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246 Cards in this Set
- Front
- Back
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Acini Cells |
Perform exocrine functions secreting digestive enzymes
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Alpha Cells |
Perform endocrine functions secreting glucagon
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Amylase
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Enzyme that digests carbohydrates
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Beta Cells
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Perform endocrine functions secreting insulin
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Endocrine
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secreting into blood or tissue
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Delta Cells
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Perform endocrine function secreting somatostatin
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Exocrine
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secreting into a duct
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Glucagon
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Hormone secreted by the Alfa cells and functions to increase activity of phosphorylase
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Insulin
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Hormone secreted by beta cells and functions to increase the uptake of glucose and amino acids by most body cells
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Islets of Langerhans
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Endocrine portion of the pancreas made up of alpha cells and beta cells, which is the source of insulin and glucagon; also called pancreatic islet
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Lipase
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Fat-digesting enzyme
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Phlegmon
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Diffuse inflammatory reaction to infection spreading along fascial pathways, producing edema and swelling
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Pseudocyst
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An abnormal or dilated cavity resembling a true cyst but not lined with epithelium
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Somatostatin
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Hormone secreted by delta cells and functions to regulate insulin and glucagon production
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What is the number one technical limitation in ultrasound of the pancreas?
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Overlying bowel gas
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What is the primary use of sonographically imaging of the pancreas?
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Identify abnormalities of other organs associated with pancreatic disease
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What is the pancreas?
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A nonencapsulated structure that lies obliquely in the anterior portion of the retroperitoneum
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What are the three main portions of the pancreas?
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1) The head
2) The Body 3) The tail |
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Where is the head of the pancreas located?
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To the right and inferior to the body and tail.
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Describe the head of the pancreas.
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It has the largest anteroposterior dimension of the gland and is bordered by the C-looo of the duodenum.
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What is the uncinate process?
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A portion of the head of the pancreas that hooks around posterior to the superior mesenteric vessels, sometimes into the nutcracker formed by the superior mesenteric artery and abdominal aorta. |
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Where is the uncinate process located?
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The uncinate process lies anterior to the inferior vena cava and posterior to the superior mesenteric vein.
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What and where is the body and tail of the pancrease bound by? |
The body and tail of the pancreas are bounded anteriorly and superiorly by portions of the stomach, duodenum, and left lobe of the liver. |
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What is the location of the body of the pancreas? |
Anterior to the aorta, superior mesenteric artery, and left renal vein. |
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What structure can be identified between the aorta, superior mesenteric artery, left renal vein and the body of the pancreas? |
The splenic vein. |
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What is the course of the splenic vein? |
It courses from the spleen towards its confluence with the superior mesenteric vein. |
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Where is the neck of the pancreas located? |
It lies just anterior to this confluence, where the vessels merge to form the portal vein. |
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In many patients, what structure lies between the body of the pancreas and the anterior abdominal wall? |
The left lobe of the liver |
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What vascular structures course along the superior border of the body of the pancreas? |
Branches of the celiac axis - namely the hepatic, left gastric, and splenic arteries. |
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What is the course of the tail of the pancreas? |
It extends from the body into the left anterior pararenal space. |
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Bordered posteriorly by the splenic vein, where does the tail of the pancreas frequently extend to? |
The splenic hilum |
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What borders the tail of the pancreas? |
Anteriorly, the stomach
Laterally by the left kidney |
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Why is the pancreatic tail often obscured by gas on sonography? |
Because of its proximity to the stomach. |
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The parenchyma of the pancreas consists of what? |
Small groups of acini, which secret digestive enzymes, clustered in multiple lobules, each surrounding a tributary duct. |
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The smaller ducts merge into increasingly larger ducts, subsequently emptying into the main pancreatic duct, also known as |
