-mass with cystic appearance, internal septations, debris
several wks-mass appears more cystic
spreading diffuse inflammatory edema of the subcutanious connective tissue, which may lead to necrosis; presents with good through transmission usually involving the lesser sac, pararenal space and transverse mesocolon
common complication of acute pancreatitis and trauma; dilatation resembling a cyst, without a true capsule and may rupture; round or oval whit sharp, well-defined walls, good through transmission, septation, debris
complication of acute pancreatitis resulting from severe infection of necrotic tissue; signs include increased WBC, fever, chills, hypotension, tender abdomen, bacteremia; cystic mass with irregular borders and internal debris ranging from cystic to hyperechoic
progressive destruction of the pancreas, more often seen in men and in alcoholics
chronic pancreatitis features
dilated pancreatic duct
complications associated with chronic pancreatitis
splenic and/or portal vein thrombosis
_____ cysts are due to abnormal development of the pancreatic duct, can be single or multiple, and range in size up to _____
up to 5cm
_____ cysts are due to cystic dilation of the pancreatic duct, parasitic or neoplastic cysts
rare benign condition of the pancreas, more often seen in elderly women; occurs in the head and is slow growing; associated with peripheral cysts, ranging from 1mm-2cm, and calcifications in a central stellate-shaped echogenic region
microcystic adenoma (aka serous cystadenoma)
rare condition of the pancreas; solitary large cyst > 2cm with or without septations; high malignant potential, especially with more solid components or papillary projections
Macrocyst (aka mucinous cystadenoma or cystadenocarcinoma)
highly fatal tumor often found in pancreas head, a leading cause of death in US; involves exocrine portion of pancreas, originating in ductal epithelium; males 60-80 yo, smokers
Adenocarcinoma (pancreatic carcinoma)
Pancreatic carcinoma features
symptoms: cachexia, abdominal/back pain, N&V, malaise
sono: echogenicity change, hypoechoic mass with irregular borders, dilated pancreatic duct, CBD and intrahepatic ducts, jaundice, vascularity
associated findings: Courvoisier GB, liver mets, ascites, lymph node or PV involvement, displaced SMA
dilated, palpable, non-tender GB, associated with tumors involving the pancreatic head
functional or non-functional tumors, benign or malignant, related to gastric hyper-secretion and peptic ulcers, associated with Von Hippel-Lindau Syndrome
Islet cell tumors
rare autosomal-dominant disorder; characterized by CNS hemangioblastomas, retinal angiomas, RCC, pheochromocytomas, and visceral cysts
Von Hippel-Lindau Syndrome
Islet cell tumor findings
size 1-20cm tumors
symptoms: abdominal pain, jaundice, palpable mass
sono: large tumor, smooth borders, hypoechogenic with areas of necrosis
*r/o liver mets
most common functional islet cell tumor; usually benign, solitary, and > 2cm, located in the body and tail, concentrated in islets of langerhans; 40-60 yo
symptoms: WDHA syndrome (water diarrhea, hypokalemia and achlorohydria), hypoglycemia, elevated plasma insulin levels
sono: solid, hypoechoic, homogeneous mass, may have calcifications and fluid spaces
non-functional=necrotic, cystic mass
results from anomalous development of pancreatic duct; multiple; 3-5cm, anechoic with good through transmission
______ result in endocrine and exocrine pancreatic insufficiency
less commonly seen cysts; may involve pancreatic head; single or lobular
disease of young adults and adolescents; increased secretions of abnormal mucous by the exocrine glands
*1/2000 incidence, 1/20 carrier
Cystic fibrosis causes thickened secretions in the _______ and degeneration of the ductules and acini, replaced by ________.
small pancreatic ducts
Cystic fibrosis findings
pancreas-hyperechoic, uneven texture, cysts (may be > 5cm)
hepatic disease, biliary cirrhosis, PHTN, splenomegaly, non-visualized GB, thickened GB walls, sludge, GI tract folds (Doughnut sign)