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50 Cards in this Set
- Front
- Back
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cystic fibrosis |
An exocrine gland disorder -Organs such as pancreas, lungs, and intestines become clogged with mucus secreted by the exocrine glands |
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Sonographic appearance of cystic fibrosis |
Appears hyperechoic due to increased fibrotic and fat infiltration
cannot compare liver to pancreas because liver is often abnormal
Sludge in the gallbladder |
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Pancreatitis |
The enzymes that help digest fats, proteins, and carbohydrates in food become active inside the pancreas and start digesting the pancreas -maybe acute or chronic -related to biliary tract disease and alcoholism -gallstones are present in 50 to 60% of patients -Acute pancreatitis is the initial symptom in 5% of patients with gallstones |
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Causes of acute pancreatitis |
Biliary tract disease Alcohol abuse Peptic ulcer, reflux trauma, surgery ERCP Drugs – steroids, estrogen Pancreatic carcinoma Infections Legionnaires disease Hereditary pancreatitis Scorpion bites and brown recluse spider bites |
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Labs for pancreatitis |
Serum amylase increases within first 24 hours and remains elevated for 48 to 72 hours
Serum lipase elevates within 48 to 72 hours and remains for 5 to 14 days |
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Clinical signs of acute pancreatitis |
Severe pain after large meal or alcoholic binge Constant, intense pain radiating to back Fever, sweating Ileus |
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Sonographic appearance of acute pancreatitis |
May be normal in 30% of patients Diffuse enlargement Less common focal enlargement Hypoechoic texture – increased amount of fluid Pancreatic duct may be enlarged |
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Pancreatic pseudocyst |
Acute pancreatitis Blunt abdominal trauma Surgery Many occur in the absence of any known cause |
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Hemorrhagic pancreatitis |
Type of acute pancreatitis caused by sudden escape of pancreatic enzymes causing focal areas of fat necrosis. This leads to rupture of pancreatic vessels and hemorrhage |
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Clinical signs of hemorrhagic pancreatitis |
Severe abdominal pain Nausea and vomiting Abdominal distention and ileus |
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Labs for hemorrhagic pancreatitis |
Elevated serum amylase and lipase Decreased hematocrit – bleeding |
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Sonographic appearance of hemorrhagic pancreatitis |
Acute – well defined homogeneous mass One week – cystic with debris Chronic – abscess, pseudocyst |
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Clinical signs of hemorrhagic pancreatitis |
Cullen's sign- superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
Grey Turner's sign- bruising of the flanks
Fox Sign- bruising is seen over the inguinal ligament |
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Phlegmonous pancreatitis |
A severe form of acute pancreatitis caused by spreading diffuse edema in the soft tissues Occurs in 15 to 20% of acute pancreatitis |
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Sonographic appearance of phlegmonous pancreatitis |
Hypoechoic area -Inflammation of the surrounding tissues of the peripancreatic area. These tissues maybe edematous with hypoechoic sonographic features, or they may be a more complex striated pattern with hemorrhage |
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Abscess |
Due to tissue necrosis
Pancreatic abscess occurs in up to 5% of people with acute pancreatitis also associated with trauma or surgery |
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Sonographic appearance of abscess |
Maybe similar to pseudocyst and pancreatitis
May have smooth walls with little or no internal echoes
May have a regular walls with increased internal echoes
Ranges from completely echo free to echo dense |
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Complications of chronic pancreatitis |
Pseudocysts -thrombosis of splenic and/or portal vein -increase in pancreatic carcinoma |
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Pancreatic cysts |
True cysts are lined by epithelium -may be congenital or acquired -congenital cysts results from a malformation of the pancreatic duct – not common -acquired cysts are retention cyst, parasitic cysts |
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Cystadenoma |
Multiple cystic masses that contains serous or mucinous secreted material |
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Cystadenocarcinoma |
Malignant tumor from glandular tissue in which secretions are accumulated in cyst |
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Classifications of cystadenoma/cystadenocarcinoma |
Microcystic adenoma Macrocystic neoplasm |
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Microcystic adenoma |
Benign tumor of pancreas -50% of cystic neoplasms -M: F = 1:4, Peak age 69 years old -tiny cysts filled with glycogen -innumerable small cysts (1 mm – 20 mm) overall mass small less than 2 cm Central stellate scar plus or minus calcification Hypervascular |
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Clinical presentation of microcystic adenoma |