The duct of Wirsung. |
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Enzymes secreted by the pancreas are carried by the main pancreatic duct into the alimentary tract via what structure? |
The ampulla of Vater. |
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What merges with the distal common bile duct to form a single perforating channel into the duodenum? |
The main pancreatic duct near the ampulla |
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What branches from the main pancreatic duct and perforates into the duodenum separately from the ampulla? |
The duct of Santorini, a smaller accessory duct. |
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What are islets of Langerhans? |
Groups of endocrine cells wedged within the acinar lobules that contain various types of cells that release hormones directly into the bloodstream and lymph system. |
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What allows hormones to be distributed throughout the body, where they stimulate other organs or functional tissues? |
The islets of Langerhans |
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What supplies blood to the pancreas? |
Branches of the splenic artery and the pancreaticduodenal arteries. |
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What structure supplies blood to the body and tail of the pancreas? |
The inferior pancreaticoduodenal artery. |
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Where does the pancreaticoduodenal artery arise from? |
The superior mesenteric artery. |
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Where do branches of the pancreaticoduodenal artery and splenic artery enter the pancreas? |
At numerous points along the body and tail of the pancreas. |
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Are congenital anomalies of the pancreas rare or common? |
Rare |
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What is the most common congenital anomaly of the pancreas? |
Pancreas divisum |
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What is pancreas divisum |
The most common congenital anomaly of the pancreas, it results from a failure of fusion of the dorsal and ventral pancreatic buds during embryologic development. |
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What happens during pancreas divisum? |
It results in anomalous drainage of the pancreatic ducts, but it usually is not associated with any significant seqelae. |
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What is an annular pancreas? |
Another congenital anomaly in which the head of the pancreas surrounds the second portion of the duodenum. |
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What is annular pancreas associated with? |
It has been associated with complete or partial atresia of the duodenum and other congenital abnormalities in up to 70% of affected infants, including duodenal stenosis or atresia, down syndrome, tracheoesophageal fistula, and congenital heart disease. |
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What is ectopic pancreatic tissue? |
A congenital anomaly of the pancreas where pancreatic tissue grows in other organs, usually the walls of the stomach, duodenum, or large or small intestine, or rarely the gallbladder, spleen, or liver. |
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What makes the ectopic pancreatic tissue so interesting? |
Because the formations of pancreatic tissues comprise the acinar and ductal structures, they are functional deposits of pancreatic tissue and are susceptible to developing acute pancreatitis or tumor. |
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What two functions is the pancreas responsible for? |
Endocrine and exocrine functions |
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What specialized cells are contained within the islets of Langerhans? |
Alpha, Beta, and Delta cells |
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What are the Alpha, Beta, and Delta cells located in the islets of Langerhans responsible for? |
The production of specific hormones. |
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What are the majority of specialized cells in the islets of Langerhans made up of? |
Beta cells |
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what is the purpose of insulin?
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Insulin aids in the metabolism of carbohydrates
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How does insulin increase the energy available for normal physiologic functions?
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By facilitating the transport of glucose across cell membranes
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what is another function of insulin?
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influences the metabolism of proteins and fats.
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How is insulin's released by the pancreas?
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Via a negative feedback
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What factors influence insulin secretion?
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1) when blood glucose level rises above a certain level (100 mg/DL)
2) Autonomic nervous system responses 3)The release of other endocrine hormones 4) Certain drugs |
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What do abnormalities of insulin secretion result in?
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Impairment of metabolic functions throughout the body
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What does diabetes result from?
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An imbalance between insulin secretion and the metabolic needs of the body
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What do alpha cells within the islets of Langerhans do?
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secrete glucogone
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What is glucogone?
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An important hormone secreted by alpha cells in the islets of Langerhans that functions primarily in the liver and aids in conversion of glycogen into glucose or usable energy
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What initiates the release of Glucagon?
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Glucose levels
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What are delta cells?
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They are the smallest component within the islets of Langerhans and are responsible for producing somatostatin.
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What is somatostatin?
