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71 Cards in this Set
- Front
- Back
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In ___% of people, the ventral duct connects to the distal common bile duct at the ampulla and drains through the head of the pancreas through the ___ papilla. The dorsal duct then drains the remainder of the pancreas through the ___ papilla. This is referred to as ___ ___.
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15-20%
major papilla minor papilla pancreas divisum |
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In most people, the dorsal and ventral duct join to form one duct that then joins the CBD to drain through the ___ papilla.
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major papilla
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What is the location of the uncinate process?
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inferior and medial to the head
between the SMV and IVC Middleton 192 Fig 7-1 |
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What is the location of the head?
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immediately anterior to the IVC
caudal to the portal vein |
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What is the location of the body and tail?
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anterior to the splenic vein and the portal splenic confluence
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What is the relationship between the celiac trunk and the pancreas?
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The pancreas is located inferior to the celiac axis
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What is the relationship between the splenic artery and the pancreas?
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The splenic artery runs near the superior aspect of the pancreas
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What is the relationship between the gastroduodenal artery and the pancreas?
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The gastroduodenal artery arises from the common hepatic artery and travels inferiorly directly over the anterior and lateral aspects of the pancreatic head.
It lies in the anterior aspect of the head. |
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What causes the prominent ring around the SMA, separating it from the pancreas?
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retroperitoneal fat
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What is the relationship between the SMV and the pancreas?
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The SMV is immediately adjacent to the posterior aspect of the pancreatic neck and body and to the medial aspect of the pancreatic head and anterior to the uncinate process
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Is the pancreatic duct more commonly visualized in the head or the body?
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body
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What is the upper limit of normal for diameter of the pancreatic duct?
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3mm
The duct does enlarge with age |
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How can you avoid the pitfall of mistaking the posterior wall of the stomach for the pancreatic duct?
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Scan in a sagittal orientation
Middleton 193 Fig 7-2 |
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Why does the pancreas become more echogenic with age?
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The amount of fat increases
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Sometimes, as a person ages, the anterior/posterior part of the pancreas has more fatty infiltration, and is therefore more echogenic than the other part.
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anterior
Middleton 193 Fig 7-3 |
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Upper limit of normal size for pancreatic head ___ body ___ tail ___
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head 3.0cm
body 2.5 cm tail 2.0 cm |
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The normal sagittal shape of the pancreas is ___
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oval
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Should the pancreas be visualized fasting or after a meal?
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fasting, to reduce the amount of overlying bowel gas. However, drinking water may help visualization
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Having the patient make a "___ ___" by pushing out their stomach can aid in visualization of the pancreas in the anterior subxiphoid view.
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beer belly
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T/F
Using a left or right lateral view, angling medially and slightly anterior may help to visualize the tail and head of the pancreas. |
True
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What is the relationship between the tail of the pancreas and the spleen?
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The tail is in the splenic hilum, just anterior to the left kidney and inferior to the splenic vein. you can visualize by starting in a coronal plane and start with a transplenic view of the upper pole of the kidney, then angle slightly anteriorly
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What are the 2 most common causes of acute pancreatitis?
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ETOH
gallstones |
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What are some less common causes of acute pancreatitis, besides ETOH and gallstones?
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biliary crystals / sludge
mumps pregnancy trauma ERCP peptic ulcers drugs tumors hypercalcemia hyperlipoproteinemia familial pancreatitis |
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What are some common causes of bile duct obstruction in someone with pancreatitis?
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gallstone or stricture obstruction of the duct
compression of the duct by pseudocyst or inflammation of the pancreatic head |
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What are the sonographic findings of acute pancreatitis?
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pancreatic enlargement
DECREASED pancreatic echogenicity HETEROGENIOUS echogenecity peripancreatic fluid collection perivascular fluid collection (along the splenic vein) periduodenal fluid collection pararenal fluid collection ascites Middleton 195 Fig 7-4 |
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What part of the pancreas is usually involved in focal acute or chronic pancreatitis?
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head
Middleton 196 Fig 7-5 |
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How can you distinguish focal pancreatitis from pancreatic cancer?
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They are difficult to distinguish sonographically, but clinical features, vascular invasion, or other evidence of metastatic disease can help.
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What is a pseudocyst?
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walled-off fluid collections that have a capsule composed of fibrous tissue rather than true epithelial cells
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What is the sonographic appearance of a pancreatic pseudocyst?
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well-defined smooth margins
loculated anechoic or low-level internal echoes hemorrhage or infection can produce complex internal echoes Middleton 197 Fig 7-6 |
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What are some complications of pancreatitis?
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pseudocyst
bile duct obstruction pancreatic abscess or phlegmon pancreatic necrosis venous thrombosis (splenic vein usually, but also SMV and PV) pseudoaneurysm Middleton 199 Fig 7-9 |
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What is the differential diagnosis of cystic pancreatic lesions?
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pseudocyst
cystic neoplasm AD PCKD von Hippel-Lindau disease cystic fibrosis vascular lesions (Doppler should always be performed on a pancreatic cyst!) Middleton 198 Fig 7-7 |
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How does a pseudo aneurysm develop from pancreatitis? What artery is most commonly involved?
