Abdm Ultra: 100802: Pancreatic Pathology

Front 1

What 3 main lab values are relevant to pancreatic pathology?

Back 1

1. Serum amylase
2. Urine amylase
3. Serum lipase

Front 2

Which lab value is released when the acinar cells are damaged?

Back 2

serum amylase

Front 3

Which lab value greatly increases and peaks with acute pancreatitis within the first 24 hours, and completely disappears after 72 hours?

Back 3

serum amylase

Front 4

Which lab value increases with acute and chronic pancreatitis, and acute cholecystitis?

Back 4

serum amylase

Front 5

Which lab value, when present in conjunction with urine amylase, indicates either acute or chronic pancreatitis, but when present without urine amylase, indicates a disease not related to the pancreas?

Back 5

serum amylase

Front 6

Which lab value increases only with pancreatitis?

Back 6

urine amylase

Front 7

Which lab value increases with pancreatitis, pancreatic duct obstruction, pancreatic cancer, and cirrhosis?

Back 7

serum lipase

Front 8

Which lab value remains longer than serum amylase with acute pancreatitis?

Back 8

serum lipase

Front 9

What lab value, with acute pancreatitis, starts to increase after 48 hours and peaks after 72 hours, and is present for 7-14 days?

Back 9

serum lipase

Front 10

What other values will increase with acute pancreatitis?

Back 10

1. WBC
2. Hyperglycemia
3. Hyperlipidemia

Front 11

What is the most common cause of acute pancreatitis in adults?

Back 11

Gallstones (actually, gallstones which have traveled down, and become ductal stones)

Front 12

What is the most common cause of acute pancreatitis in children?

Back 12

Abdominal trauma

Front 13

What is acute pancreatitis?

Back 13

Sudden onset of inflammation of the pancreas, which lasts for days.

Front 14

What causes acute pancreatitis?

Back 14

Release of pancreatic enzymes into pancreatic tissue

Front 15

With acute pancreatitis, the pancreas will be (enlarged / shrunken) and be (hyperechoic / hypoechoic) to the liver.

Back 15

enlarged
hypoechoic

Front 16

What is the most common cause of chronic pancreatitis?

Back 16

Alcohol abuse

Front 17

What is the 4th leading cause of cancer death in the USA?

Back 17

Pancreatic cancer

Front 18

What is the gender prevalence of pancreatic cancer?

Back 18

Males > Females

Front 19

What are 4 factors which increase the risk of pancreatic cancer?

Back 19

1. Exposure to petroleum products
2. Smoking
3. Diabetes
4. Chronic pancreatitis

Front 20

What are some clinical symptoms of pancreatic cancer?

Back 20

1. Severe pain radiating to back (80-85%)
2. Weight loss
3. Indigestion
4. Painless jaundice
5. Palpable, enlarged (Courvoisier) gallbladder

Front 21

What is the most common type of pancreatic cancer?

Back 21

Adenocarcinoma (malignant tumor formed from glandular structures in epithelial tissue)

Front 22

With pancreatic cancer, the pancreas asppears (hyperechoic / hypoechoic), and has (dilated / normal) gb, biliary ducts, and pancreatic duct

Back 22

1. hypoechoic
2. dilated

Front 23

Chronic pancreatitis differs from cancer in appearance in that, with chronic pancreatitis, there are (fewer / more) calcifications

Back 23

more

Front 24

What are the two most common types of (benign) Islet cell tumors?

Back 24

1. Insulinomas
2. Gastrinomas

Front 25

What are the most common type of Islet cell tumors?

Back 25

Insulinomas

Front 26

Which Islet cell tumors are secreted from beta cells?

Back 26

Insulinomas

Front 27

Which Islet cell tumors secrete gastrin, causing stomach to secrete too much acid?

Back 27

Gastrinomas

Front 28

What is another name for the condition of having gastrinomas?

Back 28

Zollinger-Ellison syndrome

Front 29

How can pancreatic pseudocysts be distinguished from true cysts?

Back 29

Pseudocysts
1. Do not exhibit posterior enhancement
2. Change in size over time
3. Have thick walls
4. May contain internal echoes

Front 30

What is the most common complication of acute pancreatitis, and when does it occur?

Back 30

Pseudocysts
About 4-6 weeks after the acute pancreatitis

Front 31

What are the most common locations for pseudocysts?

Back 31

1. The lesser omentum
2. The tail of the pancreas (aka the left anterior pararenal space)

Front 32

When is drainage of a pseudocyst necessary?

Back 32

When it is > 5 cm or lasts > 6 weeks

Front 33

With cystic fibrosis, the pancreas is (hyerechoic / hypoechoic) and (enlarged / shrunken).

Back 33

hyperechoic
shrunken

Front 34

In what age group is cystic fibrosis most prevalent?

Back 34

Pediatric patients

Front 35

What is chronic pancreatitis?

