Pancreas pathology

What is pancreatitis?

Inflammation of the pancreas

Normal measurements of the Pancreas are:

Head: ____ cm

Neck: ____ cm

Tail: _____ cm

3

2

2

Pancreatitis may be ______ or _______

Acute; chronic

Pancreatitis occurs when pancreas becomes _______ and _______ s a result of increased _______ and _______ of ducts

damaged; malfunctions; secretion; blockage

_________ occurs when pancreas becomes damaged and malfunctions as a result of increased secretion and blockage of ducts

Pancreatitis

Acute Pancreatitis is caused by inflamed ______ releasing pancreatic _______ into the surrounding pancreatic _______

Acini; enzymes; tissue

_____ pancreatitis does not last more than several days

Acute

A patient with _____ pancreatitis may be at risk for ______ and _______ secondary to the pancreatitis

acute; abscess; hemorrhage

The most common cause of pancreatitis in the United states is ______ tract disease

biliary

_______ abuse is the _____ most common cause of pancreatitis

Alcohol; second

Gallstones are present in _____ to _____ of patients, and ____ of patients with gallstones have ______ pancreatitis.

40%;60%; 5%; acute

________ are present in 40% to 60% of patients, and 5% of patients with _______ have acute pancreatitis

Gallstones; gallstones

Less common causes of pancreatitis are:

Tra____

Inflammation from adjacent peptic _____

______ infection

Pre______

Mu______

Tu______

Con_______ causes

Vas_______ thrombosis

Em______

Dr_______

Trauma

Inflammation from adjacent peptic ulcer

Abdominal infection

Pregnancy

Mumps

Tumors

Congenital causes

Vascular thrombosis

Embolism

Drugs

An _____ attack of pancreatitis is commonly related to _______ tract disease and ________

Acute; biliary; alcoholism

______ pancreatitis symptoms begin with ______ pain that occurs after a ______ meal or ______ binge

Acute; severe; large; alcohol

Serum _______ rises within 6 to 12 hours of the onset of _____ pancreatitis.

Amylase; acute

Serum amylase _____ within ____ to _____ hours of the onset of acute pancreatits

rises; 6;12

Serum _____ rises within 4 to 8 hours of the onset of symptoms for acute pancreatitis

lipase

Serum lipase _____ within ___ to ____ hours of the onset of symptoms for _____ pancreatitis

Rises; 4;8; acute

Acute pancreatitis may go on to develop other complications:

P______ formation

F____/pa_____/bl_____ vessel necrosis

Ab____

He______

Du______ obstruction

Pseudocyst formation

Fat/parenchymal/blood vessel necrosis

Abscess

Hemorrhage

Duodenal obstruction

_____ pancreatitis may go on to develop other complications:

Pseudocyst formation

Fat/parenchymal/blood vessel necrosis

Abscess

Hemorrhage

Duodenal obstruction

Acute

In the early stages of _____ pancreatitis, the sonographic appearance of the gland may _____ show _______ on sonography.

acute; NOT; swelling

When swelling does occur in acute pancreatitis, the sonographic appearance of the gland becomes ______ to _____ and is less _____ than the ______

hypoechoic; anechoic; echogenic; liver

When _____ does occur in _____ pancreatitis, the sonographic appearance of the gland becomes hypoechoic to anechoic and is less echogenic than the liver

Swelling; acute

_____ pancreatitis will have somewhat ______ but ________ borders, sonographically.

Acute; indistinct; smooth

Acute pancreatitis will have somewhat indistinct but smooth ______, sonographically

Borders

The pancreatic duct may be obstructed in acute pancreatitis due to ________, ______, ______, swelling of the ______, or _______ formation

inflammation, spasm, edema, papilla, pseudocyst

The pancreatic duct may be _______ in _____ pancreatitis due to inflammation, spasm, edema, swelling of the papilla, or pseudocyst formation

obstructed; acute

____-_______ fluid collection with ______ pancreatic enzymes is ______ suggestive of _____ pancreatitis

Peri-pancreatic; abnormal; acute; acute

_____ pancreas is more easily _____ because of ____ body fat to interfere with visualization

Pediatric; seen; less

Normally, LLL is more ______ and pancreatic gland is more _____ than ________

prominent; isoechoic; hyperechoic

With ____ pancreatitis in children, the gland is _____ with _____ pattern and an _______ outline

acute; enlarged; hypoechoic; indistinct

Findings of _____ collections and _____ are common with ______ acute pancreatitis

fluid; edema; severe

The most common sites for fluid collections are found in the lesser _____, anterior _______ spaces , me______, ______ spaces, and __________ soft tissue spaces.

