Ultrasound Abdomen ARDMS - The Pancreas 67 Questions with Verified Answers
What kind of gland is the pancreas? - CORRECT ANSWER endocrine and
... [Show More] exocrine gland
What part of the pancreas is exocrine gland? - CORRECT ANSWER -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? - CORRECT ANSWER -Trypsin, amylase, and lipase
What part of the pancreas is endocrine gland? - CORRECT ANSWER -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? - CORRECT ANSWER -Glucagon
-Insulin
-Somatostatin
What levels does glucagon raise? - CORRECT ANSWER raises the level of glucose sugar in the blood
What stimulates the cells to use glucose? - CORRECT ANSWER -insulin
What does somatostatin regulate? - CORRECT ANSWER may regulate the secretion of glucagons and insulin
What is the normal anatomy of pancreas? - CORRECT ANSWER -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? - CORRECT ANSWER -Uncinate process
-head
-neck
-body
-tail
Where is the head of the pancreas? - CORRECT ANSWER -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? - CORRECT ANSWER -the posterior border of the pancreas
The celiac axis serves as, what? - CORRECT ANSWER the superior border of the pancreas
Where does the superior mesenteric vein cross? - CORRECT ANSWER 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? - CORRECT ANSWER -head of the pancreas
Where is the neck of the pancreas found? - CORRECT ANSWER -found directly anterior to the portal-splenic confluence or superior mesenteric vein
What is the largest section of the pancreas? - CORRECT ANSWER -the body of the pancreas
Where is the body of the pancreas ? - CORRECT ANSWER -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? - CORRECT ANSWER -Begins to the left of the lateral border of the aorta and extends toward the splenic hilum
duct of wirsung (pancreatic duct) - CORRECT ANSWER -should be less than 3mm
-primary duct, extending the entire length of the gland
Duct of santorini - CORRECT ANSWER -secondary duct that drains the upper anterior head
What is the size of pancreas? - CORRECT ANSWER -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? - CORRECT ANSWER -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? - CORRECT ANSWER venous drainage is through tributaries of the splenic and superior mesenteric vein
What are the different congenital anomalies of pancreas? - CORRECT ANSWER -Agenesis
-pancreas divisum
-Ectopic pancreatic tissue
-annular pancreas
What is agenesis? - CORRECT ANSWER -complete absence of the pancreas
-results in death
What is pancreas divisum caused by? - CORRECT ANSWER -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? - CORRECT ANSWER -pancreatic tissue located in abnormal areas
-causes no problem
What is annular pancreas? - CORRECT ANSWER -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? - CORRECT ANSWER -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? - CORRECT ANSWER -lesser sac-open space anterior to pancreas
-anterior pararenal spaces
-mesocolon
-peripancreatic soft-tissue spaces
Pathology of the pancreas: Pancreatitis - CORRECT ANSWER -inflammation of the pancreas
-may be classified as acute or chronic
with acute pancreatitis, what levels are twice the normal limit? - CORRECT ANSWER Aspartate aminotransferase (ast)
What's the most common cause of acute pancreatitis ? - CORRECT ANSWER -biliary tract disease and alcoholism
What are causes of pancreatitis? - CORRECT ANSWER -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? - CORRECT ANSWER -pancreatic and parapancreatic fluid collections develop
-fluid collections may resolve spontaneously, but those that do not are recognized as pseudocysts
Are pseudocysts always acquired? - CORRECT ANSWER -they result from trauma to the gland or from acute or chronic pancreatitis
What is hemorrhagic pancreatitis? - CORRECT ANSWER -rapid progression of acute pancreatitis with the rupture of pancreatic vessels and subsquent hemorrhage
-low hematocrit in blood test
What is phlegmonous pancreatitis? - CORRECT ANSWER -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 - CORRECT ANSWER -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? - CORRECT ANSWER develops when pancreatic enzymes escape from the gland and breakdown tissue to form a sterile abscess somewhere in the abdomen
What is a pseudocyst? - CORRECT ANSWER 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? - CORRECT ANSWER in the lesser sac anterior to the pancreas and posterior to the stomach
What's the most common complication of a pancreatic pseudocyst? - CORRECT ANSWER spontaneous rupture, occurring in 5% of patients
What's the clinical symptoms of spontaneous rupture of a pseudocyst? - CORRECT ANSWER sudden shock and peritanitis
What's the mortality rate of spontaneous rupture of a pseudocyst? - CORRECT ANSWER 50%
Pancreatic Abscess - CORRECT ANSWER -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? - CORRECT ANSWER Cystic fibrosis
What is cystic fibrosis? - CORRECT ANSWER -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? - CORRECT ANSWER the exocrine portion of the gland -ductal epithelium
What's the most common primary neoplasm of the pancreas? - CORRECT ANSWER Adenocarcinoma
What accounts for more than 90% of all malignant pancreatic tumors? - CORRECT ANSWER pancreatic neoplasms: adenocarcinoma
What's the age group of carcinoma of the pancreas? - CORRECT ANSWER -rare before the age of 40 years; the majority of patients are older than age 60 years
What does adenocarcinoma obstruct? - CORRECT ANSWER causes obstruction of the common bile duct with subsequent jaundice and hydrops of the gallbladder
What's courvoisier sign? - CORRECT ANSWER palpable, nontender gallbladder accompanied by jaundice
How many patients with pancreatic carcinoma have courvoisier sign? - CORRECT ANSWER 25% of patients
What are the most common symptoms of adenocarcinoma? - CORRECT ANSWER weight loss, pain, jaundice, and vomiting as the gastrointestinal tract becomes invaded by tumor
What are the two types of cystic pancreatic neoplasm? - CORRECT ANSWER -microcystic adenoma: serous cystadenoma.
-macrocystic adenoma : mucinous cystadenoma or cystadenocarcinoma.
What is microcystic adenoma or serous cystadenoma? - CORRECT ANSWER -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? - CORRECT ANSWER -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 - CORRECT ANSWER -intraductal papillary mucinous tumor (IPMT)
Endocrine pancreatic neoplasms - CORRECT ANSWER -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? - CORRECT ANSWER -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 ? - CORRECT ANSWER Gastrinoma/G-cell or endocrine tumor
Gastrinoma/ G-cell or endocrine tumor - CORRECT ANSWER -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? - CORRECT ANSWER Glucagoma, vipoma, somatostatinoma
What is metastatic disease to the pancreas? - CORRECT ANSWER primary tumors that can metastasize to the pancreas include melanomas, breast, gastrointestinal, and lung tumors [Show Less]