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Erosion of the adjacent arteries produced by the proteolytic pancreatic enzymes.
splenic artery |
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What is the sonographic appearance of chronic pancreatitis?
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multifocal calcifications
Dilitation and irregularity of the pancreatic duct Parenchymal atrophy Middleton 200 Fig 7-10 |
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Do the calcifications of chronic pancreatitis shadow?
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They may or may not shadow depending on size and amount of calcification
Middleton 200 Fig 7-10 |
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The calcifications of chronic pancreatitis are located ___
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Intraductally, although this is not readily distinguished on US
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Pancreatic calcifications with chronic pancreatitis occur in ___% of ETOH pancreatitis and ___% of gallstone pancreatitis
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20-40%
<2% |
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The intraductal calcifications of chronic pancreatitis can lead to obstruction of the duct and worsened pancreatitis.
T/F |
true
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What is the "chain of lakes" sign?
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strictures and tortuosity of the pancreatic duct
seen with chronic pancreatitis or pancreatic cancer Middleton 200 Fig 7-10F |
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From what does pancreatic adenocarcinoma arise?
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90% are from ductal epithelium
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What location of pancreas tumor causes painless jaundice, which should raise suspicion for pancreatic cancer?
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head
this is where most pancreatic tumors arise |
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What is the usual sonographic appearance of pancreatic cancer?
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hypoechoic mass
dilation of the pancreatic duct or CBD from obstruction is common Middleton 201 Fig 7-11 |
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What is the Ddx of a solid, hypoechoic pancreatic mass?
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pancreatic ca*
focal pancreatitis* lymphoma metastasis islet cell tumor thrombosed aneurysm |
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When visualizing a focal hypoechoic pancreatic mass, what things would make you lean towards cancer and what things towards focal pancreatitis?
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Cancar = metastasis or vascular encasement
Chronic pancreatitis = calcific foci in the mass Middleton 202 Fig 7-12 |
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Endocrine tumors of the pancreas arise from the ___ __ ___
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Islets of Langerhans
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___ account for 75% of islet cell tumors
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Insulinomas
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What are the symptoms of insulinomas?
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Hypoglycemia
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What is the sonographic appearance of an islet cell tumor?
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hypoechoic solid mass
Middleton 203 Fig 7-14 and 204 Fig 7-15 |
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What islet cell tumor accounts for 20% of islet cell tumors?
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gastrinomas
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What are the symptoms of a gastrinoma?
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peptic ulcer disease and diarrhea (Zollinger Ellison syndrome)
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Match these
insulinoma gastrinoma benign malignant |
insulinoma = benign
gastrinoma = malignant |
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Match these:
microcystic adenoma macrocystic adenoma serous mucinous benign malignant |
microcystic = serous = benign
macrocystic = mucinous = malignant Middleton 205 Fig 7-17/18 |
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What is the Ddx of pancreatic cystic lesions?
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pseudocyst
macrocystic tumor microcystic tumor PCKD von Hipple Lindau cystic fibrosis aneurysm/pseudoaneurysm |
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T/F
Pancreatic cancer and islet cell tumors are both typically hypoechoic |
true
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T/F
Intraoperative US is the most sensitive means of localizing islet cell tumors |
true
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Where is the pancreatic head located?
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In the duodenal C-loop
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What is the normal length of the pancreas?
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12-15cm
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Does the pancreas have a capsule?
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no
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The head of the pancreas lies inferior and to the right of the more posterior and superior tail.
T/F |
true
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The portal confluence lies anterior/posterior to the neck of the pancreas?
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posterior
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The body is located ___ to the splenic vein and SMA
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anterior
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The __ __ __ is another name for the main pancreatic duct
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Duct of Wirsung
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The __ __ __ is another name for an accessory pancreatic duct
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Duct of Santorini
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The ___ artery supplies blood to the head of the pancreas.
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gastroduodenal artery
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The ___ and ___ arteries supply blood to the body and tail of the pancreas
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SMA and splenic artery
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Name 4 exocrine (acinar cells) enzymes produced by the pancreas and their functions
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amylase = carbohydrates
lipase = lipids peptidases = proteins bicarbonate = neutralize gastric acid |
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Name 5 endocrine (islet cells) enzymes produced by the pancreas
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insulin, glucagon, gastrin, pancreatic polypeptide, and vasoactive intestinal polypeptide are produced by the Islets of Langerhans
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Does chronic pancreatitis increase risk of pancreatic cancer?
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yes
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What is the sonographic appearance of cystic fibrosis changes of the pancreas?
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increased echogenecity 2/2 fibrosis and fatty infiltration
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Why is it important to evaluate vasculature for a pancreatic adenocarcinoma?
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vascular involvement renders the rumor inoperable
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What is the composition of a true pancreatic cyst?
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Walled by mucinous epithelium
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Do most pseudocysts resolve spontaneously or require decompression?
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most resolve spontaneously
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