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A hormone secreted by delta cells in the islets of Langerhans that is involved with regulating the production of insulin and glucogons.
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What is the exocrine function of the pancreas?
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To secrete enzymes, also known as pancreatic juice, that aids in food breakdown and digestion
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How is the excretion of pancreatic enzymes transported to the duodenum?
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Via the excretory ducts
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What does pancreatic juice consist of?
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Digestive enzymes, water, and inorganic salts such as potassium, sodium, and calcium
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What enzymes are released by the pancreas?
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Amylase, tripsinogen, and chymotrypsinogen |
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What does amylase do? |
Breaks down complex carbohydrates into usable table sugars. |
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What does lipase do? |
An enzyme that breaks down fats |
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What does trypsinogen and chymotrypsinogen do? |
Preproteolytic enzymes that reduce proteins to their component amino acids. |
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What is thought to be excreted by the same cells that secrete exocrine enzymes? |
An inhibiting factor that prevents trypsinogen and chymotrypsin from autodigesting the protein in the cell walls of the pancrease. |
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What is thought to happen with injury to the pancreas? |
The inhibiting factor is unable to prevent the activation of proteolytic enzymes, which spill out into the surrounding parenchyma. Once the process begins, it can advance rapidly, each bursting cell releasing yet more digestive juice, reducing normal tissue to amorphous fluid. |
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How much exocrine fluid is the pancreas capable of secreting per day? |
4 liters |
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What is one of the most useful laboratory values used for diagnosing pancreatic disease? |
Amylase |
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When is serum amylase considered elevated? |
when it is 2-4 times the normal reference range. |
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How long after onset of clinical symptoms does Amylase levels start to increase? |
Within 3-6 hours |
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What other disease processes is an increased Amylase level associated with? |
Pancreatic duct obstruction, pancreatic malignancy, and biliary disease |
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What non-pancreas-related processes may cause an increased amylase level? |
Perforated ulcers, bowel obstruction, and some cancers. |
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True or False
With chronic pancreatitis, it is uncommon for amylase levels to be normal or only slightly elevated. |
False. With chronic pancreatitis, it is not uncommon for amylase levels to be normal or only slightly elevated. |
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How long can a urine amylase remain elevated after serum values have returned to normal? |
7 days |
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What outside factors can cause an increased amylase level? |
Drugs such as aspirin, diuretics, alcohol, and oral contraceptives. |
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What diseases has been associated with a decreased amylase level? |
Permanent damage to the pancreas, hepatitis, and cirrhosis of the liver. |
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What is the diagnosis of acute pancreatitis often based on? |
clinical symptoms |
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When is lipase, a fat-splitting, excreted by pancreas, released into the bloodstream? |
It is released in increased quantities in the setting of inflammatory and occasionally neoplastic, pancreatic disease. |
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When are lipase levels considered elevated? |
5 to 10 times the normal reference range. |
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How long after the onset of disease does lipase levels begin to elevate? |
Within 24 to 48 hours of disease onset. |
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How long can lipase levels remain elevated? |
5 to 7 days |
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What other disease processes does elevated lipase also occur in? |
Obstruction of the pancreatic duct, pancreatic carcinoma, acute cholecystitis, cirrhosis, and sever renal disease. |
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What drugs are associated with an increased lipase level? |
Codeine, indomethacin, and morphine |
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What do fecal fat excretion values reflect? |
The amount of undigested fat molecules passing through the alimentary tract. |
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What is increased fecal fat (also known as steatorrhea) symptomatic of? |
Pancreatitis |
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What other abnormalities may also result in an increased discharge of fat into fecal matter? |
Celiac disease, inflammatory bowel disease, or short bowel syndrome |
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What symptoms are often associated with pancreatic steatorrhea? |
Weight loss, and leaking, oily stool |
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What other lab test may indicate pancreatic disease? |
Elevated bilirubin and other liver function tests. |
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Why would liver function tests indicate pancreatic disease? |
Because of the close anatomic relationships between the liver and biliary systems with the pancreas. |
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In what two structures could pathologic processes in one may cause disease in the other? |
The liver and pancreas |
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What frequently causes stenosis or complete obstruction of the distal common bile duct? |
Neoplasm or inflammatory enlargement of the head of the pancreas |
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What are some common indications of an underlying pancreatic process? |
Epigastic pain, abdominal pain or distension, or jaundice. |
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Is sonography considered the best imaging test for evaluation of pancreatic disease or neoplasm? |
No |
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What is the usefulness of ultrasound in evaluating the pancreas? |
It is useful in identifying secondary signs of a pancreatic process such as dilated biliary ducts, fluid collections, or gallstones. |
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What is the shape of the pancreas in the transverse plane? |
A crescent-shaped structure draping over the prevertebral vessels.