Back 35

Multiple episodes of acute pancreatitis, occurring over years

Front 36

With acute pancreatitis, the area of inflammation will be (focal / diffuse / either focal or diffuse).

Back 36

Either focal or diffuse

Front 37

What are the complications of acute pancreatitis?

Back 37

1. Pseudocyst (the most common complication)
2. Hemorrhage
3. Phlegmon (a spreading, diffuse inflammatory process with pus)
4. Thrombosis of splenic artery and/or vein

Front 38

What are the clinical symptoms of chronic pancreatitis?

Back 38

1. Distension of the abdomen
2. Diarrhea
3. Steatorrhea (fat in the feces)
4. Inability to digest fats

Front 39

What are other symptoms of chronic pancreatitis?

Back 39

1. Malabsorption of nutrients
2. Progressive, irreversible destruction of the pancreas
3. Fibrous scarring and loss of acinar cells
4. Inability to metabolize B12

Front 40

What common symptom is surprisingly absent with chronic pancreatitis?

Back 40

RUQ or epigastric pain

Front 41

What does chronic pancreatitis place one at increased risk for?

Back 41

1. Pancreatic cancer
2. Diabetes

Front 42

What are the sonographic symptoms of chronic pancreatitis?

Back 42

1. Mixed echogenicity within pancreas
2. Intraductal calcifications
3. Dilated pancreatic duct
4. Atrophy (shrinkage) of pancreas

Front 43

When chronic pancreatitis occurs in a patient with diabetes, the _____ cells are attacked, and the patient produces insufficient amounts of _____.

Back 43

Islets of Langerhans
insulin

Front 44

What is the 5-year survival rate following diagnosis with pancreatic cancer?

Back 44

2-5 %

Front 45

What are the most common locations of pancreatic cancer?

Back 45

Pancreatic head: 75%
Pancreatic body: 15-20%
Pancreatic tail: 5-10%

Front 46

What are the sonographically visible features of pancreatic cancer?

Back 46

1. Hypoechoic mass
2. Dilated GB
3. Dilated biliary ducts
4. Dilatation of pancreatic duct
5. Liver mets (spread of cancer from pancreas to liver)
6. Compression of IVC
7. Local lymphadenopathy
8. Encasement of mesenteric vessels

Front 47

What sonographically visible features distinguish chronic pancreatitis from pancreatic cancer?

Back 47

1. Chronic pancreatitis will have more calcifications.
2. With chronic pancreatitis, the pancreas will be more atrophied.
3. With chronic pancreatitis, the pancreas will have more mixed echogenicity.
4. With pancreatic cancer, a mass will be visible
(Image: Page #21)

Front 48

Are insulinomas benign or malignant?

Back 48

Benign

Front 49

What do insulinomas secrete, and what condition results?

Back 49

Insulin
Hypoglycemia

Front 50

What is the sonographic visibility and echogenicity of insulinomas?

Back 50

They're very difficult to see sonographically, because they're very small.

They are hypoechoic.

Front 51

Where are insulinomas usually located?

Back 51

The pancreatic body or tail.

Front 52

What are the symptoms of gastrinomas?

Back 52

1. Peptic ulcer disease
2. Diarrhea
3. Pituitary and parathyroid tumors
4. Usually does not invade beyond local lymph nodes and liver

Front 53

Are gastrinomas benign or malignant?

Back 53

Benign

Front 54

Insulinomas and gastrinomas are (functional / nonfunctional) tumors, meaning they (do / do not) release endocrine hormones.

Back 54

functional
do

Front 55

What islet cell tumors are secreted from gamma cells?

Back 55

Gastrinomas

Front 56

What are pseudocysts?

Back 56

Walled off areas of pancreatic secretions.

Front 57

What are the sonographic features of a pseudocyst?

Back 57

1. May contain debris
2. Anechoic mass
3. Usually solitary
4. Changes in size with follow-up
5. Has thick walls
6. May contain internal echoes
7. Do not exhibit posterior enhancement
8. Do not have distinct walls

Front 58

What happens to pseudocysts about 40% of the time?

Back 58

They resolve themselves within 6 weeks.

Front 59

What is the biggest danger of pseudocysts?

Back 59

Rupture, which can lead to death

Front 60

What are the clinical symptoms of pseudocysts?

Back 60

1. Severe abdominal pain

Front 61

What should the sonographer be sure to avoid when scanning a pseuodcyst?

Back 61

Applying enough pressure to cause rupture.

Front 62

How common is cystic fibrosis?

Back 62

1 in 2000 births

Front 63

What ethnic group is at highest risk for cystic fibrosis?

Back 63

Persons of northern European heritage

Front 64

What is the effect of cystic fibrosis?

Back 64

It causes thickening of mucous which lines the pancreatic and biliary ducts, and the lungs. The pancreas becomes fibrotic and fatty, resulting in "pancreatic insufficiency".

Front 65

What is the treatment for pancreatic insufficiency?

Back 65

Pancreatic supplements