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80 Cards in this Set
- Front
- Back
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When do you want to perform a CTA of the pancreas
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if you suspect a islet cell tumor
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What are the 3 phases of the pancrease and timing
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arterial (20-25 sec)
pancreatic (40-45 sec) venous (60-70 sec) |
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What 2 etiologies cause 90% of pancreatitis
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alcohol and stones
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What are the causes of pancreatitis
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alcohol and stones
hyperlipidemia drugs post ercp infectious familial |
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What drugs may cause pancreatitis
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steroids, azt, ddi, diuretics, abx
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What is grade A CT grading of the pancreatitis
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normal pancreas
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What is Grade B CT grading of pancreatitis
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enlarged and heterogenous ( no inflammation)
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What is grade C CT grading of the pancreatitis
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B + peripancreatic inflammation
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What is grade D CT grading of the pancreatitis
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single fluid collection
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What is grade E CT grading of the pancreatitis
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greater than 2 large fluid collections and or pancreatic/peripancreatic gas
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What grade is an enlarged boggy pancreas with mild stranding
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C
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What are 6 complications of acute pancreatitis
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pseudocyst
pseudoaneurysm splenic or portal vein thrombosis abscess necrosis hemorrhage |
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How long does it take to develeop a pseudocyst
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> 4 weeks
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What is the ddx of a pseudocyst
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pseudoaneurysm
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What is a clue that a pancreatic fluid collection may be an abscess
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air with in the fluid collection
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Why is it important to get a contrast enhanced image of the pancrease when look for complications
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can tell if there is a pseudoaneurysm much easier bc it will be avidly enhancing
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What complication drasticaly increases morbdity and mortality
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necrosis
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What is the cause of 75% of chronic pancreatitis
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alcohol
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What are the etiologies of chronic pancreatitis
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etoh
hyperlipidemia hyperparathyroidism pancreatic divisum |
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Can the pancreas be atrophied or enlarged in chronic pancreatitis
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yes
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What are the radiographic findings of chronic pancreatitis
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pancreatic Ca
variable pancreatic size dilation of the pancreatic duct dilation of the bile ducts pseudocyst pseudoaneurysm |
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What are the indications for drainage of a pseudocyst
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greater than 5 cm
symptomatic obstruction of bile duct, stomach or doudenum |
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What are the complications for pancreatic pseudocyst drainage
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infection
bleeding chronic fistula |
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What is the cause of pancreatic divisum
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failure of fusion of the dorsal and ventral pancreatic buds
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what complication is assoiciated with pancreatic divisum
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recurrent pancreatitis
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What is the drainage pattern of pancreatic divisum
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head by wirsungs duct (major duct)
tail and body by duct of santorini (minor duct) |
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What is an annular pancreas
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band of pancreatic tissue encircles the second part of the duodenum
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What is the finding in a cholangiogram in a pt with an annular pancreas
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a duct will be filled with contrast that encircles the pancreas
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What is the classic finding in an upper GI in a pt with annular pancreas
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short segment narrowing of the 2nd part of the duodenum
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Can a annular pancreas appear as a hypodense mass in the pancreatic head
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yes
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What is the causes of 90% of pancreatic neoplasm
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pancreatic adenocarcinoma
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What percent of pancreatic adenocarcinoma occur in the head, body and tail
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70% head
20% body 10% tail |
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What is the 5 yr survival of pancreatic cancer
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5%
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What percent of cases are unresectable at the time of diagnsosis
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90%
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What is the radiographic appearance of a pancreatic adenocarcinoma on CT
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low density mass
dilated PD and or Bile duct (double duct) pancreatic atrophy |
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What do you expect to see on a cholangiogram
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double duct sign with a stricture of both the proximal CBD and PD
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What is the criteria for unresectability of a pancreatic mass
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greater than 5cm
adjacent tissue or organ invasion (not including the duodenum wc is removed during whipple) arterial stenosis, occlusion or encasement mets distant LN peritoneal carcinomatosis venous invasion |
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What is the ddx of pancreatic carcinoma
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mets
islet cell tumor lymphoma focal fat focal pancreatitis necrosis |
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What are the cystic pancreatic neoplasms
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microcystic (serous) cystadenoma
mucinous cystic neoplasm solid and papillary epithelial neoplasm IPMT anaplastic CA cystic islet cell tumor cystic mets lymphoma |
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What percent do pancreatic adenocarcinoma and cystic neoplasm make up
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pancreatic adenocarcinoma 90%
cystic neoplasm (5-10%) |
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Are microcystic adenoma (serous) benign or malignant
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benign
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What demographic typically gets microcystic adenomas
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elderly female
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Where do these occur most frequently
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no preference for any particular location in the pancreas
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What are the radiographic findings of microcystic adenoma
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honeycomb appearance
33% have Calcification 33% have central stellate scar |
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How many cyst to microcystic adenomas have
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> 6 (each is less than 2 cm)
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What congenital dz is associated with microcystic adenoma
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VHL
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Where is the calcification in a pt with microcytic adenoma
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central (with the scar)
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Can a microcytic adenoma look solid
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yes, if the cyst are very small it may look solid
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Are mucinous cystic neoplasms malignant
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yes or potentially
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What demographic do mucinous cystic neoplasms occur
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50 y women
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Where do mucinous cystic neoplasms occur
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the tail
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What percent of mucinous cystic neoplasms have Calcification
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15%
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What is the appearance of the cyst of mucinous cystic neoplasms
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less than 6 (greater than 2 cm)
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Can a mucinous cystic neoplasm be solitary
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yes
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What is SAPEN
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solid and papillary epithelial neoplasm
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Where do SAPEN tend to occur
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pancreatic tail
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Is SAPEN a high grade malignancy
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no, it is a rare low grade malignancy
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Describe the findings of SAPEN
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large
encapsulated solid and cystic hemorrhage and necrosis |
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What demographic tends to get SAPEN
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young , women mean age is 24
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What is the treatment of SAPEN
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resection (curative)
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What is the average size of SAPEN
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9 cm
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What percent of SAPEN will have hemorrhage
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100%
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What is the pathological cause of IPMT
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range of causes from epithelial hyperplasia to carcionoma
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What are the 3 types of IPMT
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main duct
branch duct combined |
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What is the appearance of main duct type of IPMT
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diffuse or segmental main duct dilation
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What is the appearance of the branch type
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cytic dilation of the branches
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What are the causes of filling defects of IPMT on ERCP
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patulous papilla
Mucin mural nodules |
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What is more likely malignant the branch duct type or the main duct type
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main duct type
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What is the main ddx of the branch duct type
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cystic tumor
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What are 3 indicators of malignancy of IPMT
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mural nodules
thick septations dilated duct >1cm |
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What percent of islet cell tumors are functional
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85%
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What is the 2 MC islet cell tumors
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insulinoma
gastrinoma |
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What percent of islet cell tumors are malignant
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less than 105
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What percent of gastrinomas are malignant
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60%
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What causes ZES
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gastrinoma
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Do functioning islet cell tumors tend to be small
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yes
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Do non-functioning islet cell tumors tend to be large
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yes (mean size is greater than 5cm)
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What percent of NON-functioning islet cell tumors are malignant
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90%
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When do islet cell tumors enhance
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very early
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What is the US appearance of an Islet cell tumor
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hypoechoic mass
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