It has been described as horseshoe, dumbbell, or comma-shaped. |
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What is the normal echogenicity of the pancreas? |
Normally, it is equal to or greater than the echogenicity of the liver, depending on the patient's age and body habitus. |
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What accounts for the varying degrees of echogenicity and in some settings may cause contour alterations of the pancreas? |
Fat deposition |
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What is the normal echogenicity of the pancreas in children compared to adults? |
A hypoechoic pancreas in a pediatric patient is a normal finding because children normally have less pancreatic fat than adults. |
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A hypoechoic pancreas in an adult represents what kind of finding? |
An abnormal finding |
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What is the name of the main pancreatic duct? |
The duct of Wirsung |
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How does the duct of Wirsung appear sonographically? |
It appears as an echogenic lucency bordered by two parallel linear echoes traversing the body of the pancreas. |
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What is the normal measurement of the duct of Wirsung? |
It should not exceed 2 mm |
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How should the duct walls of the Duct of Wirsung appear? |
Smooth without any areas of focal dilatation. |
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What is useful in distinguishing the pancreatic duct from surround vascular structures? |
Color Doppler |
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What is the name of the accessory pancreatic duct? |
The duct of Santorini |
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What does the duct of Santorini do? |
Drains the head of the pancreas. It is not commonly seen on ultrasound. |
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What is the best way to assess the measurments of the pancreas? |
Using a true transverse plane of section. |
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How should the transducer be aligned with insonation of the pancreas? |
Make the incident beam intersect the pancreas perpendicular to its transverse axis. |
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What is the widest portion of the pancreas? |
The head of the pancreas with normal A.P. dimension measuring between 2 cm and 3.5 cm. |
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The body of the pancreas is (blank) and normally measures 2 cm to 3 cm. |
The body of the pancreas is narrower and normally measures between 2 cm and 3 cm. |
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The tail may be (blank) to image from a projection that provides a true A.P. measurement, but in the normal gland, it measures 1 to 2 cm. |
The tail may be difficult to image from a projection that provides a true A.P. measurement, but in the normal gland, it measures 1 to 2 cm. |
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Relative to other upper abdominal organs, how will a child's pancreas appear? |
A child's pancreas is smaller than an adult's but, relative to other upper abdominal organs such as the liver and kidneys, it may appear larger. |
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What are important considerations when identifying pancreatic disease? |
Size, texture, and contour |
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In what plane should the common bile duct be seen in cross section entering the head of the pancreas? |
In the transverse place, the common bile duct should be seen in cross section entering the head of the pancreas. |
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In a longitudinal section, how is the pancreas identified? |
As an ovoid or circular structure lying anterior to the prevertebral vessels. |
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In what view might the common bile duct be seen entering the pancreatic head? |
From a slightly oblique longitudinal section. |
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What is visualized anterior to the bile duct? |
The gastroduodenal artery is visualized. |
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How does the neck of the pancreas sonographically appear? |
As a narrow structure just anterior to the confluence of the Superior Mesenteric Artery and the splenic vein. |
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What can be seen anterior to the Superior Mesenteric Artery and Posterior to the left lobe of the liver? |
The body |
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How does the tail of the pancreas appear sonographically? |
In a true longitudinal section through the left anterior pararenal space, the tail appears thicker than the other portions because it is being transected as it dips posteriorly. |
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Instructing the patient to take a deep breath does what when insonating the pancreas? |
Enhances the liver's usefulness as an acoustic window. |
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The head and the body of the pancreas are visualized 70% to 77% of the time when what occurs? |
Adequate preparation. |
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What part of the pancreas is often difficult to visualize? |
