Ultrasound Abdomen ARDMS - The Pancreas Questions and Answers 100% Pass

Ultrasound Abdomen ARDMS - The Pancreas Questions and Answers 100% Pass What kind of gland is the pancreas? endocrine and exocrine gland What part of the pancreas is exocrine gland? -Acinar cells around the pancreatic ducts complete the job of breaking down protein, carbohydrates, and fats using digestive juices of pancreas (trypsin, amylase, and lipase) combined with juices from the intestines What are the fats using digestive juices of pancreas? -Trypsin, amylase, and lipase What part of the pancreas is endocrine gland? -Contains islets of langerhans, which are tiny groups of specialized cells that are scattered throughout the organ -secretes hormones that affect the level of sugar in the blood What do the endocrine cells secrete? -Glucagon -Insulin -Somatostatin What levels does glucagon raise? raises the level of glucose sugar in the blood What stimulates the cells to use glucose? -insulin What does somatostatin regulate? may regulate the secretion of glucagons and insulin What is the normal anatomy of pancreas? -Majority of the pancreas lies in the retroperitoneal cavity, except for a small portion of the head that is surrounded by the peritoneum What are the areas of the pancreas? -Uncinate process -head -neck -body -tail Where is the head of the pancreas? -lies anterior to the inferior vena cava, to the right of the portal-splenic confluence inferior to the main portal vein and caudate lobe of the liver and medial to the duodenum as it "lies in the lap" of the c-loop of the duodenum What part of the pancreas is the portal venous system? -the posterior border of the pancreas The celiac axis serves as, what? the superior border of the pancreas Where does the superior mesenteric vein cross? crosses anterior to the uncinate process of the head of the gland and posterior to the neck and the body of the pancreas What lies anterior to the inferior vena cava and posterior to the superior mesenteric vein? -head of the pancreas Where is the neck of the pancreas found? -found directly anterior to the portal-splenic confluence or superior mesenteric vein What is the largest section of the pancreas? -the body of the pancreas Where is the body of the pancreas ? -Anterior to the aorta and celiac axis (superior mesenteric, common hepatic, and left gasteric arteries) left renal vein, adrenal gland, and kidney Where does the tail of pancreas begin? -Begins to the left of the lateral border of the aorta and extends toward the splenic hilum duct of wirsung (pancreatic duct) -should be less than 3mm -primary duct, extending the entire length of the gland Duct of santorini -secondary duct that drains the upper anterior head What is the size of pancreas? -Head less than 3cm, neck less than 2.5cm, body less than 2.5cm, tail is less than 2.0cm What should pancreas look like under ultrasound? -should be more Echogenic than liver, less or more echogenic than spleen but depends on fatty/fibrous texture -smooth slightly lobular, islets of langerhans (collection of endocrine cells) What vessels drain blood from pancreas? venous drainage is through tributaries of the splenic and superior mesenteric vein What are the different congenital anomalies of pancreas? -Agenesis -pancreas divisum -Ectopic pancreatic tissue -annular pancreas What is agenesis? -complete absence of the pancreas -results in death What is pancreas divisum caused by? -caused by failure of the ducts of the dorsal and ventral buds to fuse during embryologic development -causes no problems What is ectopic pancreatic tissue? -pancreatic tissue located in abnormal areas -causes no problem What is annular pancreas? -rare condition in which the second part of the duodenum is surrounded by a ring of pancreatic tissue continuous with the head of the pancreas can contrist the duodenum and block or impair the flow of food to the rest of the intestines -causes issues acid reflux, surgical removal What is laboratory test for pancreas? -amylase: breaks down carbs into sugars -lipase: breaks down fats -protease or tryposin: breaks down proteins -glucose Extrapancreatic fluid collections and edema: What's the most common sites for fluid collection? -lesser sac-open space anterior to pancreas -anterior pararenal spaces -mesocolon -peripancreatic soft-tissue spaces Pathology of the pancreas: Pancreatitis -inflammation of the pancreas -may be classified as acute or chronic with acute pancreatitis, what levels are twice the normal limit? Aspartate aminotransferase (ast) What's the most common cause of acute pancreatitis ? -biliary tract disease and alcoholism What are causes of pancreatitis? -Alcoholism, gallstones, abdominal surgery, certain medications, cigrette smoking, cystic fibrosis