sac; pararenal; mesocolon; perirenal; peripancreatic

The formation of pseudocyst occurs when the fluid collection develops into a well-_____,______-off fluid collection of _______

defined; wall; amylase

A ______ is a collection of fluid that arises from the loculation of ________ processes, _______, or _______

pseudocyst; inflammatory; necrosis; hemorrhage

A pancreatic ______ is a ___-filled mass that develops ______ of the pancreas

pseudocyst; fluid; outside

The most common location of a pseudocyst is in the ______ sac ______ to the _______ and ______ to the _______

lesser; anterior; pancreas; posterior; stomach

A ______ is a result from _____ to the gland or _______

pseudocyst; trauma; pancreatitis

A _______ takes contour of the available _____ around them

pseudocyst; space

The second most common location of a pseudocyst is the _____ _____ space that is _______ to the _____ sac and bounded by ______ fascia

anterior; pararenal; posterior; lesser; Gerota’s

______ occurs more commonly in the _____ pararenal space than in the _______

Fluid; LEFT; right

Sonographically, pseudocysts appear as ____-_____ masses, _______ with increase through _______

well-defined; anechoic; transmission

______ seen within the pseudocyst may occur from complications of ______ or _______

Debris; infection; hemorrhage

Borders of pseudocysts are very _______, and they usually are _____ than other simple cysts. ________ may develop _____ the walls of the pseudocyst

echogenic; thicker; Calcification; within

When a suspected pseudocyst is located near the stomach, the stomach should be _______ so the cyst is not ______ for a _____-filled stomach

drained; mistaken; fluid

Be sure not to confuse a fluid filled stomach with what?

Pseudocyst

A ________ rupture is the most common complication of a pancreatic ________, occurring in ____ of patients.

Spontaneous; pseudocyst; 5%

Clinical symptoms of a _______ rupture of a pancreatic pseudocyst are _____ and _______.

spontaneous; pseudocyst; shock; peritonitis

The mortality rate of a _______ rupture is _____

spontaneous; 50%

Hemorrhagic pancreatitis is a rapid progression of ______ pancreatitis with _______ of pancreatic ______ and subsequent __________

rapid; acute; rupture; vessels; hemorrhage

In _______ pancreatitis, there is diffuse _____ destruction of the pancreatic substance caused by a sudden escape of ______ pancreatic ________ into the ______ parenchyma

hemorrhagic; enzymatic; active; enzymes; glandular

Pancreatic enzymes cause focal areas of fat ______, _____ and ______ the pancreas, which leads to _____ of pancreatic ______ and _______

necrosis; in and around; rupture; vessels; hemorrhage

Patients with ______ pancreatitis has sudden _______ destruction of the pancreas AFTER an ______ binge or an excessively _____ meal

hemorrhagic; necrotizing; alcoholic; large

Sonographically, hemorrhagic pancreatitis depends on the ____ of the hemorrhage

age

Sonographically, a ______ necrosis may be seen as a ___- defined, ________ mass in the area of the pancreas

fresh; well; homogenous

Sonographically, at ____ week, the mass (hemorrhage) may appear ____ with ____ elements or _______

1; cystic; solid; septation

Sonographically, after _____ weeks, the hemorrhage may appear ______

several; cystic

Pancreatic _______ is fat that replaces or infiltrates the pancreas

lipomatosis

Pancreatic lipomatosis is _____ that _____ or _____ the pancreas

fat; replaces; infiltrates

______ ______ sign is an uncommon subcutaneous manifestation of intra-abdominal pathology that manifests as discoloration of the flanks.

Gray Turner’s

Gray Turner’s sign is an uncommon _________ manifestation of intra-abdominal pathology that manifests as _______ of the _____.

subcutaneous; discoloration; flanks

Gray turner’s sign causes discoloration of what?

Flanks

A _______ pancreatitis is an _______ process that spreads along _____ pathways, causing localized areas of diffuse inflammatory _____ of soft tissue that may proceed to necrosis and suppuration

phlegmonous; inflammatory; fascial; edema

______ pancreatitis occurs in ___-___ of patients with _____ pancreatitis

Phlegmonous; 18-20%; acute

Sonographically, phlegmonous tissue appears ______ in texture with good through-_____

hypoechoic; transmission

Sonographically, how does phlegmonous tissue appear?