The tail |
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What borders the tail of the pancreas? |
It is bordered anteriorly by the stomach and splenic flexure of the colon. |
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In using the lateral approach to insonate the pancreas, what should be remembered? |
The plane of section is now coronal with the near field representing lateral and the far field representing medial. |
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What approach produces limited results, but may be useful when other approaches have failed to visualize the tail of the pancreas? |
With the patient in the prone position. |
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What is another technique used to examine the tail of the pancreas? |
Have the patient drink approximately 150 mL of water and then examine the patient in either the upright or in the left lateral decubitus position, depending on which position provides the best acoustic window. |
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What is the most common lethal genetic defect of the pancreas in the Caucasian population? |
Cystic Fibrosis |
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What is Cystic Fibrosis? |
It is characterized by a dysfunction of the epithelial chloride transport that affects multiple organs, including the lungs, liver, intestine, reproductive tract, and the pancreas. |
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What is the major cause of pancreatic exocrine failure in children? |
Cystic Fibrosis |
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What occurs as a result of exocrine failure of the pancreas? |
Pancreatic exocrine failure results in decreased enzyme production, which, in turn leads to improper digestion of food and liquids. |
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How many children with cystic fibrosis suffer from pancreatic insufficiency? |
Approximately 85% to 90% |
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What is also seen in patients affected by cystic fibrosis? |
Steatorrhea |
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How will the pancreas of a cystic fibrosis patient appear on ultrasound? |
Hyperechoic and small. Hypoechoic areas representing pancreatic fibrosis may be seen and small cysts and calcification may also be present. |
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What are other common disease processes with cystic fibrosis? |
Gallstones and liver disease |
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Which part of the pancreas is affected by acute pancreatitis? |
All or part of the pancreas. |
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What are the two most common causes of acute pancreatitis? |
Biliary tract disease and excessive alcohol |
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What is seen in approximately 60% of the patients with acute pancreatitis? |
Gallstones |
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What is acute pancreatitis characterized by? |
An edematous, enlarged gland with a subsequent breakdown of pancreatic architecture. |
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What is believed to be the process of acute pancreatitis? |
A blockage of the pancreatic ductule leads to a release of digestive enzymes, which lyse cell walls. |
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What else can cause duct obstruction? |
Biliary or duodenal reflux or hypersecretion of pancreatic enzymes. |
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When an inflammatory reactions occurs in the pancreas, the gland becomes (blank). |
Edematous. |
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What are some other causes of Acute Pancreatitis? |
Abdominal trauma, drugs, viral infections, and many other causes exist. |
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How long does acute pancreatitis normally last? |
Approximately 5 days if no complications occur. |
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What complications can occur during acute pancreatitis? |
Pancreatic abscess, fluid collections, spreading of the inflammation to surrounding soft tissues, dehydration, subsequent renal failure, pulmonary edema, and the development of chronic pancreatitis. Death may occur in a small percentage from accompanying shock. |
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Where does the fluid most frequently accumulate from a pancreatic abscess? |
In the anterior pararenal space, although may extend posteriorly to a potential space behind the renal fascia. |
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What is a phlegmon? |
An inflammatory process that spreads along fascia pathways, producing edema and swelling. |
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What does the course and prognosis of acute pancreatitis depend on? |
The severity of the complications and the underlying cause. |
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What symptoms does the patient clinically present with for acute pancreatitis? |
Sudden onset of severe abdominal pain, usually localized in the epigastrium or upper quadrants, often radiating to the back, nausea, vomiting, fever, increased serum amaylase, elevated white blood count, proteinuria, elevated bilirubin, and elevated serum lipase. |
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In acute pancreatitis, when does pain reach a maximum level? |