Pain, weight loss, jaundice, palpable mass |
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Sonographic appearance of microcystic adenoma |
Echogenic mass, may also have |
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Macrocystic neoplasm |
M: F =1:9, 40–60 years old -malignant or premalignant -large mass (mean 12cm) -Multilocular cysts, thick septations -tail/body in 85% unlike adenocarcinoma -differential diagnosis – pancreatic pseudocyst -has malignancy potential |
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Sonographic appearance of macrocystic neoplasm |
-Multiocated mass with thick septations -Macrocystic adenomas are usually greater than 20 mm in diameter. They may also have internal septa and contain calcification -Hypoechoic, solid mass with multiple small, internal anechoic cysts in the tail of the pancreas |
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Pseudocysts |
Fluid collections that arise from inflammatory process, necrosis, or hemorrhage. They contain pancreatic juices, blood, and debris. -they are usually single oval to round, very in size -Lie within the pancreas or adjacent to the pancreas – tail! -thin wall because of fibrous capsule versus epithelial covering |
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Adenocarcinoma |
Arises in the ductile epithelium and involves the exocrine portion of the gland -most common fatal tumor -males 60%, 66% after age 60 -70% in head, 20% in body, 5% in tail
-Focal mass in 95 -pancreatic head in 66% - small, low density, hypoechoic mass -infiltrates locally, obstructs ducts and encases vessels -mets to liver, local nodes |
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Risk factors of adenocarcinoma |
Tobacco Diabetes Pancreatitis Not alcohol! |
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Clinical signs of adenocarcinoma |
Symptoms occur late -90% have localized spread by time of diagnosis - Weight loss -back pain -New onset of diabetes -Courvoisier's sign |
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Sonographic appearance of adenocarcinoma |
Focal 90% enlargement – head -Hypoechoic mass -irregular borders |
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What is the most common cystic lesion in the pancreas? |
Pseudocysts |
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What is the most common site of pseudocysts? |
The lesser sac |
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Labs for pseudocyst |
Persistently increased amylase and lipase Just stays elevated |
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Sonographic findings of pseudocysts |
Usually single but may be multiple -usually acoustic enhancement -walls maybe sharp, smooth, well-defined, or thickened -maybe anechoic or have low-level echoes -not to be confused with fluid filled stomach -dilated pancreatic duct -left renal vein -Cystadenoma/cystadenocarcinoma |
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Chronic pancreatitis |
Occurs over a long period of time and does not resolve itself. Chronic pancreatitis results in a slow destruction of the pancreas. The usual cause of chronic pancreatitis is many years of alcohol abuse, but the chronic form may also be triggered by only one acute attack, especially if the pancreatic ducts are damaged. The result of chronic pancreatitis is an inability to properly digest fat caused by A lack of pancreatic enzymes. The production of insulin is also affected. |
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Labs for chronic pancreatitis |
Jaundice -amylase, lipase not good indicators (better for acute) -fat in stool -abnormal glucose – tolerance test |
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Clinical findings of chronic pancreatitis |
More common in males -persistent epigastric and back pain -nausea, vomiting, and flatulence -Weight loss -diabetes |
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Sonographic findings of chronic pancreatitis |
Heterogeneous, increased echogenicity due to fibrotic and fatty changes -calcifications -ductal dilation |
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phlegmonous pancreatitis occurs in what percent of acute pancreatitis? |
15-20% |
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Abscess occurs in what percent of acute pancreatitis? |
5% |
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What makes up 50% of cystic neoplasms? |
Microcystic adenoma |
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What are tiny cysts in microcystic adenoma filled with? |
Glycogen |
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What percent of pancreatic neoplasms are found in the head? |
66% |
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What is the second most common tumor? |
Gastrinoma |
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Islet-cell tumors |
Adenomas arising from Islets of Langerhans -benign or malignant Rare (1 in a million) |
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Insulinoma |
Beta cell tumor (most common) -usually solitary in body or tail 90% benign More common in females 30-50 Elevated insulin levels |
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Gastrinoma |
2nd most common tumor Most common in males Small, slow growing, multiple, high level for malignancy Tail or body Solid, hypoechoic, hypervascular |
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Lymphoma |
Metastatic disease Hypoechoic mass in pancreas Smv is displaced anteriorly |