Hypoechoic with good through transmission

Phlegmonous pancreatitis usually/commonly involves the ____ sac, ____ anterior _____ space, and transverse ______.

lesser; left; pararenal; mesocolon

Pancreatic abscess has a ___ incidence

low

Pancreatic abscess is a condition that is related to the degree of tissue _______

Necrosis

Majority of patients develop abscesses ______ to _______ that develops from _____-_____ procedures

secondary; pancreatitis; post-operative

Pancreatic ______ has a very _____ mortality rate IF left ______

abscess; high; untreated

A pancreatic abscess may be ________ or ________

abscess; unilocular; multilocular

A pancreatic abscess can spread _______ into the _______, ______ to transverse mesocolon, or down to the ________ into the______

superiorly; mediastinum; inferiorly; retroperitoneum; pelvis

Sonographically, a pancreatic abscess is a poorly defined ______ mass with ______ or _______ thick walls, causing few _____ echoes

hypoechoic; smooth; irregular; internal

Sonographically, if ____ _____ are present in a pancreatic ______, an ______ region with a ______ posterior is imaged

air bubbles; abscess; echogenic; shadow

Chronic pancreatitis results from _____ attacks of ____ pancreatitis and causes continuous ______ of the pancreatic parenchyma

recurrent; acute; destruction

Patients with chronic pancreatitis may be _______

asymptomatic

Clinical findings of chronic pancreatitis include _______ pain radiating to the back and _______

epigastric; nv

Chronic pancreatitis is generally associated with chronic _______ or ______ disease

alcoholism; biliary

Patients with ________ (elevated calcium levels) and ________ (elevated fat levels) are more _______ to _______ pancreatitis

Hypercalcemia; hyperlipidemia; predisposed; chronic

Chronic ______ pancreatitis causes increased pancreatic _____ secretion with subsequent ______ obstruction resulting in chronic ______ pancreatitis.

alcoholic; protein; ductal; calcifying

Chronic ______ pancreatitis has fibrous _____ tissue that rapidly grows around the ____ and between _____ that results in ______. This leads to a _______, _____ surface of the pancreas

Alcoholic; connective; ducts; lobules; scarring; nodular; irregular

A chronic obstructive pancreatitis is caused by ______ of the sphincter of _____ by ______ or pancreatic _____

stenosis; Oddi; cholelithiasis; tumor

Chronic obstructive pancreatitis presents with non-______ distribution, less ductal _______ damage and ______ stones

lobular; epithelial; calcified

____-____ of patients with _____ pancreatitis develop ________

25-40%; chronic; pseudocysts

Patients with chronic pancreatitis may develop pseudocysts, a dilated ________, or _______ of the ______ vein with extension into the _______ vein.

CBD; thrombosis; splenic; portal

Patients with ______ pancreatitis have an ______ risk of developing pancreatic ______

chronic; increased; cancer

Sonographically, chronic pancreatitis may appear _____ or ______ with increased ______, size _____, ______ borders, and ______ duct

localized; diffuse; echogenicity; reduced; irregular; dilated

What is a classic finding of chronic pancreatits?

Calcification

Normal Pancreatic duct measurement:

Head: ___-____ mm

Body: ___-____ mm

Tail: ___-___ mm

3-3.5; 2-2.5; 1.5-2

What causes pancreatic ductal dilation?

Acute/chronic pancreatitis and pancreatic neoplasms

Check pancreatic ducts for what?

Choledocholithiasis

Check gallbladder for ________ with pancreatic duct dilation

gallstones

Autosomal Dominant Polycystic disease is characterized by the presence of multiple small ____ in the _____ and _____ and rarely in the _____

cysts; kidney; liver; pancreas

Autosomal Dominant Polycystic disease have cysts that vary from _______ to several _______ in diameter and with _______ size, may _____ the normal pancreatic tissue

microscopic; centimeters; increasing; destroy

von Hippel–Lindau syndrome is an _____ disorder characterized by the formation of _____ and _____ sacs (cysts) in many different parts of the ______

inherited; tumors; fluid-filled; body

People with von Hippel–Lindau syndrome commonly develop cysts in the ______, _____, and______ tract.

kidneys; pancreas; genital

Von Hippel-Lindau have tumors that may either be _________ or _______ and most frequently appear during _____ adulthood

noncancerous; cancerous; young

Patients with Von-Hippel Lindau syndrome have an _____ risk of developing pancreatic ________ tumor

increased; neuroendocrine