Within minutes or a few hours after onset of the disease and persists until the inflammation subsides. |
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What is characteristic of the pain associated with pancreatitis? |
The relief obtained by sitting up or bending at the waist. |
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How does an inflamed pancreas appear sonographically? |
Enlarged and hypoechoic, although in some cases, it may appear normal. Additionally, the enlargement may be focal or diffuse. The pancreatic duct may appear enlarged secondary to obstruction |
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Why might the echotexture of the inflammed pancreas be hypoechoic and the borders appear irregular? |
Because of edema. |
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How does acute pancreatitis present in children? |
Similar to adults with decreased echogenicity and increased A.P. Diameter. |
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What is generally a more reliable indicator of disease than echogenicity in children? |
Diffuse or focal enlargement of the pancreas |
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When biliary calculi are a precipitating factor in pancreatitis, what might be seen in the pancreatic duct? |
Biliary calculi, which may be seen sonographically as highly echogenic foci within the dilated duct. |
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What are pancreatic pseudocysts? |
Encapsulated collections of the byproducts of tissue destruction. |
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What might be used to follow pseudocyst maturation and, when necessary, to guide drainage? |
Sonography |
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Where are pseudocysts most frequently found? |
In or around the pancreas itself, especially in the area of the tail. |
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What might occur if a pseudocyst hemorrhages? |
Hemoorhage might occur as a result of tissue necrosis and, if blood loss is significant, emergency surgical intervention may be indicated. |
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What may necessitate drainage of a pseudocyst? |
Secondary infection |
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What might be contained in a pseudocyst? |
pancreatic juice, blood, pus, and/or inflammatory byproducts. |
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Why should any cystic looking structures in the region of the pancreas be carefully evaluated? |
Because pseudocysts are a frequent complication of acute pancreatitis. |
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What is the sonographic appearance of a pancreatic pseudocyst? |
They can have a varied sonographic appearance. They might be smooth-bordered and entirely cystic to poorly marginated, seemingly solid masses with no posterior acoustic enhancement. |
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What might be seen within a pancreatic pseudocyst? |
Septa or debris and free fluid may be found in the retroperitoneal compartments. |
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What is the reported accuracy of sonography detecting and following pseudocysts? |
96%, owing to displacement of gas-containing bowel by the mass. |
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What might be useful in the early diagnosis of acute pancreatitis? |
Endoscopic sonography |
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What is not a factor in endoscopic sonography? |
Gas obscuration |
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What is commonly visualized in patients with edematous pancreatitis? |
An enlarged pancreas with normal echogencity |
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What mode of imaging is utilized to make a final diagnosis of acute pancreatitis and delineate the extent of the disease? |
C.T. and M.R.I. |
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What is chronic pancreatitis? |
The result of repeated bouts of acute pancreatitis. |
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What is the result of chronic pancreatitis? |
Progressive interlobular fibrosis and destruction and atrophy of functioning tissue results. |
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What anatomic changes occur as the disease progresses? |
The pancreas becomes small and atrophic, interparenchymal fluid collections are frequently seen, and calculi may be found within the pancreatic duct system, and cystic formations are common. |
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When is the prognosis for chronic pancreatitis best? |
When the causative agent can be removed, as in chronic cholecystitis, or alcohol-induced disease. |
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What other diseases may cause chronic pancreatitis? |
hypercalcemia or hyperlipidemia |
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What are the clinical symptoms of chronic pancreatitis? |
Persistent epigastric pain radiating to the left lumbar region, nausea, vomiting, flatulence, and weight loss. |
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What are some common complications of chronic pancreatitis? |
Paralytic ileus, jaundice, elevated serum amylase and bilirubin levels. |
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Are the sonographic findings of chronic pancreatitis varied or static? |