endoscopic, family history of pancreatitis, high calcium levels in the blood (hypercalcemia), infection, injury to the abdomen, pancreatic cancer What are complications of pancreatitis? -pancreatic and parapancreatic fluid collections develop -fluid collections may resolve spontaneously, but those that do not are recognized as pseudocysts Are pseudocysts always acquired? -they result from trauma to the gland or from acute or chronic pancreatitis What is hemorrhagic pancreatitis? -rapid progression of acute pancreatitis with the rupture of pancreatic vessels and subsquent hemorrhage -low hematocrit in blood test What is phlegmonous pancreatitis? -a phlegmon is an inflammatory process that spreads along fascial pathways, causing localized areas of diffuse inflammatory edema of soft tissue that may proceed to necrosis and pus formation Chronic pancreatitis -results from recurrent attacks of acute pancreatitis -causes continuing destruction f the pancreatic parenchyma -associated with chronic alcoholism or biliary disease How do pancreatic pseudocyst develop? develops when pancreatic enzymes escape from the gland and breakdown tissue to form a sterile abscess somewhere in the abdomen What is a pseudocyst? a collection of fluid that arises from a inflammatory processes such as pancreatitis, necrosis, or hemorrhage Where is the most common location of a pseudocyst? in the lesser sac anterior to the pancreas and posterior to the stomach What's the most common complication of a pancreatic pseudocyst? spontaneous rupture, occurring in 5% of patients What's the clinical symptoms of spontaneous rupture of a pseudocyst? sudden shock and peritanitis What's the mortality rate of spontaneous rupture of a pseudocyst? 50% Pancreatic Abscess -related to the degree of tissue necrosis -majority of patients develop abscess secondary to pancreatitis that develops from postoperative procedures What can be a cause of cystic lesions of the pancreas? Cystic fibrosis What is cystic fibrosis? -disease that affects most critically the lungs, and also the pancreas, liver, and intestine. -It is characterized by abnormal transport of chloride and sodium across an epithelium, leading to thick, viscous secretions Does pancreatic Neoplasms adenocarcinoma involve exocrine or endocrine? the exocrine portion of the gland -ductal epithelium What's the most common primary neoplasm of the pancreas? Adenocarcinoma What accounts for more than 90% of all malignant pancreatic tumors? pancreatic neoplasms: adenocarcinoma What's the age group of carcinoma of the pancreas? -rare before the age of 40 years; the majority of patients are older than age 60 years What does adenocarcinoma obstruct? causes obstruction of the common bile duct with subsequent jaundice and hydrops of the gallbladder What's courvoisier sign? palpable, nontender gallbladder accompanied by jaundice How many patients with pancreatic carcinoma have courvoisier sign? 25% of patients What are the most common symptoms of adenocarcinoma? weight loss, pain, jaundice, and vomiting as the gastrointestinal tract becomes invaded by tumor What are the two types of cystic pancreatic neoplasm? -microcystic adenoma: serous cystadenoma. -macrocystic adenoma : mucinous cystadenoma or cystadenocarcinoma. What is microcystic adenoma or serous cystadenoma? -rare, benign disease is found more often in older women -tumor is well circumscribed and usually consists of a large mass with multiple tiny cysts What is macrocysticadenoma or mucinous cystadenoma/ cystadenocarcinoma? -may be either malignant or benign with a malignant potential -occurs predominantly in women -usually occurs in the body or tail -well-defined cysts contain thick mucinous fluid, internal septations, or mural nodules (means cancer) What is a form of mucinous cystic neoplasm -intraductal papillary mucinous tumor (IPMT) Endocrine pancreatic neoplasms -arises from the islet cells of the pancreas -usually do not spread beyond the regional lymph nodes and the liver What is islet -cell tumors insulinoma? -most common islet tumor -a tumor in the pancreas that produces too much insulin What is the secondary most common functioning islet cell tumor that produces the zollinger-ellison syndrome ? Gastrinoma/G-cell or endocrine tumor Gastrinoma/ G-cell or endocrine tumor -caused by non-insulin-secreting pancreatic tumors, which secrete excessive amounts of gastrin -stimulates the stomach to secrete great amounts of hydrochloric acid and pepsin, which in turn leads to peptic ulceration of the stomach and small intestine What are rare Islet- cell tumors? Glucagoma, vipoma, somatostatinoma What is metastatic disease to the pancreas? primary tumors that can metastasize to the pancreas include melanomas, breast, gastrointestinal, and lung tumors