Varied |
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Why are sonographic findings of chronic pancreatitis varied? |
Because gross anatomic changes may not occur in the course of the disease, therefore ultrasound may not detect abnormalities. |
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In cases where anatomic changes from chronic pancreatitis have occurred, what does sonographic evaluation most frequently reveal? |
Heterogeneous increased echogenicity secondary to fibrotic and fatty changes, enlargement with irregular boarders, and the pancreatic duct may be dilated. |
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What is a sonographic hallmark of chronic pancreatitis? |
The presence of calcifications within the parenchyma, which appear sonographically as bright reflections that may or may not cast a posterior acoustic shadow. |
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What are some reported complications associated with chronic relapsing pancreatitis? |
Dilated biliary system resulting from common bile duct strictures, pseudocyst formation, and venous thrombosis |
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What is ranked as the fifth leading cause of cancer-related deaths in the United States? |
Malignant tumors of the pancreas |
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Why is there such a poor prognosis with pancreatic malignancies? |
Because many pancreatic malignancies do not produce symptoms until late in the disease |
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What are the statistics of pancreatic tumors? |
Most commonly occur in men older than 30 years of age and are approximately 50% more common in black men. |
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What are the risk factors of pancreatic tumors? |
Smoking, high-fat diet, chronic pancreatitis, diabetes, and chirrhosis of the liver. |
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Why is the pancreas unique in cellular structure and physiologic function? |
Because of its dual role as an exocrine and endocrine gland. |
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What comprises the largest group of pancreatic tumors? |
Neoplasms of exocrine origin including acinar cell adenocarcinoma. |
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Which type of pancreatic carcinoma accounts for 95% of all pancreatic malignancies? |
Adenocarcinomas |
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Where do pancreatic carcinomas usually occur in the pancreas? |
70% of leasions occur in the head of the pancreas, approximately 20% occurring in the body, and 10% occur in the tail. |
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What is one of the most lethal of all malignancies? |
Adenocarcinomas with an overall 5 year survival rate of 2% or less. |
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What is the overall anatomical appearance of adenocarcinoma? |
The leasions vary in size and gross appearance. Some are well-circumscribed, solid, ovoid masses, whereas others infiltrate surrounding pancreatic parenchyma so diffusely that the pancreas appears as a matted mass of tumor. |
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Where would some small carcinomas be very difficult to detect sonographically? |
In the Ampulla of Vater |
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Where do tumor in the pancreatic head tend to spread into? |
The duodenum and compress the common bile duct and ampulla vater. |
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What is a reliable indicator of a lesion in the pancreatic head? |
A markedly distended and clinically palpable gallbladder, commonly referred to as a Courvoisier gallbladder that is easily visualized sonographically |
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What are some rare forms of exocrine lesions? |
benign solid adenoma, cystadenoma, cystadenocarcinoma, squamous cell carcinoma, and adenocanthoma |
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Which pancreatic leasions are more common in females? |
Benign solid adenomas and cystadenomas |
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Where do tumors of endocrine origin virtually always arise from? |
The islet cells |
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What are tumors that arise from the islet cells known as? |
Islet cell tumors |
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What are some forms of Islet cell tumors? |
Insulinomas, gastrinomas, or glucagonomas |
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What is the physical appearance of Islet cell tumors? |
Most are solid and are often very small. They can be singular or multiple. |
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Where are islet cell tumors most commonly found in the pancreas? |
In the body or tail of the pancreas |
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Sonographically, how do solid pancreatic tumors appear? |
Echopenic or echogenic areas within the parenchyma. The borders may be well defined, but more often they appear as poorly marginated, complex masses. |
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Compared to the surrounding tissue, how does a solid pancreatic tumor appear? |
Hypoechoic. |
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Where is the most common location for a solid pancreatic tumor? |
The pancreatic head. |
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What will often show increased vascularity to areas of the tumor? |
Color Doppler Ultrasound |
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What are some complications of pancreatic tumors? |
Inflammation of the pancreas and obstructive jaundice |
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What is more accurate that ultrasound in identifying small pancreatic lesions? |
Endoscopic sonography |
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What else is endoscopic sonography the most sensitive means for detecting? |
Venous and gastric invasion of pancreatic lesions |
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The majority of pancreatic tumors are (blank), but (blank) do occur. |
The majority of pancreatic tumors are solid, but cystic neoplasms do occur. |
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What is the most likely diagnosis when a fluid-filled structure is seen in or around the pancreas? |
Pseudocyst |
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How can differentiation between a pancreatic pseudocyst and a pancreatic tumor be made? |
By analyzing laboratory results, which will most likely demonstrate inflammatory disease. |
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What should be considered in the absence of clinical suspicion of acute or chronic pancreatitis? |
Cystic neoplastic disease |
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What are the two groups of cystic neoplastic lesions? |
Benign microcystic adenomas and malignant mucinous cystic adenomas |
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What are microcystic adenomas? |
Benign lesions composed of many cysts smaller than 2 cm. |
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Where do microcystic adenomas most frequently occur? |
In the head of the pancreas. |
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Describe microcystic adenomas morphologically. |
These tumors have thin, well-defined, fibrous capsules containing multiple cysts of varying size. |
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What are mucinous cystic adenomas also referred to as? |
Cystadenocarcinomas |
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What are mucinous cystic adenomas? |
Predominantly malignant lesions composed of larger cystic areas (greater than 2 cm) and may contain peripheral rim calcifications. |
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Where do most mucinous cystic adenomas occur? |
About 60% occur in the tail of the pancreas. |
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Which pancreatic malignancy has a good prognosis? |
Mucinous cystic adenomas |
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What is the clinical presentation of symptoms of pancreatic carcinoma? |
Vague, diffuse pain located in the epigastrium that radiates to the back. Leaning forward or sitting upright may alleviate the pain. Other symptoms include Jaundice and weight loss. |
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What is the sonographic appearance of primary cystic neoplasms? |
Variable |
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What are most primary cystic neoplasms in the pancreatic bed related to? |
85% - 90% of cystic masses are related to inflammatory disease. |
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What is the sonographic appearance of microcystic adenomas? |
Poorly marginated, echogenic lesions |
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What are some other noninflammatory cystic lesions of the pancreas? |
Polycystic disease and cystic fibrosis |
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What is polycystic disease? |
Polycystic disease is an autosomal dominant disease characterized by the presence of multiple small cysts in the kidney, liver, and less commonly the pancreas. |
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What do patients with polycystic disease normally present with? |
A family history of polycystic disease or they are being worked up for hypertension, renal insufficiency, or pyelonephritis. |
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What do patient's normally succumb to with polycystic disease? |
Renal failure well before the pancreas is physiologically affected. |
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What should the finding of well-defined cystic lesions in the pancreas alert the sonographer to? |
The possibility of polycystic disease. |
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In the case of polycystic disease, what else should be evaluated? |
The liver and kidneys should be evaluated for the presence of multiple cysts |
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When can the diagnosis of polycystic disease not be made? |
In the absence of renal or hepatic cysts |
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What is Von Hippel-Lindau Disease? |
An autosomal dominant disorder that involves the central nervous system. |
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What are the pancreatic abnormalities associated with Von Hippel-Lindau disease? |
Adenomas, islet cell tumors, pancreatic carcinoma has also been reported, and some have peripheral calcifications |
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What percentage of people with Von Hippel-Lindau disease have pancreatic cysts at autopsy? |
70% |
